[Digestive organs 131]

Cancer of the gall bladder, and bile ducts.  Causes.—­It usually occurs between forty and seventy years of age.  The cases that originate here show no percentage in either sex; but those that appear here as secondary cancers are three times as frequent in women as in men.  Chronic irritation by gall stones is an important cause.  They are hard to diagnose and, of course, fatal in the secondary kind.  For the primary kind early complete removal may cure if you can get at them.

Circulatory disturbances of the liver. (Acute Hyperemia or Congestion).—­This occurs normally after meals, and in acute infections, diseases, etc.

Chronic congestion or nutmeg liver.—­This is due to an obstruction of the blood circulation in the liver by chronic valvular heart disease with failure of heart action.  Lung obstruction in the trouble called Emphysema, Chronic Pneumonia, etc., may cause it.  The cut section of a liver shows an appearance like a nutmeg, due to a deeply congested central vein and capillaries.  In a later stage the liver is contracted, central liver cells are shrunk and the connective tissue is increased.

Acute yellow atrophy. (Malignant Jaundice).—­This is fortunately a rare disease.  There is rapid progress, and it is fatal in nearly all cases.  The liver is very small and flabby.  The symptoms are many and are hard to differentiate.  You must depend upon your physician.  The only thing for him to do is to meet the symptoms and relieve them if possible.

Cirrhosis of the liver. (Sclerosis of the Liver, Hobnail Liver, Gin Drinkers Liver, Hard Liver).—­This occurs most often in men from forty to sixty years old.  It is not uncommon in children.

Cause.—­It is usually due to drinking of alcohol to excess, especially whisky, brandy, rum or gin.  The liver is small and thin; hard, granular, white bands run through it and press on the liver cells and destroy them.

Symptoms.—­These are few as long as proper circulation in the heart is maintained.  Fatty cirrhosis is often found in post-mortems.  The first symptoms are the same as those accompanying chronic gastritis, dyspepsia, They are:—­Appetite is poor, nausea, retching and vomiting, especially in the morning; distress in the region of the stomach, constipation or diarrhea.  These increase and vomiting of blood from the stomach may occur early and late.  Bleeding from the stomach and bowels, etc., cause the stools to look like tar.  Nosebleed and piles are common and profuse; bleeding may cause severe lack of blood.  The epigastric and mammary veins are enlarged.  Ascites (dropsy in the abdomen) usually occurs sooner or later and may be very marked, and it recurs soon after each tapping.  The feet and genital organs may be oedematous (watery swelling), jaundice is slight and does not occur until late.  During the late stage the patient is much shrunken, face is hollow, the blood vessels of the nose and cheeks are dilated, abdomen is greatly distended.  Delirium, stupor, coma or convulsions may occur at any time.