FATTY LIVER HEP AR ADIPOSUM. 689 



change of the intestines, in phthisical patients who have fatty liver, is 

 caused by the latter. Schonlein and Frerichs speak in the same way. 

 I have seen obstinate diarrhoea in non-phthisical patients, where exces- 

 sively fatty liver was the only anomaly found in the abdominal organs 

 on post-mortem examination. 6 



TREATMENT. In gluttons and topers, the causal indications im- 

 peratively demand a change of the mode of life. General advice is of 

 no use, as it is badly followed. For such patients we should prescribe 

 the hours of exercise, forbid afternoon naps, give careful directions 

 about their meals, forbidding all gravies and other fatty substances ; 

 tor supper we should only allow water-soup and a little stewed fruit. 

 The use of coffee and tea should be limited, that of liquor entirely for- 

 bidden. In the fatty liver occurring in consumptive diseases, particu- 

 larly in pulmonary consumption, we can rarely fulfil the causal indica- 

 tions. 



The indications from the disease have long been supposed to 

 require remedies for increasing the secretion of bile. And, in the 

 present state of physiology, we must suppose that the success of this 

 intention would have the best effect on fatty li ver. We find less fat in 

 the hepatic vein than in the portal vein. Frerichs saw the secretory ac- 

 tivity of the liver-cells diminish as their fatty contents increased ; hence 

 we can hardly doubt that the fat going to the liver is used up in the 

 production of bile, and that the superfluous fat must disappear from the 

 liver-cells when the secretion of bile is increased. But our knowledge 

 of the difficulty of fulfilling this indication increases in proportion with 

 our comprehension of its urgency. At present we can scarcely hope 

 that an inert indifferent vegetable extract will decidedly increase the 

 secretion of bile, since we no longer regard the bile as a secretion 

 necessary for digestion, or, at least, only secondarily so, but as a prod- 

 uct whose quantity and quality vary with the acceleration or retardation 

 of the change of tissue, or with its other modifications. It is possible 

 that the freshly-expressed juices of taraxacum, chelidonium, etc., have 

 a curative influence when used as " spring cures " (Fruhlingscuren), 

 while the patients rise early, live moderately, and exercise freely ; but 

 it is probable that the benefit is mostly due to the change in the mode 

 of life. The case is different with the treatment at Karlsbad, Marien- 

 bad, Homburg, Kissengen, etc.' In the results there obtained, the 

 favorable mode of life must be taken into consideration ; but the free 

 and continued use of the different solutions of salts must have just as 

 much effect on the change of tissue. It is certain that the superfluous 

 fat of the body soon disappears under the use of these mineral waters, 

 and after a month's residence in Karlsbad most patients return home 

 much thinner than when they went there. Simple pedestrian excur 

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