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antimony. After first keeping them in storage, it then attempts
to eliminate these noxious substances. According to Slowzoff
and Bamossi, the various poisonous metals and alkaloids enter
into combinations with the proteid bodies of the liver. Animals
that have been richly fed have been found to be better protected
against these poisons because of their livers being richer in
proteid contents and glycogen.

The liver also protects the body against the numerous toxic
products formed in the stomach and intestines during the process
of digestion and assimilation. The most important of these are
the carbamins and ammonia salts, which would be injurious to us
if the liver did not protect us by converting them into urea.



s Quoted after Metschnikoff.

9 Fraser: British Med. Journal, vol. ii, p. 595, 1897.



152 Old Age Deferred.



When the liver is excluded from the circulation, as Nencky
and his pupils have secured by establishing an Eck's fistula, then
toxic symptoms arise when the animals are given albuminous
food, and these symptoms can only be explained from the fact
that the liver is unable to destroy toxic products. The more
albuminous food taken, the more marked are the symptoms of
intoxication.

The liver aids in the transformation of the poisonous end-
products of proteid metabolism by bringing about the combina-
tion of the toxic end-products with sulphuric acid (Baumann,
Emden and Glaesner). Thus these dangerous substances are
eliminated as ethereal sulphates, which are practically harmless.
Even when these ethereal sulphates are present in large amounts
in the urine there may be no symptoms of auto-intoxication.

When the liver is extirpated, a condition of acidosis arises,
and a large quantity of ammonia is eliminated, which is produced
in order to neutralize the acids present. The liver protects us
against acids formed. in the organism. After eating a quantity of
meat, we would be menaced by the acids formed through its
decomposition, were the liver not active.

We can prevent acidosis if we eat a considerable amount
of carbohydrates, at least ioo grammes a day as Hirschfeld has
proved. It has been shown by Waldvogel that these carbohy-
drates do not prevent acidosis if they are given by a method which
precludes their passage through the portal circulation, — e.g.,
subcutaneously.

As we have seen above, the liver receives an enormous
amount of toxic products from the stomach and intestine, which
it transforms or destroys. Like any other organ which is over-
worked, the liver may undergo certain changes when continually
subjected to a strain, and great quantities of these toxins might
be able, after a long-continued action, to alter the liver tissue.
Such a condition we may note in gastric and intestinal diseases,
especially in those cases where large amounts of fatty acids are
formed.



Destruction of Toxic Products by the Liver. 153

Bouchard found an enlargement of the liver in 23 per cent.
of all his cases of dilatation of the stomach.

We can understand that when fatty acids, as a result of
gastro-intestinal disease, pass for a long time through the liver,
they may destroy the delicate epithelium of this organ. Boix
demonstrated this by experiments. By feeding animals with
lactic, butyric, and acetic acids, he produced hepatic cirrhosis.

So long as the liver is healthy it is able to withstand the con-
stant inflow of toxins and will transform them into less harmful
compounds. But when the liver is altered, as in cirrhosis,
things are different. We then find a diminution of urea, and
an increase of ammonia. Happily such a condition arises only
when there are considerable anatomical and histological changes
in the liver.

Salaskin and Zaleski have shown in animals that when
there are serious anatomical changes in the liver, the ammonia
is increased, and the urea is diminished. We may suppose that
in old age, when the connective tissue is more or less increased
and important liver elements destroyed, a similar decrease in the
urea formation may take place just as in chronic cirrhosis.

That in diseases of the liver toxic products are formed
and eliminated by the urine in increased amounts, has been shown
by Professors Bouchard 10 and Roger. They found that the
urine of patients suffering from diseases of the liver is more toxic
than that of normal persons.

That the normal urine is toxic has been proved by Seglas
and Vauquelin, 11 and also by Bocci. 12 Bouchard has designated
as the urotoxic unit the quantity of urine necessary to kill an
animal weighing 1 kilogramme, and as the urotoxic co-efficient
the relation of the urotoxin eliminated in twenty-four hours to the
body weight of the animal. This latter, then, indicates the quan-
tity of urotoxins a man eliminates in twenty-four hours.



10 Lemons sur les autointoxications dans les maladies.

11 Journal de Magendie, vol. ii, p. 357, 1822.
i2Centralbl. fur med. Wiss. 51, 1882.



154 Old Age Deferred.



All these calculations of Bouchard have had no great suc-
cess, however, for many authorities, as Gumprecht, 13 Heymans
v. d. Bergh, etc., have shown that the toxic effects of the injected
urine may be explained in part by the difference in osmotic
pressure between the injected urine and the blood.

