LIVER, Cirrhosis of.
A history of spirit-drinking is obtainable in nearly all cases, and if the disease is detected in the preliminary stage of enlargement a confident hope may be expressed that permanent cure will follow upon the removal of the exciting cause.
Change of occupation is necessary in dealing with cirrhosis in publicans, barmen and waiters. It is almost impossible for such men to abstain once they have become enslaved to alcohol unless a new sphere of labour be opened up to them.
Active open-air exercise or labour is of great importance, and the diet should be plain and nutritious. Attention should be paid to the amount of liquids imbibed, Where there is as yet no sign of effusion into the peritoneal cavity a liberal allowance of liquid food is very desirable. Milk may be taken in large amount mixed with an equal quantity of aerated water, and the best diet is a liberal fish dinner and breakfast. A few months of vegetarian living often give excellent results. In Ireland buttermilk or the home-made Koumiss mentioned upon p. 19 affords a most valuable dietary. Koumiss or Buttermilk mixed with Kali Water and Kali Water with milk are invaluable as an aid in overcoming the desire for alcoholic drink.
The bowels must be kept in the healthiest state possible. Purgatives are useful at all stages of cirrhosis, and saline cathartics as Epsom or Carlsbad Salts and the various purgative mineral waters are the best. Where the patient's means permit, a sojourn at Carlsbad, Vichy or any alkaline spa is very valuable. By an occasional dose of Blue Pill given at bed-time, followed by a morning saline, the portal system is very powerfully influenced. Mercurials must be used with great caution where there is any renal mischief associated with the hepatic lesion. Podophyllin or I ridin may then be employed in such cases advantageously. A full dose of any natural purgative water every morning with an occasional mercurial or podophyllin pill given the night before soon tells upon the hepatic enlargement and induration.
Mercury may also be given for about a month in small doses, alternating with large doses of Iodide of Potassium administered for a similar period. This latter drug is of great value in syphilitic cases; and malaria are the cause of cirrhosis in a small percentage of cases. and every case of cirrhosis, whether in the stage of enlargement or contraction, where a history of indulgence in concentrated spirits is absent should get the benefit of a course of large doses of Iodides on the possibility of a syphilitic foundation being the primary factor in the disease. The Wassermann test should never be omitted.
When malaria is suspected Quinine and Arsenic should be persisted in.
Murchison attached importance to the action of the Chloride of Am monium and Green Iodide of Mercury in ordinary alcoholic cirrhosis ( to gr. three times a day). These remedies in the great majority of cases cannot be pushed with safety, especially as most of the victims of cirrhosis are suffering from gastric troubles. Many of them are debilitated from want of common food, having long since ceased to live with regularity and prudence. In such cases there is no remedy so frequently applicable as the Diluted Nitro-Hydrochloric Acid in full doses, combined with a vegetable bitter in small amount. It may, moreover, be given at the earliest, and is often grateful during the later stages of the disease. The Nitro-Hydrochloric Acid bath is prepared by mixing r oz. of strong Nitric and 2 oz. of Hydrochloric Acid in 2 gallons of warm water. A local pack may be administered by soaking flannel cloths in this mixture and applying them to the abdomen and lower part of the chest. The writer, however, prefers to apply the acid mixture in the above strength upon spongio piline worn under a bandage over the entire hepatic region. As soon as any eruption appears the acid may be discontinued, but in some cases the mild counter-irritation produced by covering the acid lotion with an impervious tissue is productive of benefit.