HEPATIC DYSFUNCTION : REMEDIES OF MORBID TEMPERAMENTS OF THE HEPATICS.
Multiple are the stages that are encompassed within the field of the word “Hepatic insufficiency”.
1. First of all it is described by the name of “Hepatism” (de Glenard) an ensemble of troubles that helps to reveal a fragility of the liver acquired or very often hereditary, weakness that predisposes the individuals to liver affections in general and to many other diseases such as asthma, urticaria, migraine, uricemia, biliary lithiasis, rheumatism, neuralgias etc. The term “Hepatism” is replaced by some authors by the word “Arthritism”. It has now been considered as a real diathesis.
The process of palpation of the liver by the thumb (Glenard), periodic measurement of the height of the liver on the mammary line, the researches for the digestive troubles of reflex origin (aversion for fat, salivation, pain of the right shoulder), allow the use of the word “Hepatism”, a very seducing clinical conception, but which is controversial at present. However we cannot deny the possibility of the fragility of the liver, as the first step towards the functional trouble of that gland.
2. Secondly, it was said and still it is said about the extraordinary frequency of cases labelled as Hepatic insufficiency. Habitually as regards thyroid, suprarenal or other glandular organs, one speaks about hyperfunctions and hypofunctions. As regards liver, there is only the insufficiency of the function which one can take into account clinically. But the functions of the liver is multiple and their classification differs with different authors. Every year something new is discovered. It is for this reason the word hepatic insufficiency is a vague term, very wide, which may be characterised by some numerous different syndromes.
It is this that was shown in the International Congress of hepatic insufficiency which was held last year in Vichy. It was right to have wanted to characterise the cases of insufficiency or hypofunction of liver, not only by current clinic, but some researches, some physiological tests, allowing a solid and quantitative basis of appreciation.
3. It is then perceived that the techniques proposed for characterising the hepatic insufficiency is only valuable in certain limited cases : (a) The great insufficiency for grave type of jaundice, which differs, what is curious, from hepatectomy. Grave toxic hepatitis (Phosphorus, Apiol, Cicophane etc.) or infectious, have augmentation of azotemia, of polypeptides, of amino acids and of residual nitrogen of the blood, and moreover some important haemorrhages, with delay in coagulation and the time of blood flowing increased.
(b) The great hepatic insufficiency as a consequence of hepatectomy characterized by hypoglycemia, sudden fall of the glucose in blood, fall of the quantity of urea in the blood and urine, by augmentation of ammonia in the urine, amino acids, polypeptides of the blood and of the bilirubinemia.
(c) Hepatic insufficiency of organic diseases of the liver (hepatitis by infections or intoxications, cirrhosis at the beginning). In these cases the treatment of the hepatic insufficiency is unstable and difficult to realize with elimination of all possible causes of error.
(d) Finally there are numerous cases of so-called hepatic insufficiency which the Prof. Cheray calls “false medico- mundane”. These are multiple observations that the profanes and even the doctors believe to have related to hepatic insufficiency, but they are very often really some intestinal statistics because the chronic intestinal affections secondarily cause hepatobiliary reactions.
Some cases of chronic hepatic congestion (great eaters, great drinkers, amoebiasis) or chronic cholecystitis cause secondary hepatobiliary reactions which are so-called “insufficiency”.
(4) In all these cases, the tests and the researches are negative. There is only the clinical picture (dirty tongue, bad smelling breath, bitter taste in the mouth, constipation alternating with diarrhoea, big liver, urobilinuria, hunger pain dermatoses, pruritis, chill, headache, asthenia, insomnia, post- prandial somnolence etc.). Prof. Chiray shows with reason that in all these cases some rational treatments of the intestinal stasis, of typhocolitis, non-lithiasic cholecystitis, and other causes, cause rapid disappearance of the digestive and biliary symptoms. One re-establishes the permeability of colons with liquid paraffin or some mucilages, by washing of the intestines etc. and may often cure the patient.
Even in Homoeopathy Nux Vomica, Aloe, Mercurius solubilis, Podophyllum, Berberis, Bryonia, act with success in such cases, as well as Opium, Graphites, Alumina, Taraxacum and the remedies of constipation.
In a word if it is necessary to distinguish on the one hand the cases, which are not relatively frequent, of hepatic insufficiency which can be revealed by the tests from the multiple cases of simple congestion of liver secondary to some troubles of the intestine or of the bile duct.
But it is necessary to know the therapeutics of these two kinds of diseases and one cannot deny that in the second case, even if there is no hepatic insufficiency in the real sense of the term the functions of the gland are often troubled by Hepatic Overwork more or less slightly or temporarily.
It is for this reason the word “Dysfunction” characterises better the ensemble of cases of functional troubles of the liver, either because of the real insufficiency, deep or slight, or because of certain functions of the hepatic cells, without any real insufficiency.