If prophylaxis fail, and disorder be actually present, immediate treatment must be undertaken. The first step will be to remove, if possible, the causes of the disorder. A careful inquiry into the habits and constitution will often reveal serious errors in the mode of living. 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 employed, so as to sweep the intestine of imperfectly digested food, and stimulate its absorptive, excretory, and locomotive functions. 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 discharge. 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 neutralised 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 (Digestion.-The Stomach)., especially with Rhubarb, Senna, or Aloes. In more chronic cases, Chloride of Ammonium or Arsenic often proves of great service given immediately after meals, or that valuable combination of hepatic stimulants, the Pilula Hydrargyri Sub-chloridi Composita, given every night for a week on end. In cases of chronic hepatic disorder originating in the tropics, Diluted Nitrohydrochloric Acid is often used with success both internally and as a bath. The effects of hepatic disorder upon other parts of the system frequently demand direct relief, such as the headache, languor, or mental depression. Alcohol will frequently answer the purpose, but induces further hepatic disorders, and is otherwise obviously objectionable. The same remarks apply to Opium, except in very small doses "to take the edge off the misery." Quinia given after meals is of unquestionable service in many instances. Tea and coffee are useful and safe remedies. But on the whole too much reliance must not be placed on treating symptoms.

For the treatment of that remarkable disorder of hepatic metabolism which is called diabetes mellitus, the complete rearrangement of the diet is the first requisite, by the removal of amyloid and saccharine substances from the food. Nothing in the whole range of therapeutics is more striking in its way than the effect of Opium, Morphia, or Codeia in dispelling the last trace of sugar from the urine in such cases, the quantity of the drug tolerated being sometimes enormous.

Substances which act upon the Liver.

Direct Cholagogues.

Antimonium Sulphuratum Aciduin Arseniosum Dilutum Acidum Nitricum Acidum Nitrohydro. Dil. Hydrarg Perchlor Soda Salts Ipecacuanha Colocynthis Podophyllum Sodae Salicylus Ammonia Phosphas Euonymin Iridin Aloes Colchicum Jalapa Scammonium.

Direct Chola-gooues. - (Cont.)

Rheum

Acidum Benzoi-cum

Indirect Chola-gogues.

Hydrargyrum Cathartic Purgatives

Antichola-gogues.

Opium Morphia Piumbi Acetas Intestinal Irritants

Glycogenic Stimulants.

Amyl Nitris

Sodae Bicarbonas

Acidum Nitrolydrochloricum

Dilutum

Glycogenic Depressants.

Acidum Arseniosum Opium Morphia Codeia

Substances Increasing Urea.

Antimonium Phosphorus Acidum Arseniosnm Ammouii

Chloridum Ferrum

Substances Diminishing Urea.

Opium

Morphia

Colchicum

Alcohol

Quinia