TROPICAL LIVER 



1909 



right shoulder, and there may be slight signs of jaundice in the 

 yellow conjunctiva and sallow skin. The urine may be diminished 

 in quantity, high-coloured, and with high specific gravity, and 

 loaded with uric acid and urates. The nervous system is also 

 affected, and the patient is usually very cross and irritable. The 

 temperature is generally normal, but sometimes it rises, and when 

 above 100° F. it is usual to call the disease hepatitis, instead of 

 congestion of the liver. The common non-febrile variety lasts 

 from two to seven days, but is liable to recur. 



Varieties. — Congestion of the liver may be acute when associated 

 with some other disease, or chronic when due to gastro-intestinal 

 disturbance. 



Diagnosis. — The diagnosis is based on the painful enlargement of 

 the liver, which, in the absence of other disease, is usually unaccom- 

 panied with marked rise of temperature. 



Treatment. — In the acute attack it is as well to keep the patient 

 in bed and begin the treatment with a dose of calomel (gr. ii. to 

 gr. v.), followed a few hours later by a saline in the form of mag- 

 nesium and sodium sulphates or Carlsbad salts. An effervescing 

 mixture of ammonium carbonate (gr. iv. to gr. v.) and sodium bi- 

 carbonate (gr. XX.), with citric acid (gr. xv.), may be given every 

 three hours, or a mixture containing ammonium chloride in some 

 combination. At the same time hot fomentations or a thick coat 

 of antiphlogistin may be applied to the region of the liver. The 

 diet should consist of soups and milk, diluted with Vichy or barley 

 water, and no alcohol in any form allowed. 



When the condition has become chronic, the patient must be 

 carefully dieted and placed upon a course of treatment with the 

 above effervescing mixture and Vichy (Grande Grille), and when 

 leave in Europe is available, should be sent to Vichy, Carlsbad, 

 Harrogate, or Montecatini. He should avoid alcoholic stimulants 

 and rich food of every description, and especially tinned food, and 

 should restrict his diet to fowls, clear soups, fish, and well-cooked 

 vegetables and milk, avoiding meat and curries. 



Whenever the acute attack is over, the patient should be advised 

 to take exercise daily — ^walking, riding, golf, or tennis, combined 

 with the usual so-called liver exercises. 



Prophylaxis. — Plain, simple, not highly spiced food should be 

 taken, and such pernicious drinks as the heavy forms of beer, 

 sherry, champagne, etc., should be avoided. If any form of alcohol 

 is to be taken in the tropics, this should be Scotch whisky, well 

 diluted, or light clarets, and then only in moderation. Chills must be 

 avoided as carefully as possible, especially when there is a land wind, 

 in the rains, and when changing from a warm to a cooler climate. 



With regard to the cold bath, there is no doubt that the majority 

 of people are unable to stand this in the tropics, and therefore it 

 is better to use water with the chill removed. 



Some persons are, however, distinctly benefited by a cold bath, 

 and therefore individual peculiarities must be considered. 



