444 MATERIA MEDIC A AND THERAPEUTICS. 



skin, and bowels, all of which, will unburden the liver by 

 hastening the removal from the blood of metabolic products. 



If prophylaxis fail, and disorder be actually present, imme- 

 diate treatment must be undertaken. The first step will be to 

 remove, if possible, the causes of the disorder. A careful in- 

 quiry into the habits and constitution will often reveal serious 

 errors in the mode of living 1 . These must be reformed as has 

 just been suggested. Active medicinal treatment must be begun 

 at the same time ; and in arranging the details of this, several 

 objects may be combined. A brisk purge must first be em- 

 ployed, so as to sweep the intestine of imperfectly digested food, 

 and stimulate its absorptive, excretory, and locomotive func- 

 tions. The question of the selection of a purgative introduces 

 us to the use of cholagogues. Calomel and Colocynth, Rhubarb 

 and Colocynth, Podophyllin, and a variety of allied purgatives 

 and cholagogues, mentioned in the second section, in proper 

 combination with carminatives, are in constant employment for 

 increasing the flow of bile. An almost invariable practice is to 

 follow up the purgative by a saline, and the rationale of this 

 plan is obvious. The Sulphate of Magnesia, Sulphate of Soda, 

 or Tartrate of Potash and Soda with Tartrate of Soda (Seidlitz 

 powder), not only complete the evacuation and stimulation of the 

 bowel and the cholagogue effect, but their hydragogue influence 

 (with that of the previous purgative), will drain a certain amount 

 of water from the portal vein, and thus relieve the circulation 

 within the liver. At the same time some of the salts will be 

 absorbed into the blood and excreted by the kidney, which, as 

 we shall afterwards see, they powerfully stimulate, thus opening 

 the second great channel of relief to the liver the urinary dis- 

 charge. The tartrates pass out in the urine as alkaline 

 carbonates, and by this means the excess of uric acid which 

 may have threatened or had actually produced gravel, is neu- 

 tralised and safely conducted from the body. Altogether the 

 time-honoured Blue Pill and Seidlitz powder are a combination 

 which is in every respect scientifically sound, although probably 

 of purely empirical origin. In urgent cases of acute hepatic 

 disorder, the therapeutist may even divert part of the blood- 

 supply by tapping the portal vein, that is, by applying leeches 

 round the anus. 



An attempt may next be made to act upon the liver directly : 

 to rouse its metabolic energy by one of the specific agents 

 already enumerated. Perhaps the best of these in acute 

 hepatic disorder is Bicarbonate of Soda, given between meals 

 in some of the combinations suggested in chapter iii., espe- 

 cially with Rhubarb, Senna, or Aloes. In more chronic cases, 

 Chloride of Ammonium or Arsenic often proves of great 



