In this case, all the symptoms pointed to congestion of the liver ; and palpation of the belly detected enlargement of the organ without any al teration in its consistence.
In warm climates, it is important to exclude hepatitis. In suppurative inflammation of the liver, the pain and tenderness are greater than if the liver be merely congested ; the general disturbance, although considering the serious nature of the disease proportionately slight, is greater ; the child looks ill, which is not the case in uncomplicated congestion, and there is fever.
Prognosis.—Congestion of the liver is in itself a trifling ailment. Any danger connected with the case is dependent upon the general condition of the child, or the existence of serious disease of a vital organ.
Treatment.—If the congestion is dependent upon overfeeding and in sufficient exercise, we should be careful to regulate the diet, and allow only food which is digestible and unstimulating as well as moderate in quantity. The child should be restricted for a day or two to bread and milk with mutton-broth or a little boiled fish for his dinner. His belly should be protected by a flannel band, and the action of the skin should be promoted by a warm bath before going to bed. The medicinal treatment should begin with a few grains of gray powder combined with half a grain of powdered ipecacuanha and two to five of jalapine. This should be given at bedtime, and in the morning the child may take a dose of liquid magnesia or other saline aperient. Remedies which act upon the skin and kidneys are useful in these cases. We may give two or three times a
day a mixture composed of solution of acetate of ammonia, sweet spirits of nitre, and a few grains of the bicarbonate of soda or potash. Chloride of ammonium (gr. iij. to gr. vj.) is also recommended. It may be made palatable by extract of liquorice, chloric ether, and glycerine.
The same treatment is useful if the hepatic congestion can be attributed to a chill. In these cases, especially if there is jaundice, we should be careful not to employ senna and other purgative drugs which act principally upon the upper part of the intestinal canal, in order not to increase the irritation of the duodenum ; but should keep the bowels regular by aloes or the saline aperients.
If the congestion of the liver occur as a consequence of heart disease, it will be relieved by measures directed to strengthen the cardiac action and lessen the general hyperemia from which the patient is suffering. If it arise in the course of an attack of malarial fever, it must be reduced as rapidly as possible by saline and mercurial purges (see Ague).
Children who are habitually indulged and injudiciously fed, especially if they are accustomed to warm stuffy rooms, may suffer from frequent attacks of hepatic congestion, and their livers may seem to be permanently enlarged. In such cases, it is useful to send them to a watering-place where they can drink regularly of some natural saline aperient, and take daily and sufficient exercise in the open air. After a short course of the waters, iron and quinine can be given with benefit.