Treating Hepatic Disorder With Hydrochloric Acid (Acidum Hydrochloricum)

In hepatitis, not so much in the acute as in the chronic form of the malady, which usually ends in enlargement and induration, it has been praised by good authorities. Sir R. Martin strongly recommends its application by means of a bath, putting about 1 1/2 oz. of acid to each gallon of water (v. Preparations). Two gallons represent an average quantity for a foot-bath, which should be used warm, and while the feet are immersed, the inner side of the limbs and the regions of liver and spleen should be sponged alternately for ten to fifteen minutes altogether. Martin recommended this bath morning and evening, but I have usually found an evening bath sufficient, and have seen excellent results from it; generally it has regulated the action of the bowels, and even produced laxative effects. Some patients are nauseated and weakened by its use, though they receive benefit: it requires watching, and smaller quantities of the acid should be tried first in delicate subjects. If it does not relax the bowels, an aperient should be taken occasionally during the course of the baths.

In hepatic torpor, or chronic catarrhal jaundice, if no inflammation be present, and in chronic dysentery with hepatic congestion, this form of bath is also valuable, and may be conjoined with the internal exhibition of the acid: even in cirrhosis and the consequent dropsy, benefit has been derived from this treatment.

Treating Hepatic Disorder With Nitric Acid (Acidum Nitricum)

Nitric acid has long been held in repute for the treatment of chronic hepatic congestion, or chronic hepatitis, especially when occurring in Anglo-Indians, and after mercurials have been used. Dr. Murchison met with marked improvement, even in cases of waxy liver, from the continued use of nitric acid with vegetable bitters ("Diseases of Liver," 1868, p. 33), but in later writings he remarks that there is no evidence of its assisting bile-flow, and that its action is less direct than that of alkalies; that in congestion (of acute character), or when lithiasis is present, it either does no good, or aggravates the malady, though it may relieve the dyspepsia of debility: he sometimes gives alkalies before a meal, and acid after (British Medical Journal, i., 1874). R. Martin, Thudichum, and indeed the majority of writers twenty years ago, allowed to nitric acid a larger sphere of usefulness in hepatic disorder, jaundice, etc.; it was presumed to "lixiviate biliary deposits, tone digestion, and act antiseptically" (British Medical Journal, ii., 1860). Annesley noted that it acted better, the more freely it was diluted - he used it in chronic splenic disorder. I have found nitric acid useful in chronic hepatitis, when watery diarrhoea and constipation occur alternately.

Treating Hepatic Disorder With Magnesium

I have already mentioned that Mr. Ure found 1 to 2 dr. of the sulphate act as a cholagogue purgative (Pereira), and Dr. Goolden gave it in cases of enlarged liver with dark or pale stools, and jaundice, when no abscess or acute symptoms were present. Most of the patients (at the Dreadnought Hospital) were in weak condition, having returned from India, and he sought for a non-mercurial remedy to stimulate the liver. He says that 10 or 20 gr. of sulphate of manganese, though at first it excited nausea or vomiting, soon acted on the bowels to the marked relief of the patient, and with rapid clearing away of the jaundice (Lancet, 1840). This favorable result has, however, not been corroborated by the experience of others, but recently Dr. Goolden has written to direct attention again to the subject, stating that he has continued to use the remedy with success in hepatic dropsy, hemorrhoids, bronchial congestion, hypochondriasis, etc.: he usually combines it with Epsom salts, in a glass of effervescent water (Lancet, i., 1878).

Polli and Galamini state that they have cured cases of biliary calculus by peroxide of manganese, given in gramme doses daily as an electuary: they explain the solution of the calculi by the action of oxygen from the peroxide upon the cholesterine (Gazette de Paris, 1856).

Treating Hepatic Disorders With Ammonia Gas (Ammonium)

In various forms of hepatic disorder accompanied with congestion, ammonium chloride is a valuable remedy, perhaps not yet sufficiently known in this country. Dr. Murchison recommended it in "functional liver-disorder" accompanied with lithaemia, and Dr. Anstie in suppression of biliary secretion consequent on nerve-shock. It is much used abroad in catarrh of the bile-ducts, and in the jaundice dependent on this condition; also in hepatic dropsy; but perhaps its best effects are seen in passive hepatic congestion when there is deficient intestinal secretion with loaded urine, constipation, coated tongue, and general "bilious" condition. As already stated, the chloride stimulates a due secretion of bile and increases the excretion of urea. Dr. Stewart, of the Indian service, has especially drawn attention to the value of this remedy in hepatitis, and even hepatic abscess, and has found it act better in acute than in chronic stages of these maladies. If the skin be dry, he orders first the acetate of ammonia and afterward 20 gr. of chloride every four or six hours: a feeling of warmth and exhilaration is produced, hepatic pain is quickly and markedly relieved, perspiration and urine are freely secreted, and sleep commonly follows (Lancet, 1870; British Medical Journal, ii., 1878).

Treating Hepatic Disorders With Natrium (Sodium)

For congestion of the liver, with deficient secretion of bile, soda is of proved value in several combinations, and it relieves such symptoms as have been already described under dyspepsia.

Phosphate of soda especially is said to promote the flow of bile, and acting in full doses as a gentle laxative, it is useful in "bilious or sick headache," and in catarrhal jaundice. It has some value, also, in preventing biliary calculus, which condition arises generally from continued catarrh of the bile-duct and inspissation of mucus and bile. (Vichy water presents a good natural combination for such cases and for chronic hepatic congestion.) The salt cannot be expected to control fully developed attacks of biliary colic, but if a dose of 20 or 30 gr. be taken regularly before meals for some months, it seems to have the power of lessening the calculi, or preventing fresh formations (Bartholow, p. 80); from larger doses (1 to 2 dr.) of the carbonate in copious draughts of hot water, Dr. Prout has often seen immediate relief even during the attack of colic.

In fatty degeneration of the liver we have the authority of Dr. Mur-chison for saying that large quantities of common salt, eaten with the food, have proved useful, and there is at least encouragement to try saline waters in this condition ("Clinical Lectures," p. 51). In the case of ill-conditioned children passing pale and pasty stools, 5 or 10 gr. of the phosphate taken with meals, will often serve to regulate digestion and improve nutrition (Stephenson).