DISEASES OF THE LIFER. 



progress by strictly forbidding the use of spirituous liquors. The 

 treatment recommended for hyperaemia of the liver is also suited to 

 these cases, particularly the occasional application of leeches about the 

 anus, and the administration of saline laxatives. The latter are best 

 prescribed as natural or artificial mineral waters of Karlsbad, Marien- 

 bad, Tarasp, etc., in which they are better borne than they are without 

 the addition of carbonic acid and the alkaline carbonates. If the 

 nutrition of the patient have already suffered much, we give the prefer- 

 ence to springs containing small quantities of iron, such as the Eger, 

 Franzenbrunnen, Kissengen, Ragoczy, and Homburg springs. 



In the second stage, even at its commencement, we can no longer 

 hope to arrest the disease. As the neoplastic tissue, which fills a loss 

 of substance in the skin, continues to shrink till a firm cicatrix has 

 formed, so the neoplastic connective tissue in the liver unceasingly 

 contracts till the evil results arise which were depicted under the head 

 of symptoms. But then radical aid is entirely impossible, for the dense 

 tissue can never expand again. Subsequently the treatment of cir- 

 rhosis can only be symptomatic. Among the symptoms of congestion, 

 the gastric and intestinal catarrh demand particular attention, as they 

 increase the emaciation and debility of the patient. According to the 

 rules previously given, it is just in this form of gastric and intestinal 

 catarrh that the administration of the alkaline carbonates is most bene- 

 ficial ; they appear to decrease the toughness of the mucus, and thus 

 to enable the mucous membrane to get rid of its mucous coating more 

 readily. The haemorrhage from the stomach and intestines should 

 also be treated according to the rules previously laid down, although 

 we cannot hope for very favorable results. We should only tap the 

 patient when it is imperatively necessary, for the ascites, dependent 

 on obstniction in the portal vein, is particularly liable to return very 

 quickly, as soon as the pressure of the fluid, which has impeded the 

 transudation, has been removed. But, if we have been obliged to tap, 

 we may hope to retard the fresh collection of fluid by compressing the 

 abdomen with a proper bandage. The assertion previously made, that 

 diuretics are as useless as they are irrational in the treatment of ascites, 

 is particularly true of this form of the disease. The most important 

 indication in the treatment of cirrhosis is, to improve the strength and 

 nutrition of the patient. While the state of the digestive organs per- 

 mits it, we should give him nutritious diet and preparations of iron, 

 which are not unfrequently well borne and very beneficial. In one 

 patient, with cirrhosis of the liver, who afterward died of haemate- 

 mesis, under free use of iron, and a diet consisting mostly of milk and 

 eggs, I have frequently seen the fluid in the abdomen diminish, while 

 it increased again when the patient was removed from the hospital, 



