My cup runneth over

A History of the Assessment of Liver Performance

“…The challenge of ascites to the well‐being of the individual was appreciated by the ancient Egyptians, the Hebrews, the Greeks, and the Mayans (Fig. 11) alike 48 . Hippocrates observed pithily that “when the belly becomes full of water, death follows.” 49 Methods were devised early on to alleviate ascites, including physical drainage and the early introduction of dietary salt restriction.…”

DANTE’s Medical Knowledge: The Case of INFERNO, Canto XXX

“…The word "dropsy" refers to any accumulation of liquids in the serous cavities or connective tissues of the body, and it appeared in English in the late 13th century, whereas "ascites"-derived from the ancient Greek term askos (αςκος) meaning a leather bag used to carry liquids-entered the language a century later, referring specifically to abdominal dropsy (Ruben, 2004). However, the phenomenon of fluids accumulating in the abdominal cavity had already been known since ancient times.…”

“…He ascribed ascites to a rock-hard liver: "...as water cannot accumulate... in any other way than from narrowness of the blood vessels going through the liver". According to him, congestion (hyperemia) or plethora, as he named it, was a main cause of ascites (Ruben, 2004;Dawson, 1960;Dobson, 1925). The original writings of Erasistratus are lost, but many of his ideas have been preserved in Galen's writings, who quoted him frequently, usually to disagree with him (Ruben, 2004 [...] amplius inturgescit" (…bloated abdomen….neck and limbs become very skinny…..patients with ascites become heavy, weighty and thirsty, in a way that the more they drink, the more thirsty they feel…and the more bloated their abdomens become) (Ledda, 2011).…”

“…Swelling of the abdomen with fluid is described in the Old Testament, in Egyptian Papyrus Ebers (from the reign of Amenophis I, ca. 1550 BCE), and in an ancient Indian medical treatise which probably dates around 1500-1300 BCE (Ruben, 2004). Hippocrates realized that not only did abdominal dropsy derive directly from the diseased liver, but it was also a fatal complication, as he states in his Aphorisms (VII:55) that "When the liver is filled with water and bursts into the epiploon (the omentum), in this case the belly is filled with water and the patient dies" (Ruben, 2004).…”

“…1550 BCE), and in an ancient Indian medical treatise which probably dates around 1500-1300 BCE (Ruben, 2004). Hippocrates realized that not only did abdominal dropsy derive directly from the diseased liver, but it was also a fatal complication, as he states in his Aphorisms (VII:55) that "When the liver is filled with water and bursts into the epiploon (the omentum), in this case the belly is filled with water and the patient dies" (Ruben, 2004). A century later, Erasistratos of Chios, active in Alexandria, proposed a pathophysiological explanation for hepatic ascites that was not too far from the truth.…”