In the case of hypertrophic cirrhosis, rapid alternations in the rapidity of the pulse, or drowsiness and nervous symptoms, are of very unfavour able import.
Treatment.—It is so seldom possible in the child to ascertain the exist ence of hepatic cirrhosis in the earlier stage, that treatment at this period is confined to attention to the digestion, and to the efficient performance of the various organic functions. When the more characteristic symp toms begin to be noticed, there are two forms of treatment which may be adopted. The patient may be treated with alkalies and aperients, or with tonics. On account of the gastric derangement, an alkali with a vegetable bitter is usually prescribed, and this mode of treatment answers very well in cases. For a child of ten years old we may give eight or ten grains of bicarbonate of soda with infusion of chiretta or calumba ; and the addition of a few drops of the tincture of nux vomica increases the efficacy of the mixture. Most cases, however, do better under the use of iron and quinine. Ten or fifteen drops of the tincture of perchloride of iron with a grain of quinine given three times a day, and continued for a lengthened period, often seem to have great value in reducing the ascites and improving the general condition of the child. Mild aperients should also be made use of, and laxative doses of the Carlsbad or Hunyadi Janos waters are well borne in these cases. A good form of iron is the exsiccated
sulphate, which agrees well with children. It must, however, be given in full doses ; and two to five grains, according to the age of the child, may be taken after each meal in a teaspoonful of glycerine. The diet should be liberal. It is well to allow meat twice a day ; and farinaceous foods may be used, having due regard to the state of the stomach and the child's power of digesting them. The action of the skin should be pro moted by a daily warm bath, and the patient should be dressed from head to foot in flannel or some warm woollen material.
The ascites is not benefited by the ordinary diuretics, but Dr. Basham's chalybeate diuretic, in which the iron is kept in solution by the acetic acid,' I have sometimes thought to be useful.
If much fluid accumulates in the peritoneal cavity, and causes distress by interfering with the action of the diaphragm, the effusion must be re moved by tapping the abdomen. The operation is accompanied by no danger to the child, if the aspirator or a fine trocar be used. It should be performed early and repeated as often as is necessary. Hemorrhages, unless they are copious, need not modify the treatment, but sufficient bleeding to manifestly weaken the patient must be combated with gallic acid, dilute sulphuric acid, and other styptics. Severe dyspeptic symptoms are best treated with bismuth and alkalies.