Still the fact remains that the urine of many cases of liver
disease has been found to be more toxic than the urine of other
persons.

When the liver is damaged it cannot destroy poisons in the
normal manner, as was shown by experiments. Thus, the liver
cells have been experimentally injured when it was found that
such a liver was not able to destroy strychnine as well as a normal
liver. Very important findings have been made by Roger and
Gamier. 14 They have ascertained that privation, bad nutrition,
etc., can also lower the vitality of the liver and diminish its anti-
toxic properties.



13 Centralbl. fur Inner. Med., 24, 1897.

14 Roger et Garnier: C. R. Soc. de biol., p. 209, 1899.



CHAPTER XIV.
The Hygiene of the Liver.

We have often observed that people suffering from diseases
of the liver feel and look much better after abstaining from meat
and living on milk and a vegetarian diet. If such a diet be bene-
ficial in cases where the tissues of the liver are degenerated, it
appears reasonable to assume that it will be equally efficacious
when the liver has not yet been altered by disease. We must
realize that the various unwholesome matters we eat or drink-
are carried to the liver to be dealt with, and that the end-products
of the decomposition of the meat, and other elements contained in
preserved meat which may not be perfectly sound, may injure
the liver-tissue, or, at any rate, throw more work on this organ
than food in the nature of vegetables or milk.

A milk diet has the further great advantages that it assists
in destroying toxic products in the intestine, and also that it can
hinder the development of gall-stone disease (see Chapter
XXXIX).

Not only meat used in abundance, but also various kinds of
spices, condiments and stimulants may be very injurious, espe-
cially alcohol, if taken in large quantity. Gin and brandy are
the most deleterious in their action. Wines containing little alco-
hol are less harmful, but acid or strong white wines may injure
the liver-tissue.

The well-being of this organ is essentially dependent on
the good condition of various other organs with which it stands
in very close relation, in particular the intestines, for instance. It
is from here that most of the toxic products enter the liver,
either by the portal vein or through the choledochus. The intes-
tine always contains myriads of microbes, which may enter the

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156 Old Age Deferred.



liver either by the blood or the bile, and thus provoke very impor-
tant changes in the liver-tissue. Professor Adami, 1 of Montreal,
found colon bacilli in a cirrhotic liver.

It follows, therefore, that we must maintain the intestine in
the best possible condition, and avoid constipation and stagnation
of faecal matters, with the augmentation of toxic products. That
constipation is very deleterious to the liver can be best shown
by the fact that very often affections of the liver and bile-ducts, —
and especially gall-stone disease, — are developed in persons
suffering from habitual constipation. The best treatment for
these liver affections is a purging treatment, and it is mainly on
account of their action in this manner that certain alkaline min-
eral waters have attained so great a fame ; in addition, due to
increased peristalsis, the circulation of the bile is enhanced.

Proper movements of the bowel are indispensable to a sound
condition of the liver and for the prevention of hepatic disease,
and we, therefore, refer the reader to the chapter that deals in
detail with the prevention and treatment of constipation.

Not only the intestine, but the stomach also, must be in-
good condition. It has been noted by Bouchard and Hanot that
chronic gastric and intestinal troubles are apt to cause enlarge-
ment of the liver. Bouchard has found an enlarged liver in 23
per cent, of his cases of dilatation of the stomach. Hanot and
Boit 2 have shown experimentally that the different acids formed
in the gastro-intestinal tract are able to produce a genuine cir-
rhosis of the liver. Therefore acid fermentation must be care-
fully avoided ; and to prevent such fermentation in some degree
in the stomach and in the intestine, it is necessary to masticate
the food thoroughly, as will be shown.

Another very important organ, the sound condition of which
is of great importance to the liver, is the pancreas. It has been
found by several authors, particularly by Steinhaus, 3 in his in-



1 Quoted from Quincke : "Diseases of the Liver" in Nothnagel's "Practice."

2 Hanot and Boit: Congresso Med. Internat. di Roma, 1894.

3 Steinhaus: Deutsches Archiv fiir klin. Medicin, 1902.



The Hygiene of the Liver.



vestigation of some 40 cases of hepatic cirrhosis, that the pan-
creas is also affected in each case of this type; and we further
know that after disease of the pancreas, as in diabetes, for
example, the liver is also, as a rule, altered. Thus these two
organs are in close relationship.

