THERE is probably no term designed to express an abnormal condition, that greets the eye or the ear of the physician more frequently than does the vague and nondescript one of multifarious signification “biliousness.” Like the ubiquitous “cold,” which is said to have been “taken,” it is the cause of, or is combined with, a large portion of the extensive list of ailments which afflict humanity. It answers, or is expected to answer, as a description of indefinite states induced by unavoidable or avoidable causes. Its only synonym would be indefinableness.
The debauchee ascribes to this unknowable influence his post-prandial or post-bacchanal troubles; the overworked business man finds in it the explanation of his ill-feeling; the traveller who has been exposed to noxious miasmata has feeling which he must use the word “bilious” to express; while the general feeling of malaise attending the incipient stage of so many acute or chronic affections comes under that all-comprehending expression.
When analyzed, what does “biliousness” mean? Who could answer this without writing a book? It means, in part, according to the various conditions to which it is applied, a “bad” feeling, a “mean” feeling, a “sluggish” feeling, a “sickish” feeling, “qualmishness,” “ane ne sais quoi,” “indefinable,” “don’t-know-what to-call-it” feeling. As to the extent to which bile has anything to do with it, of course our patients cannot know this, and it must be confessed that often we have little the advantage of them in this respect.
It is a semi-technical term in popular and in professional nomenclature, as often signifying a deficient as an excessive action of the liver, and the patient in this sad condition, whatever it may be, usually pleads for something to “touch up the liver,” when, perhaps, that much- accused and much-abused organ, the largest and best-able-to-take- care-of-itself gland in the body, as all the while overworked and innocent of any peccancy!.
An organ whose usual function, in the average man, is to secrete about forty ounces of bile in twenty-four hours, may well very a few ounces in a day within normal limits, and it is rarely that there is really excessive variation in the amount of secretion, one way or another, in those cases which are with much emphasis denominated “bilious.” The throwing up of a tablespoonful of bile, which, mingled with the fluids of the stomach, seems like a gill, is considered proof of biliousness, while in truth instead of proving excessive secretion, it is only evidence that this important digestive or emulsifying fluid is taking the wrong direction-by regurgitation-and is wasted.
Given a case of ordinary flow of bile, with a reversed action of duodenum and stomach, half an ounce or an ounce can easily be caught from the current that actively flows from the ductus communis choledochus. Yet what serious importance is sometimes ascribed to this! A seasick person is often a good illustration of the really slight significance of the ejection of a little bile. Active emesis, from almost any cause, is liable to furnish this fluid in abundance.
Icteroid conditions are spoken of as “bilious,” with more of reason, indeed; for there is in jaundice an excess of bile in the system, although not necessarily an excess of secretion. An obstruction of the main bile-duct by calculi will certainly cause a surcharging of the system with absorbed bile; but this appears to be of itself of little disadvantage-at least, illness does not seem to be in proportion to the extent of this; for after the absorption of bile has been discontinued, it is often long before the deposit, at least of the pigment, can be eliminated, even after a fair degree of health has been recovered. A considerable amount of bile-pigment in the skin seems to be not incompatible with medium health. Such conditions are, of course, abnormal, but do not necessarily produce, and are not attended by, the feelings or conditions described as “biliousness”.
The bitter taste in the mouth which causes some to think themselves bilious may be due to the taurocholic acid of the bile, which is intensely bitter, in the blood, or in the secretions of the mouth (the bile pigments are tasteless), but it may also be due to hallucination of the nerve of taste at times, instead of the bile acids. As we have hallucination of the sense of sight in the phenomena of nausea volitantes, and of then sense of hearing in the way of tinnitus aurium, and of the sense of touch or general sensation as in formication, so we may have hallucination of the sense of taste in the form of acid, sweet, salty, bitter or other taste, when the secretions of the mouth would be void of any such actual conditions. This bitter taste is often found in connection with a clean tongue, while a foul or coated tongue, with bad taste and pasty feeling, is regarded as one of the most usual indications of biliousness.
