In regard to the suggestions given below, it must be remembered that they are very general, and are applicable rather to the chronic types of hepatic disease, although they will serve also for those afflicted with recurrent or intermittent attacks of biliousness, and should be followed between the attacks. In very active disease, such as-acute congestion, acute yellow atrophy, abscess of the liver, etc., obviously the diet must be much more limited. In ordinary uncomplicated bilious attacks induced by high living, a day or two of practical starvation with the use of a mercurial cathartic is wholly curative.

The following articles can usually be allowed in moderation excepting in very severe cases:

Animal Food

Fish, such as sole, flounder, halibut, smelt, white-fish; the soft part of oysters, liver, sweetbread; lean meat, such as roast beef, broiled beefsteak, mutton chops, or chicken (lean beef is better than poultry or game); eggs, milk and its preparations, such as koumiss, whey, buttermilk, junket, malted milk. Many persons with hepatic disorder insist that milk always makes them bilious. If this proves to be true of natural milk, it should be predigested or given with sodium bicarbonate or Vichy, or in one of the numerous ways described on p. 79.

In advanced cases of hepatic disease milk constitutes an excellent food, and may be used abundantly, provided the proper form for its administration in a given case is determined. Baked custard and blancmange or other forms of gelatin may be eaten.

Vegetable Food

Of fresh green vegetables the following may be eaten: Spinach, asparagus, tomato, squash, pumpkin, celery, oyster plant, beet tops, cresses, lettuce (without oil).

Cereal Foods

Bread should be eaten in small amount. It must be stale or toasted. Zwieback is good, and dry rusk, not too sweet. Graham, gluten, or wheaten crackers may be permitted. Other starchy foods should be eaten sparingly; but boiled rice, rice pudding, sago, and tapioca are admissible.

Fruits

Fresh fruit in season is wholesome, and useful to overcome the tendency to constipation. Grapes, oranges, strawberries, peaches, and roast apples may be eaten.

Water should be drunk freely, except when ascites is present; and light beverages, such as lime juice in aerated water, lemonade, or dilute raspberry vinegar, may be serviceable.

Directions For Eating

The manner of taking food is very important. There is apt to be hyperaemia of the stomach and intestines from time to time, as a result of engorgement of the portal system, and catarrhal conditions are easily excited in these organs by food which is hastily bolted without thorough mastication or which is not well cooked or not perfectly fresh. The teeth should always be examined to ascertain if the patient can masticate properly. Fluids should not be drunk with meals. The patient should not eat directly after violent exercise or fatigue, but should first lie down and rest for three quarters of an hour. If he buffers from dyspepsia, he should rest after meals as well. In many cases three meals a day suffice, but they should be given at intervals of about six hours, to insure complete digestion between. In others, when considerably enfeebled, or in cases of hepatic congestion and advanced cirrhosis, it is better to feed the patient four or five times a day, or once in three hours, giving a smaller quantity of food which is easily digested.

It is advisable to take the principal meal at noon.

From the fact that the bile is diminished in amount or altered in composition, constipation is the rule, and proper laxatives should be frequently given if the bowels cannot be kept in order by fresh fruit.

Hot water in an empty stomach is quickly absorbed, and passes directly to the liver through the portal vessels. If salts, such as Carlsbad salt, are given, they are absorbed with the water, and stimulate the liver cells. The water increases the portal blood pressure, and thus indirectly the pressure of the gall ducts, and favours the elimination of bile.

Moderate systematic exercise should be prescribed whenever possible, and the best forms are horseback and bicycle riding. The "jouncing" movements of the former shake and compress the liver, and stimulate its circulation and the outflow of bile.