Symptoms

"Biliousness" is an unscientific but very convenient term employed to express functional disorder of the liver, usually accompanied by an oversecretion of bile, which is often vomited. The condition is characterised by headache, nausea, vomiting, constipation, a furred tongue, anorexia, offensive breath, malaise, and, if it continues, by a sallow, yellowish, or pasty complexion.

Causation

The most common cause of biliousness is eating too much food or too rich or badly cooked food combined with sedentary habits.

Sir Henry Thompson, speaking of the habit of overeating, says: "The surplus fund of nutrient material unused is stored up in some form. When a certain amount has been thus disposed of - the capacity for storage varying greatly in different persons - an undesirable balance remains against the feeder, and in young people is mostly rectified by a 'bilious attack.' This relieves the system for a month or six weeks, when the process may be repeated".

"In functional derangements of the liver much more permanent benefit is to be expected from careful regulation of the ingesta than from physic" (Murchison).

Continued disregard of the warnings of bilious attacks is liable to lead in time to more serious trouble, such as habitual lithaemia or oxaluria, and in some cases gout. It is possible, although it is not absolutely proved, that diabetes may be placed in the same category.

Persons spending a holiday at the seaside, who breathe more invigorating air than that to which they are accustomed in inland cities, often are tempted to eat too -much and exercise but little, with the prompt result of overloading the liver and inducing a bilious attack, for, as Harley says, the liver "acts like a wise horse when overloaded - simply stands still until part of its burden is removed".

Those who have a tendency - often hereditary - to biliousness frequently exhibit idiosyncrasies in regard to special articles of diet, the eating of which, even in moderation, may quickly precipitate an attack.

A bilious condition is sometimes induced by absorption of ptomaines from food in the alimentary canal, which are taken up in such quantity that the liver fails to destroy them.

Bouchard has attempted to show that the ptomaine-destroying function of the liver is aided by glycogen, and is consequently favoured by ingestion of starches.

Dietetic Treatment

The digestive functions of the liver are so varied that it is difficult to arrange any diet for either functional or organic diseases of that organ which meets all the requirements of theory, but clinical experience has abundantly proved the value of certain general principles, the most essential of which is that the liver should be taxed as little as possible, and a non-stimulating diet is required.

Food in general after it has reached the duodenum acts as a stimulant to the liver, and two or three hours after a full meal the bile secretion is increased; but there are a few foods to which a special stimulating effect has been attributed, although their influence, if any, is slight. These are chiefly the succulent vegetables, like tomatoes, and also spinach and cresses. Strong alcohol, condiments, such as pepper, mustard, spices, and especially curry, have the same effect, and should be avoided. Fats and sugars eaten too freely are very apt to disturb the action of the healthy liver, especially during hot weather.

Coffee and tea may be allowed only in such moderation as one cup a day. Alcohol had better be prohibited entirely. Beer, ale, porter, strong liquors, liqueurs, and all sweet wines, such as champagne, sherry, Madeira, port, and Tokay, must be absolutely forbidden. If necessary as a tonic, a little Rhine wine, hock, or Moselle may be used (not over a couple of glasses daily), or much-diluted whisky. Of all the organs of the body, none is more often poisoned and made cirrhotic by alcohol than the liver, and the moral needs no further emphasis. Many other chemical stimuli, such as opium, derange the liver functions and interfere with the elaboration of food.

More or less intestinal dyspepsia always results from alterations in the quantity or composition of the bile, and on this account as well the food must be carefully selected, and all sugars and most starchy aliments must be forbidden as well as fats.

Among the articles especially prohibited in all cases of liver disease are condiments, spices, curries, pickles, sauces, rich soups, fried food of every kind, veal, pork, sausages; salt foods, such as corned beef and salt fish; crustaceans, new bread, preserves, and sweets of all sorts; pastry, puddings, cakes; all the heavier starchy vegetables, such as potatoes, corn, peas, beans; salad oil; oily fish, like salmon and sardines. Only fresh food should be given.

In acute functional derangement of the liver, whether there is imperfect or diminished secretion of bile or hypersecretion, it is best to considerably reduce all food in quantity. At first, if there are vomiting and headache, only light broths, beef tea, and perhaps dry toast or a cracker should be given.

In acute hepatic disease the tongue becomes furred and the appetite is apt to fail. The latter, in a manner, keeps guard over the liver, for when that organ is overloaded or incapacitated to work a failing appetite leads to taking in less food until proper functional activity is restored. But there are many chronic cases in which continued absence of appetite leads the patient to take less nourishment than is really needed, and in such cases it is not a reliable guide. It is not desirable to restrict the diet too closely or allow it to become monotonous. The palate should rather be tempted by reasonable variety.