| MEDICAL INTRO |
| BOOKS ON OLD MEDICAL TREATMENTS AND REMEDIES |
THE PRACTICAL |
ALCOHOL AND THE HUMAN BODY In fact alcohol was known to be a poison, and considered quite dangerous. Something modern medicine now agrees with. This was known circa 1907. A very impressive scientific book on the subject. |
DISEASES OF THE SKIN is a massive book on skin diseases from 1914. Don't be feint hearted though, it's loaded with photos that I found disturbing. |
THE LIVER AND KIDNEY |
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175 |
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“ More than three-fourths of the disorders in what we call ‘ fashionable life’ arise from the use of alcohol.”—The late Sir Andrew Clark, M.D., etc.
“Liver disorders are probably in all cases prejudicially influenced by alcoholic beverages. In kidney diseases alcohol should be withheld. Alcohol in moderate quantities irritates the kidneys.”—Dr. J. M. Whyte Edinburgh Medical Journal, March 1901. |
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176 |
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CHAPTER X
LIVER AND KIDNEY
To study the precise effect of alcohol on the living structure of a warm-blooded animal, with its complexity of organs and circulations of blood and of lymph, is so difficult that we naturally turn to such organs as are relatively simple in structure and are made of large masses of protoplasm (built up, of course, by innumerable cells or corpuscles).
In these we can see, by the microscope, what structural changes are taking place, and we can compare such with the disorders of function which they involve.
To take a separate organ for consideration always leads to one disadvantage, namely, that attention is apt to be concen trated on that particular one, whereas it is but one part of the body, and is merely an example of what is going on throughout the whole organism. With this prefatory warning, we will choose the liver and kidney as suitable for our purpose. We choose the liver, because in addition to being the largest gland in the body (weighing 4½ lbs.), and therefore permitting naked eye observation and study, it has other vastly important duties of storage and internal secretion, processes which are the basis of the normal metabolism and life of the individual. The kidney, too, readily permits of anatomical investigation, and is at the same time an example of a physiological function very different from that of the liver. It is part of the great excretory system, expelling in the urine all important chemical waste products of the body.
Structure of the Liver—Different Types of Liver Cells
The liver is the most important gland of the whole body. The thousands of cells of which it consists are engaged in
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178 ALCOHOL AND THE HUMAN BODY chap. x
working upon our food, partly in digesting it, partly in storing it, and changing it in various ways. Part of the duty of these cells is to secrete and pour out a fluid into the upper part of the intestine. This fluid is known as bile, and it is of great importance in the digestion of our food, especially of the fatty foods. Another part of the duty of these cells is to alter the starchy foods, and to store them up so that they can be used as they are wanted. It is important to the body, therefore, that the food should come into contact with the liver cells. This is brought about by the position of the liver being such that all nutriment absorbed by the stomach and intestines into the blood must pass through it. The blood-vessels which carry away the products of digestion from the stomach and intestine are gathered together from these organs into larger vessels, but when they reach the liver they break up into smaller and smaller branches, and these small vessels convey the blood containing the partially digested food material to the liver cells (Fig. 24). But these small vessels are also built up of cells, and other cells accompany them to support them, so that the liver cells are not the only ones in the organ. Again, the bile, which, as we have seen, is produced by the liver cells, must be carried to the intestine. This is done by means of what are called bile ducts, and these too are formed of cells and supported by others. So that we see that in the liver there are three chief kinds of cells : —
(1) The liver cells proper.
(2) The cells lining the blood-vessels and the bile ducts.
(3) The cells supporting the whole and keeping it together —called fibrous tissue cells.
Action of Alcohol on the Liver.—Alcohol when taken in moderate amount is practically entirely absorbed by the stomach. That is to say, it is taken up by the blood-vessels of the stomach wall, and is in consequence carried straight to the liver. There fore, as the first organ in the path of the absorbed alcohol, we should expect the liver to be most affected by it. We find that in many instances this is the case. Not only so, but the liver is also an excellent field for studying the action of alcohol upon cells in general. It will, therefore, occupy more of our time than most of the other organs.