As pancreatic diseases are among the most difficult to diag-
nose, and people suffering from them live and die, as do also many
diabetics, without their particular state having been recognized,
so, the rational treatment of these diseases being still imperfect,
we cannot offer advice in regard to their prevention. But, at
any rate, the safest course will be moderation in diet, especially
fatty food, which exacts the active co-operation of the pancreas.
As in the case of all other organs, long-continued overwork will
exhaust this gland, and thus induce a diseased condition. Mod-
eration in diet will be the best policy for the pancreas, as also
for the liver; and to maintain these organs in sound working
order, meat in particular should only be taken in small quantities,
and fat also should not be partaken of in large amount.

Milk and vegetable food, with but little meat, and that pref-
erably as fish, will certainly furnish the best diet to avoid dis-
eases of the liver. As Quincke 4 mentions, experience shows also
that water in large quantities, especially certain alkaline saline
waters, can increase the flow of the bile; and therefore, as also
for other reasons mentioned in this book in Chapters XXXIV
and XLI, water should be drunk in sufficient quantity every day.
The alkaline waters referred to are certainly superior in their
action to ordinary water, especially those kinds which at the
same time cause purging.

Hot climates have a deteriorating effect on the liver. We
have often noted the great frequency of liver complaints under
these conditions, and we have never had a patient from the hot
parts of Mexico who has not had a hypertrophied liver. We are
inclined to believe that it is not so much the climate as faults in
hygiene, especially in diet and in the use of stimulants, which are

4 Quincke: "Diseases of the Liver," in Nothnagel's "Practice," 1907.



158 Old Age Deferred.



the cause of such a condition in Europeans residing in tropical
climates.

A vegetarian diet is certainly the best in tropical countries,
as we personally found during a stay in Southern Florida, Texas,
and Mexico. Just as for the kidneys, so for the liver, a bath, and
particularly a sweat-bath, is of great benefit, since by means of
it toxic products may be eliminated which would otherwise
be carried to the liver.

We have found these baths to be of great benefit in liver
diseases, and considering the amelioration of the processes of
oxidation brought about by such baths, it seems highly probable
tnat they are capable of improving also the working condition of
a liver not as yet diseased.

In general, it is our opinion that to prevent disease in an
organ the surest method is to use those means through which that
organ, when diseased, is found to benefit. Of course this is only
meant as a general statement ; but in the children of those suffer-
ing from liver complaints such preventive treatment is particularly
indicated, as these conditions, we have found, are most frequently
inherited. We have treated cases where three or four genera-
tions of one family had been sufferers from the same complaint.

Here, as always, let us follow the wise precept: "Preven-
tion is better than cure."



CHAPTER XV.

On the Destruction of Toxic Products by the
Adrenals.

There is ample evidence in support of the contention that
the adrenals play an important part in the destruction of toxic
products in the body. As long ago as 1853, one of the leading
authorities on the adrenals as ductless glands, Brown-Sequard,
noticed that the blood of animals without adrenals was more
toxic than that of animals the adrenals of which had not been
removed.

Langlois and Abelous 1 confirmed the conclusions of Brown-
Sequard. They also established the fact that the blood and mus-
cular extracts of frogs whose adrenals had been removed, were
toxic, and contained a poison of the nature of curare. The
animals died from auto-intoxication, and these savants came to
the conclusion that the adrenals were created to neutralize or de-
stroy poisons which are evolved during muscular work. Frogs
from which the adrenals had been removed showed also lessened
resistance to muscular fatigue. Similar results have been ob-
served by Langlois in the case of other animals: rabbits, dogs,
guinea-pigs, etc. Albanese 2 also found that animals operated
on as above exhibited more fatigue than those whose adrenals
had been allowed to remain intact. The recent labors of Sajous
which have shown conclusively that the adrenals furnish to the
blood one of its important immunizing constituents explain all
the above observations.

The fact, observed by all these authorities, that when one



1 Abelous et Langlois: Archives de physiologie norm, et path., p! 267, vol.
iii, 1892, and "Travaux de Laboratoire," Lancet, August 20, 1898; Societe de
biologie, 1892.

