BILIOUSNESS. 135 



Aconite is useful in sudden acute bilious attacks following chills, with high 

 temperature, and slight jaundice. It may be given alternately with mercury. 



Quite recently Iridin and Euonymin have been introduced as remedies for 

 different forms of liver complaint. Iridin is the active principle of Iris versicolor, 

 or blue flag, whilst Euonymin is obtained from Euwiymus atropupureus, spindle- 

 or mahoo. Both powerfully stimulate the liver, and from their milder action 

 on the bowels are in many cases preferable to podophyllin. The dose of iridin for 

 an adult is four grains ; of euonymin two grains. They may be made into pills 

 either with sugar of milk or with a grain or two of extract of byoscyamus. With 

 many people these doses taken at bed-time produce a sufficient purgative effect ; 

 but in other cases the purgation is insufficient or is delayed, and griping is then apt 

 to ensue. The best way is to follow the pill by a dose of some saline aperient in 

 the morning the Piillna or Carlsbad water, for example so that the bile secreted 

 during the night may be fully and quickly evacuated. Neither remedy produces 

 sickness or headache. Euonymin will usually remove a slight feeling of biliousness, 

 but when the tongue is decidedly yellow, iridin is preferable. Another remedy is 

 Hydrastin, the active principle of Hydrastis canadensis. It not only stimulates the 

 liver, but acts as a general tonic. The dose is from one to two grains at bed-time. 



Alkalies are very useful in the treatment of functional diseases of the liver. The 

 greatest benefit is often derived from a course of alkalies, such as carbonate of potash, 

 or soda, or lithia. Sometimes it is better to give the alkaline mineral waters, such 

 as those of Vals, Vichy, or Ems. It is well to suspend their use occasionally, as 

 they are apt, when long continued, to upset the stomach, but in cases in which 

 they are indicated they are usually well borne. "When there is much sleeplessness, 

 a dose of bromide of potassium fifteen or twenty grains may be added to the 

 water taken at bed-time. Should the waters in any case appear to be too weak, 

 twenty grains of chloride of ammonia may be added to each dose for a few days. 



Mineral acids are often employed in derangements of the liver. Nitric acid 

 especially has been thought to have the power of augmenting the flow of bile, but 

 this is very doubtful. The acids may be of use when there is debility and want of 

 tone, but the chief good which they effect is probably by improving digestion. 

 Sometimes both acids and alkalies may be given, not mixed, but the alkalies 

 before meals and the acids after. 



Tonics, as a rule, do no good in liver complaints, for they are apt to disagree. 

 People often improve at once on substituting abstinence from alcohol with aperients, 

 blue-pill, carbonate of soda, and careful regulation of the diet, for quinine, iron, the 

 mineral acids, and stimulants. Opium is usually to be avoided when the liver is out 

 of order it increases the torpidity, both of liver and bowels. 



When a patient has had a very bad attack of liver, and the more urgent symptoms 

 have passed off, he will still have to be very careful of himself. The acid and 

 gentian mixture (Pr. 15), with or without the addition of five drops of tincture of 

 nux vomica to each dose, taken three times a day, often proves very useful at this 

 stage. The diet may be rather more generous, particularly if the patient is much 

 pulled down, although the greatest care must be taken to avoid everything likely to 

 produce a relapse. Fermented liquors are still interdicted ; and if wine be allowed 