In considering the action of alcohol on the liver, we may divide the subject into :— |
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Normal. Cloudy Swelling. Fatty Degeneration. |
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a—Nucleus of liver cell. l—Leucocyte or white blood corpuscle.
b—Nucleus of cell forming the wall of c. r—Red blood corpuscle.
c—A capillary blood-vessel. f—Fat droplet. |
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Fig. 24.—Three microscopical sections of human liver (magnified 750 diameters), drawn by Dr. James Miller. The Normal Liver section shows four columns of liver cells, each with a round stained healthy nucleus, and separated by capillary blood-vessels containing blood which has come from the stomach and bowel. The red corpuscles and two white corpuscles (each distinguished by a stained nucleus) are shown on the blood-vessel. The specimen exhibiting Cloudy Swelling shows the same columns of liver cells swollen, their nuclei pale and beginning to shrink. The capacity of the blood-vessels is diminished by the swelling of the liver cells. The section of Fatty Liver represents the protoplasm of the liver corpuscles as containing numerous fat droplets which are gradually increasing in size. |
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180 ALCOHOL AND THE HUMAN BODY chap.
1. Its action on the blood-vessels.
2. Its action upon the liver cells.
(a) on liver cells proper.
(b) on fibrous tissue cells.
1. Action on Blood Vessels leading to Congestion of the whole Organ with Blood.—The blood-vessels of the liver are (even by small doses of alcohol) quickly dilated, just as are those of the skin, the effect in the case of the liver being, how ever, much more marked, because that organ is so rich in large vessels. This engorgement of blood makes the organ heavier than normal (“Beer Drinker’s Liver”), and causes also a slight stretching of its covering membrane or capsule, both of which conditions lead to a sense of local weight and discomfort. The sufferer is probably at a loss to explain why he or she feels so wretched, and it often never occurs to him to associate his sensations with his habit of taking alcohol. This condition of liver engorgement occurs chiefly in the early stages of the taking of alcohol, and considering the facility with which it can be evoked it is especially astonishing that those who live in tropical climates do not recognise this fact, and abstain from the use of alcohol as a beverage.
2. Action on Liver Cells.—Before considering the action of alcohol upon the cells of the liver, let us recall what we have already learned about the action of alcohol upon cells in general (Chap. III.). It will be remembered that when we take such a cell as the yeast cell and allow alcohol to act upon it, we find that its nutrition, its growth, and its power of reproduction are all interfered with. We have, in short, seen that alcohol is a cell poison.
Now, how does alcohol affect the liver cell? In the first place, we must distinguish between the different varieties of liver cells, and for our purpose it will be sufficient to divide these into two varieties, namely, the liver cells proper and the supporting or fibrous tissue cells. Why should this distinction be necessary 1 It is necessary, because although alcohol is a cell poison, it does not affect all cells in the same way. We have divided the cells of the body according to the work that they have to perform, but we may also divide them according as they behave under adverse circumstances. Now, just as there are some people in a nation who, from their mode of upbringing, are not fit for a rough life, and others who take to |
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X LIVER AND KIDNEY 181
it naturally and thrive upon it, so there are some cells in the body which rapidly succumb to poisons, while others are even stimulated or irritated in such a way that they increase in numbers.
Action of Alcohol on the Liver Cell Proper
Let us take the first variety of cell which is found in the |
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A |
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B |
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A—Liver cell shrinking. B—Connective tissue notably increased and separating the lobules of liver cells.
FIG, 25.—Microscopical section (magnified 100 diameters) from the liver shown in Fig. 27. It will be seen that instead of the whole section exhibiting liver cells arranged in healthy lobules, most of the picture is occupied by a highly corpusculated (? inflammatory) connective tissue, which by its scar-like contraction causes shrinkage and wasting of the liver cells.
liver, the liver cell proper—the cell which secretes the bile and which stores the starchy food—and let us see how it is affected by such a poison as alcohol. Practically the effect is very much the same as the effect of other poisons, such as arsenic and phosphorous. Usually it is not so great, because these are much more powerful poisons ; still, when alcohol is taken in |
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182 ALCOHOL AND THE HUMAN BODY chap.