2 Albanese: Archiv. Ital. di Biologia, p. 338, 1892.

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160 Old Age Deferred.



of the adrenals is removed the other becomes hypertrophied,
sometimes to a great extent, seems also to point to the conclu-
sion that greater demands are made on the gland that remains,
the hypertrophied condition of which appears to be due to the
increased work required of it in protecting the body from
infection.

That these organs really assist in the defense of the body
against the attacks of microbes or the introduction into it of
certain toxic products can be best demonstrated by the fact that
after such infections the adrenals are, as a rule, altered, showing
that a pronounced reaction antagonistic to these agencies has
occurred.

It has thus been proved by a succession of authors: Char-
rin, 3 Langlois, Roux, Yersin, Professor Roger, and more recently
by Oppenheim and Loeper, 4 that in experimental or in sponta-
neous infectious diseases the adrenals present important altera-
tions as a result of the reaction against infection.

Oppenheim and Loeper found that important changes fol-
lowed upon experimental infectious diseases; for example, after
infection by the bacilli of diphtheria or anthrax, or by the pneu-
mococcus; also in such infectious diseases as diphtheria, pneu-
monia, small-pox, typhoid fever, etc. ; and also after experimental
poisonings, as with arsenic, phosphorus, or mercury. There
occurred leucocytic reaction, diffuse diapedesis, or infectious nod-
dules, and also a congested condition of the adrenals, sometimes
so marked that haemorrhage took place, with complete destruction
of the parenchymatous tissue of the glands.

Very important are the conclusions of Oppenheim, 5 that
when animals have received poisonous products, together with
adrenal extracts, after having previously lost these glands by
operation, such animals show a longer survival, sometimes even
of indefinite duration, as compared with animals without adrenals

3(Jharrin: "Les defenses naturelles de Forganisme," Paris, 1898; C. R.
Soc. de biologie, 1892.

4 Oppenheim et Loeper: C. R. Soc. de biol., 22 mars, 1901.

5 Oppenheim: "Les capsules surrenales, "These de Paris, 1902.



Destruction of Toxic Products by the . Utrcnals. 161

to which have been administered the same toxic products, but
without adrenal extracts.

With phosphorus and urinary poisons in particular, this
author has obtained most striking results from the injection into
animals of adrenal extracts at the same time as the poisonous
substances.

Oppenheim comes to the same conclusion as Abelous, Char-
rin, Langlois and Sajous: that the adrenals play a great role in
the destruction or neutralization of microbic or other poisons
introduced into the system.

We are thus in possession of powerful arguments in support
of the presumption that the adrenals are antitoxic glands. The
fact, found by Langlois, that the adrenals contain less adrenalin
after experimental infectious diseases, and that established by
Luksch, that after certain experimental infectious diseases such
as diphtheria, typhoid, or tuberculosis, the extract from the
adrenals no longer produces an increased blood-pressure, do not
seem to us sufficient to invalidate our belief in the antitoxic
properties of these glands ; for here we are witnessing the same
occurrence as has been previously noted in reference to the thy-
roid, — that the functional hyperactivity of the gland may be
followed by its exhaustion.

Moschini, Nicholas, and Bonnamour have also found his-
tological evidences in the adrenals in infectious diseases indicating
a hyperactivity of these glands.

The fact that different toxic products, such as alcohol, can
produce alterations in the adrenals, indicates also a role of these
glands in defending the body against toxic doses of this sub-
stance (see Chapter III).

It was found by Aubertin 6 and other authors that there is
a hyperplasia of the adrenals after experimental intoxication of
the guinea-pig by alcohol. Bernard and Bigart found important
alterations of the adrenals after experimental poisoning by



6 Aubertin : C. R. Soc. de biologie, 22 juillet, 1902.

ll



162 Old Age Deferred.



mercury, arsenic, lead, etc. As shown by Professor Sajous, 7
various drugs act on these glands, and he attributes the rise of
blood-pressure therefrom to the action of such drugs on the
adrenals, whose function, as is well known, is to raise the blood-
pressure. We can thus understand how if alcohol be taken in
large quantities it is able to produce atheroma and arteriosclerosis,
as are also other toxic bodies, such as nicotine.

