The results of recent investigation would seem to indicate that the metabolic function of the liver is far more important than its secretory function—to make a literal rather than a scientific distinction. The pancreatic juice, in conjunction with the gastric and the intestinal juices, seems fully capable of satisfactorily effecting the processes of digestion without the aid of the bile, but failure in the metabolic activity of the liver results at once in the development of symptoms of intoxication. These disturbances are, as a rule, unattended with appreciable anatomic alterations, and are thus beyond actual demonstrative proof. In addition to the secretion of bile, the liver stores up glycogen, takes an active part in the formation of urea, and removes or neutralizes poisons contained in the portal blood and largely derived from the gastro-intestinal tract.
In a suggestive communication on hepatic insufficiency, Pick1 discusses four states that he considers