such large quantities as to cause death from “ acute alcoholic poisoning,” we find changes in the liver similar to those found in cases of phosphorous poisoning. The first change which the cells undergo is a swelling (cloudy swelling, Fig. 24), which causes them to take up more room, so that the whole liver is enlarged. If the action of the poison is continued the proto- |
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Normal Liver (much reduced in size)
Fig. 26. — This figure shows the smooth appearance of a healthy human liver viewed fro’m the front and above. The larger lobe is the right. Compare this figure with the next. (Fig. 27.)
plasm of the cell becomes transformed into globules of fat, this process being known as “fatty degeneration” (Fig. 24). Needless to say that such a liver is incapable of performing the work which it ought to do. We see, therefore, that the liver cells belong to that group of cells in the body which are easily damaged by adverse conditions and to which alcohol is a true “ cell poison.” |
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x LIVER AND KIDNEY 183
Action of Alcohol on the Fibrous Tissue Cell
But now, turning to the other great group of cells in the liver—the fibrous tissue cells—we find that the effect of alcohol upon them is very different. They belong to the cells of the body which are not easily damaged, and a substance |
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Drunkard s Liver (similarly reduced)
Fig. 27.—This figure shows the appearance of one form of alcoholic disease of the liver, namely, that in which the connective tissue increases and the liver cells degenerate and atrophy. This particular form is known as gin-drinker’s or hobnail liver. Compare with the healthy liver shown in Fig. 26.
which will act as a poison to some of the other cells will simply irritate these cells and cause them to multiply. Now, of course, if alcohol is taken in very large quantities, so as to produce fatty degeneration of the liver cells, death occurs rapidly, and there is no time for any changes to occur in the fibrous tissue cells, or rather the changes in them are quite |
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184 ALCOHOL AND THE HUMAN BODY chap.
unimportant. But when there are small quantities of alcohol frequently filtering through the liver, then we have an oppor tunity of seeing what changes occur in these cells. We find, then, that in such a case, partly because they are irritated by the alcohol, and partly because the gradual degeneration of the liver cells leaves them more room, these fibrous tissue cells multiply and increase in number. Now, if this irritant— alcohol—after being taken for only a short time, is removed, the condition of the liver will go back to what it was before irritation occurred ; in other words, these new cells will dis appear. But if the irritant be applied again and again, if there are constantly small quantities of alcohol filtering through the liver, then a time comes when these new cells settle down and develop into permanent fibrous tissue cells, forming what is known as “ scar tissue,” and the peculiarity of scar tissue is that it cannot be removed. We have seen that this new tissue partly takes the place of liver cells which have degenerated and disappeared, and, in addition, it also pushes aside and destroys other liver cells (Fig. 25). Hence it follows that not only are the liver cells which have to do the work more or less damaged, but in actual number they have diminished, and are replaced by useless scar tissue. A liver in this condition and also congested with blood is often enlarged and very unhealthy.
Drunkard’s Liver
Moreover, another characteristic of scar tissue is that it tends to contract, i.e. to get smaller. This tendency on the part of scar tissue affects the liver structure as follows :—As a rule the scar tissue has been formed in patches and bands, especially round the blood-vessels where fibrous tissue exists normally. The contraction of these bands causes the liver to shrink, but this shrinking is only in places, so that portions are left projecting. Thus we have produced in severe and longstanding cases of alcoholism what is sometimes called the “ drunkard’s ” or “ hobnailed ” liver, hobnailed because of the knob-like projections on its surface (Fig. 27).
This contraction or shrinking of the liver still further presses upon the liver cells and interferes with the work they ought to do. It also presses upon and makes smaller the vessels which are carrying the blood through the liver ; the watery part of the blood (which is able to travel forward at its |
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LIVER AND KIDNEY |
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X |
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proper rate) tends to ooze out of the blood-vessels before these reach the liver, and thus what is known as dropsy is produced.
