Both Rolleston and Kelynack agree that a little under half the cases die di rectly from the effects of hepatic cir rhosis, though it is a little doubtful what effects they include under this term.
is no treatment known save the palliative, and it is, in deed, difficult to see how to arrest the condition once there is marked develop ment of this contracting, fibrous tissue in the organ. The avoidance of alcohol, spices, coffee, and other irritant sub stances; avoidance of fatigue and of cold, together with maintenance of regular action of the bowels by mild aperients are all indicated. Several authorities have recommended a milk diet, but, ac cording to Jaccoud and others, it has absolutely no effect in arresting the progress of the disease.
In cirrhosis of the liver abstention from alcohol and all stimulating ing,esta is the first requisite. Diet should be re stricted to milk, eggs, simple proteids, bread, and fresh fruit and vegetables. Predigested foods are necessarv in some instances. W. B. Cheadle (Lancet, Apr 14, 1900).
Some more recent writers recommend massage as improving the general con dition of the patient. The treatment which affords most relief would appear to be the employment of alkaline mineral waters and saline purgatives, whereby some relief is given to the congestion of the portal system.
Where ascites is present, tapping gives great relief, and, as pointed out by Murchison and recommended by Graham in his admirable article in the Loomis Thompson "System of Practical Med icine," after this tapping digitalis and diuretics are both effectual and useful.
Special attention drawn to the value of urea as a diuretic. Two and a half drachms given in the day, increased up to 5 drachms, eontinned for 2 or 3 weeks. No unfavorable effects witnessed. The unpleasant taste may be done away with by drinking milk immediately after taking it. G. Klemperer (Berl. klin. Woch., Jan. 6,.'96).
Report of a case which improved remarkably under tbe administration apoeynum Cannabinum (Canadian hemp), 5 drops of the fluid extract thrice daily. 'Whenever the patient in
terrupts it for a few days aseites reap pears. F. J. Bowles (Therap. Gaz., Feb., 1901).
The treatment should be largely di etetic and hygienic, great care being taken to see that the functions of the gastro-intestinal tract are kept in tion and the renal secretions properly regulated as well tbe action of the skin. Three deaths personally known to have followed the operative treat ment of htemorrhoids, and at the ne cropsy eirrhosis of the liver was dis covered for the first time. In all eases of laemorrhoidal disease a thorough knowledge of the state of the liver should bc obtained before any operative interference is advised. In the ment of a.scites mild purgation and mel from time to time: calomel also used in 1/.,cgrain dose every three hours as a diuretic. The old-fashioned pill, digitalis, squills, and calomel and eo paiba are useful. Tapping is resorted to early and frequently. j. H. Musser (Phila.. Med. Jour., June 15, 1901).
After hmmorrhage from the oesoph agus of the stomach, ice should be taken internally and morphine may be aiven ' • The operation of bleeding has so fallen into disuse that scarce any authority recommends this as a means of rapidly relieving the congestion. Personally I have been struck at autopsies by the amount of blood still present in the organs even when profuse hEemorrhage has been the cause of death; and it seems worth while to suggest that, where other means fail, the removal of blood from the general circulation, by temporarily low ering the general blood-pressure, is ca pable of aiding the more rapid flow of blood from the congested portal circula tion into the inferior vena cava and vena azygos, and so is capable of aiding the development of a more satisfactory col lateral circulation.