The most customary feelings of one calling himself bilious, beside that just mentioned, are probably those of sluggishness, especially of the bowels, with fulness of or pain in the head; loss of appetite and of spirits; indisposition to exertion at labor or amusement-suggesting loss of proper functional action of the system generally-which is what biliousness most commonly means. This is the feeling that seems, in the amateur fancy, to call for a “touching up of the liver,”and by this touching up is meant a general stimulation of the whole digestive system, including the secretions of the alimentary canal.
From this state of impairment of function and general sluggishness the system sometimes spontaneously reacts, often with excessive secretion and increased peristaltic action of the intestines, which is at times followed by an improved condition of the feelings. It is, doubtless, from this hint that grew the general practice, carried to an extreme, of using purgative medicines for this biliousness.
That benefit has sometimes followed a judicious course of this sort can scarcely be denied, and that there has been an abuse of it in practice does not argue against the idea that a properly directed physiological stimulation of organs perhaps in a state of passive congestion or inertia may at times be of advantage. A stupid fallacy it is, however, which gives delight to many when they see a free flow of bile as a result of the hobby dose of calomel, as though bile was produced to be wasted in this manner!.
Various indeed are the cause assigned, justly or fancifully, for the state-the concurrent of so many diseases-called biliousness Malaria-whatever that may mean-comes in as a principle factor. Indigestion is a prolific cause. Pregnancy gives a rich assortment of “bilious” symptoms. Whiskey and tobacco and their congeners are exceedingly active. Beer and similar disturbing drinkables follow closely.
The bon vivant who has indulged late at night in too much lobster salad, brandy, cigars, etc. is apt to report himself to his physician in the morning as “bilious.” Depression of spirits from frustrated plans in love, war or business, or other serious disappointments are very bilious in their effects. Of course, traumatism, orificial troubles, uric acid in the blood, or some serious renal, nervous or cerebral difficulty may be the basis of some of these feelings.
Fancies are numerous as to what has bilious tendencies, often from the fact that the condemned articles were at some time taken inopportunely or in excessive quantity. Even the most innocent of foods, milk, is charged with a bilious effect, and idiosyncrasies at times render every edible and potable article “bilious.” Whatever may chance to derange the stomach at some time is accused of exciting this abhorred condition, and people who are imprudent in eating and drinking are, as a rule, most subject to “bilious attacks.” Improved sensation and hygiene would prevent many such cases.
As an illustration of the strange use sometimes made of the term “biliousness,” may be given the case of a small boy who had several severe “bilious” attacks during twenty-four hours, violent vomiting coming on suddenly, with bile, and as suddenly subsiding. No other cause being apparent to the family, of course it was ‘biliousness.” On the second day,after an unusually severe paroxysm of vomiting, beside some bile and some blood, which fell upon the towel over his chest, appeared-what astonished the writer as well as the mother of the child-a carpet tack!.
Biliousness, so called, is the result of almost every conceivable indiscretion, and is really synonymous with “sickness” in a large class of cases, so that those who prescribe for a name with a hobby remedy will have a varied if unsuccessful experience.
What bushels of compound cathartic pills; what tones of Mercury, in the shape of Blue mass, Calomel, etc.; what cargoes of advertised vegetable and antibilious pills; and what oceans of opening draughts have been used in contending with this most general complaint-biliousness. What slight ailments have been made serious, what millions of teeth have been loosened, what lives have been destroyed by this indiscriminate “doctoring” for this vague and undefined condition?.
Well indeed, is it, that Homoeopathy has come in vogue to change, at least to some degree, this vicious system. The milder method, with the specialization of cases, has done much toward breaking up the random, haphazard plan of securing the interior- “cleansing the primae viae,” as our Old-School friends have had it-ad nauseam, and still there is much to do in this direction. Routinism is still the evil of the day; individualization, a special feature in Homoeopathic practice, is the method of the advanced school and of the future. Let us avoid the empirical snare of hobbyism and follow the index of scientific specialization; so shall succeed in dealing with even this protean disorder-biliousness.