Scar Tissue found in other Organs
What we have seen occurring in the liver occurs also in other tissues and organs of the body. We find this fibrous tissue everywhere—in the stomach, in the kidneys, in the arteries, and in the brain ; the fact being that this scar tissue is liable to be produced in all parts when there is present a constant irritation from alcohol, the normal cells of the structure being everywhere pushed aside. The general useful ness of an organ is thus seriously impaired, and there is a tendency for the circulation of the part to suffer.
Diseases of the Liver1
But in all this we have said nothing of the way in which these various changes in the liver affect the person himself. In the first place, interference with the amount and quality of the bile inevitably leads to indigestion and constipation, and a similar interference with the action of the liver cells and their chemical changes sets up in many cases gouty conditions, accompanied by mental depression or irritation. Swelling of the liver causes pain, discomfort, and sometimes jaundice ; and contraction of this organ produces, as beforesaid, dropsy and swelling of the veins, in addition to symptoms which result from destruction of the liver cells. These symptoms are many and various, the liver being a most important organ and intimately associated with so many different bodily functions.
Diseases of the liver occur more frequently as a result of the frequent taking of small doses of alcohol (though never reaching the stage of intoxication) than as a result of indulging more freely but at intervals. Thus it comes about that publicans and commercial travellers head the list of deaths from liver disease.
Note.—We have, of course, to remember that different people are affected in different ways by the action of alcohol. In some patients the nervous system succumbs quickly, whilst in others, in whom the nervous tissue is more resistant, the irritant action of the alcohol upon the liver has time wherein to manifest itself, and various disorders gradually arise.
1 For list see p. 231. |
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The Kidney |
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It is not easy in a few words to describe the elaborate mechanism of the kidney, which consists of a filtering system of thousands of tubules arranged closely side by side, whose function it is to carry away from the body the waste material, which otherwise would interfere with the vitality of the different organs.
Suffice it to say that the part played by the kidney in rapidly eliminating effete material is a part that cannot be too carefully safeguarded. Anything that interferes with its work will sooner or later cause retention of waste products in the system, and also will permit the escape of the valuable albuminous substances of the blood through the filtering apparatus.
Effect of Alcohol.—Such an effect alcohol, unfortunately, has upon the kidney, and to a degree that can only be described as disastrous. To those whose duty it is to in vestigate the medical causes of death, it is a matter of common observation that very characteristic changes are found in the kidneys of those who have habitually taken alcohol.
These changes are of the type already described in the previous section upon the liver.
They consist of :—
(1) Cloudy swelling.
(2) Fatty degeneration.
(3) Increase of fibrous tissue, followed by shrinkage of the
kidney into what is known as the granular kidney. All of these conditions seriously interfere with the work required of this important organ ; and, as a consequence of its deficient action, the body becomes subject to numerous physical troubles, such as “ rheumatic ” pains, mental depres sion, loss of appetite, sickness, and other symptoms of impaired digestion.
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LIVER AND KIDNEY |
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187 |
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CHAP. X |
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Dr. Francis Hare, Medical Superintendent of the Norwood Sanatorium for the Treatment of Inebriety, has drawn attention to the frequency with which albuminuria occurs in alcoholics. In his report for 1908 he says :—
“ By far the most frequently recurring evidence of visceral damage has been in connection with the kidneys. If we consider alone the class of chronic inebriety, and take note only of such patients as are still drinking on admission, the percentage of cases (male) showing albuminuria is at least 80. The quantity of albumin varies from 1/3 to a trace : usually it is small. In the majority of cases, it rapidly clears up after the cessation of all alcohol. In a minority—although it never fails to diminish greatly—it persists until the patient leaves the sanatorium. In some, though not in all, of the persistent cases, tube casts have been observed. In cases which have shown temporary albuminuria and relapsed into alcoholism, the albuminuria has always been reproduced.”
The early appearance of albumin in the urine as a con sequence of unsuspected alcoholism often leads to the refusal of an individual for life insurance without the causation of the condition being realised or properly dealt with by abstinence.
Later, the excretion of the urine is diminished in proportion as the kidney shrinks, and finally the condition known as chronic Bright’s disease ensues, which ultimately ends fatally. |
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