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the stomach, or unwary enough to irritate the mucous membrane of his stomach or duodenum by wines or spirits, the case is at once altered, for now the swollen mucous membrane of the duodenum tends to close the orifice of the bile-duct, or the congestion may even extend up the duct itself. Thus an impediment, however slight it may be, is opposed to the exit of bile from the liver. The pressure under which the bile is secreted, as I have already said, is very small, and there being no extra pressure put upon the liver by the diaphragm and abdominal muscles, instead of the bile being at once forced out of the bile-capillaries it will remain in them, causing more or less congestion, and now follows a whole series of disagreeable results. The bile, which may be looked upon as a waste product of the liver, not being removed, the other functions of the liver are disturbed. Assimilation becomes imperfect, we find lithates appearing in the urine; the circulation in the liver itself may be altered, and thereby the whole circulation in the stomach and intestines may be impeded, for it must be remembered that all the blood from the stomach and intestines has to pass through the liver before it again reaches the general circulation. Thus the individual becomes troubled with hæmorrhoids, secretion and vermicular movement in the bowels are impaired, so that constipation results; congestion of the stomach, with loss of appetite, impaired digestion, and flatulent eructations ensue, and the brain and nervous system begin to suffer from the accumulation in them of their own waste, or the absorption of abnormal products of assimilation.

Feeling weak, dull, and melancholy, the sufferer now thinks he ought to take meat three times a day, and perhaps, during the intervals of his meals, to take strong beef-tea, or perhaps a glass of wine or a nip of brandy. Yet, in spite of all this, he becomes weaker, more stupid, and more melancholy; and no wonder. He is simply further overtaxing his already overworked digestive organs. He is piling up fuel, instead of removing ash, and choking the vital processes both in his digestive and nervous systems. What he wants is not more nutriment, but a more rapid removal of waste, and the change upon the adoption of a proper system of treatment is in many cases most marked and satisfactory, both to the physician and the patient.

The first thing to be done is to clear out the liver. This may seem to be an unscientific expression, one adapted rather to popular notions than in accordance with ascertained facts. But this is not the case. In a former paper on the action of purgative medicines,[1] I have explained the way in which certain purgatives may be said to have the effect of clearing out the liver, and first among those we must reckon mercurials. In the case which we have just been describing, five grains of blue-pill may be taken every night, or two or three grains of calomel either alone or combined with extract of hyoscyamus or conium, and this should be followed next morning by a saline draught.

  1. ↑ "Practitioner," vol. xii, pp. 342, 403.