It is well known that arteriosclerosis is frequent in great
smokers. It has been found by several authorities, among them
Borylac, that inhalation, or mastication, of tobacco produces
atheroma, and by Boverie and Loeper 8 that similar changes
have followed experiments with tobacco or ergotin. Very im-
portant data have also been established by Drs. Isaac Adler and
Hensel, of New York, 9 who have found that atheromatous alter-
ations of the aorta can be produced experimentally by powerful
doses of nicotine. Such alterations were similar to those effected
by adrenalin, but were neither so constant, nor so marked.

These experimental facts, together with observations by
Dr. Sajous, prove that the atheromatous condition brought about
after using certain drugs, such as alcohol and tobacco, can be
ascribed to the adrenals. Josue, in 1893, 10 showed that by inject-
ing adrenal extracts (solution 1 : 1000) into the veins of a rabbit,
atheromatous patches of the aorta will appear after five or six
weeks. The changes described by Adler and Hensel from the
effects of nicotine confirm the probability that tobacco acts on
the adrenals first, then, by their medium, on the blood-vessels
(see, also, Chapter XLIII).

The above observations show that the same is also probable in
the case of alcohol, to which we may add a case of Widal and
Boivin, who found in a young woman dipsomaniac a hyperplasia
of the adrenals and atheroma of the aorta ; and to complete the
value of these observations we subjoin those of a series of cases

7 Sajous : Log. eit.

8 Societe d'Anatomie, Mai 31, 1907.

9 Deutsche Med. Woehenschrift 8, 1906.
IOC. R. Soc. biologie, Nov. 14, 1893.



Destruction of Toxic Products by the Adrenals. 163

of atheroma by Joshua, in three of which a hyperplastic condition
of the adrenals was found.

It follows logically from the foregoing effects of alcohol and
tobacco, that we must avoid large quantities of these substances if
we desire to keep in a normal condition the heart and blood-
vessels, upon the perfect state of which depends, in a great degree,
our chances of a long life and extended youthfulness.

We will deal further with the latter points in the following
chapter.



CHAPTER XVI.

Hygiene of the Adrenals and of the Circulatory Sys-
tem — A Few Remarks on the Cause, Prevention,
and Treatment of Arteriosclerosis.

In order to obtain the best hygienic condition of the circu-
latory system, it is indispensable to avoid all that are harmful to
the adrenals. There can no longer be any doubt that these glands
exercise a controlling influence on the heart and the whole circu-
latory system. They are in intimate relation with the principal
nerves that regulate the heart: the sympathetic and the vagus.
Thus, for instance, emotions that act on these nerves excite
through them a hypersecretion of the adrenals and a contraction
of the small blood-vessels, with a rise in the blood-pressure. By
the hyperactivity of these glands their secretion, in larger quan-
tity than usual, is thrown out into the system, producing toxic
effects which result in an atheromatous condition of the arteries.
According to our present knowledge, we imagine this athero-
matosis to be due to the toxic effect of the adrenals quite inde-
pendently of the increase in the blood-pressure, for it has been
distinctly shown that even substances which diminish blood-
pressure, such as amyl nitrite, for example, are also capable of
producing atheroma. The toxic effects of adrenalin are proved
by the experiments of Amberg 1 in the laboratories of the Johns
Hopkins University.

We must especially insist on the fact that high blood-pres-
sure is not a condition essential to arteriosclerosis. It has been
shown by Sawada, la Groedel, 2 and Ferranini, 3 through measuring

i Amberg: Archives Internationales de Pharmakodynamie et Therapie,
1905.

l a Deutsche Med. Wochenschrift, No. 12, 1907.

2 Congress fiir Innere Medicin, 1907.

3 Grom. Int. della Soc. Med., xxvi.

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Prevention and Treatment of Arteriosclerosis. 165

the blood-pressure by Riva-Rocci's instrument, that numerous
cases of arteriosclerosis can arise without any increase at all in
the blood-pressure. According to Professor Romberg, 4 there is
only high blood-pressure in such cases of arteriosclerosis where
there is a diseased condition of the kidneys. According to this
leading authority on heart diseases, high blood-pressure is one
of the earliest symptoms of kidney complication in arterioscle-
rotic persons. We believe that the high blood-pressure found in
kidney diseases may be brought into correlation with the previous
statement, by the fact that in such conditions, and especially in
sclerosis of the kidneys, the adrenals, if examined, are frequently
found to be hypertrophied, as was noted by Parkes Weber, 5
Lemaire, and in four cases of Troin and Rivet. 6 At the last Con-



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