The course of the disease is a chronic one. Its first symptoms are usually concealed by those of a persistent catarrh of the stomach or of the intestine. It is recognised with certainty principally when the liver shows changes in size. The liver is first enlarged, and then (as a rule) diminished in size. Abdominal dropsy, occurring in the course of this disease, is usually one of the symptoms which cause the patient to consult a physician. Jaundice, but more often a sallow or pasty complexion, is a subsequent condition. Still later other symptoms set in ; such as marked general emaciation, dropsy in the legs, and dilatation of the veins of the skin (blue veins), especially in the neighbourhood of the navel.
The essential part of the treatment is early abstinence from alcoholic drinks, which alone renders recovery possible, although not certain. Other wise, death occurs either from general exhaustion or in consequence of gastric or intestinal haemorrhages, paralysis of the heart, etc. Patients usually consult a physician s:) late that it is possible only to alleviate or cure the more dangerous symptoms ; this, however is at least conducive to prolonging life.
During the term of treatment the diet should consist of easily digestible, non-irritating foods, such as milk, eggs, soup; fish, lean meat, fruits, and easily digestible vegetables. The of certain medicinal spas (in Europe: Carlsbad and Kissingen ; in the United Stales : Hot Springs, Va., Saratoga Springs, N.Y., and blot Springs, Ark.) are often beneficial to patients suffering with cirrhosis of the liver. In cases where the disease is so far advanced that it is hopeless, the physician cannot always strictly prohibit the use of alcoholic stimulants.
11 abdominal dropsy be present, the water must be tapped from time to time by means of abdominal puncture. This affords great relief to the patients. Within recent years surgical operations have been devised which have for their object the relief of abdominal dropsy in cirrhosis. The observations on their results have not vet been sufficient to justify any definite general conclusions.
Echinococcus of the Liver.—The human liver may become infested with the larva: of the Ternia echinococcus, a small tapeworm of the dog (see Fig. 259). These larva: occur in a compound state, as round cysts, or brood-capsules, which may reach the size of a man's head. if the tape worm eggs dischargeA from a d ig get into the human body, the latter may acquire the echinococcus. Hence the disease principally prevails where (logs are raised under uncleanly conditions.
A person who caresses his dog, or allows it to lick his face, exposes himself to this danger. Dogs, as is well known, are in the habit of cleaning their anus by licking it, thus causing the eggs of the tapeworm to be deposited on the tongue.
The liver is the favourite seat of the echinococcus, and infection of this organ causes it to increase greatly in size. This in turn causes compression of the right lung, upward pressure upon the heart, and severe dyspnoua. The cysts sometimes perforate into adjacent parts of the body, such as the pericardium or the pleura. 'hey may also empty into the lungs, and the contents be coughed 1.11). If perforation takes place into the stomach or into the intestine, the contents are vomited, or discharged with the stools.
The only practical treatment for this disease is by operation. It is often difficult, however, to recognise the affection. It should be borne in
mind that prevention is easier than cure, and that proper precautions will generally suffice to eliminate the danger of infection. The echinococcus of cows, sheep, and other animals may be discharged with their excrements, and then be eaten by dogs. Strict cleanliness should, therefore, be observed by all those who come in contact with these animals.
Fatty Degeneration of the Liver.—As a rule, this disease is a result of errors in diet. It occurs in persons who eat too much starchy food and sugar, and who drink excessive quantities of alcoholic beverages, without taking sufficient muscular exercise. In addition to fatty degeneration of the liver, these patients show signs of general obesity. The disease may affect also those who are debilitated by loss of blood, and .those who suffer from chronic diseases of the lungs. It occurs to a very marked degree in cases of poisoning with phosphorus, arsenic, etc.
Fatty degeneration of the liver may be present without causing any symptoms ; but, as a rule, the patients complain of a feeling of tension or of pain in the region of the liver, loss of appetite, eructation, vomiting, and inclination to diarrhea. The stools are sometimes very pale in colour, owing to their small contents of bile. The disease is not in itself fatal ; hut the resultant disturbances of digestion and of metabolism, in the presence of a serious acute affection, may hasten the unfavourable termination.
Syphilis of the Liver.—The liver is a frequent seat of syphilitic infection. The disease runs a very protracted course, and bears a direct relation to the causative affection. Upon the cure or non-cure of the original malady depends the termination of the local condition. The symptoms may be like those of abscess of the liver or of chronic cirrhosis.
LIVER-FLUKE.—See WoaMs.
LIVER-SPOTS.—Yellowish, brown, or black patches on the skin. They are generally rounded, moderately raised, and sharply defined from the surrounding skin. Liver-spots have nothing in common with the liver other than a remote similarity of colour. Sometimes congenital, they often develop in great numbers in consequence of pregnancy, and disappear spontaneously. They may arise also in the course of debilitating diseases, such as cancer or tuberculosis. if the spots appear in large numbers and are of a bluish-black colour. with severe general symptoms, they may repre sent malignant tumours. Since the latter occasionally develop from simple spots, their removal by a slight and painless operation should not be neglected. Local treatment of the condition consists in touching the spots for several hours with a solution of corrosive sublimate. This is often followed by scaling off of the skin, leaving the parts colourless. The spots are apt to recur, however.
LOBELIA.—The leaves and top of the Indian tobacco or Lobelia in/la/a. The active principle is lobelia, an alkaloid of somewhat uncer tain action. An over-dose causes vomiting, prostration with feeble pulse, cold and clammy skin, and perhaps convulsions and death from respiratory failure. The only use for lobelia internally is in asthma of a nervous origin ; and it is not an entirely safe drug in that condition, although sometimes productive of good results The infusion is sometimes used as an applica tion in ivy-poisoning. The dose of the tincture is from ten to thirty drops.