This malady is generally believed to be incurable, but physiologic recoveries do occur.

The common cause of hepatic cirrhosis is the habitual and excessive use of alcoholic beverages. It is occasionally due to syphilis or malaria, and rarely to other infections, such as tuberculosis and scarlet fever. That it may result from prolonged indigestion seems probable. Strong spices, curries, and similar condiments have also been blamed for its production. It is self-evident that the cause must be removed if possible. Alcoholic beverages should be forbidden in all cases. A change of climate may be needed for the malarious, and appropriate treatment for the syphilitic and the dyspeptic, cases.

It has been shown repeatedly that a milk diet contributes more to recovery than any medicine or other factor of regimen. It is unfortunate that milk should have to be a patient's exclusive diet for many months, for it is difficult to maintain such a diet. But the patient must be made to understand that it is his only hope. Milk may be given cold or hot, according to taste. I believe it is longer relished if it is sometimes taken warm and at other times cold. As much as three or four pints should be drunk daily. This is best accomplished by taking a glassful every two or three hours from seven in the morning to nine or ten at night.

When milk is not well tolerated, or when its exclusive use has been continued a long time, it is well to alternate periods of its exclusive use with periods when substitutes are taken. This mode of treatment is not the best, but is often necessary. A diet of milk can be varied by the eating of fruit, especially oranges, grape-fruit and lemons, without materially changing its character or lessening its value and it becomes thereby much more tolerable for the patient. The exclusive milk diet is sufficient so long as a patient is quiet, but it is not enough if much exercise be taken, or work be attempted. A complete disgust for it arises at times, and a modification of the regimen must be made. Bouillons or soups with a milk basis, egg and milk, or custards, warm or iced, may be tried. If they are well digested and the urine does not show an increase of coloring-matter, indican, and ethereal sulphates, their use may be continued for a time, and Zwieback or pulled bread and a small quantity of vegetables and fruit may also be eaten. Such a diet is very grateful to those who have been upon an exclusive milk diet, but care must be taken at this time to give water freely so that elimination by the kidneys may be augmented. Tea and coffee may also be permitted, but they should not be sweetened with sugar. Saccharin may be used in its stead.

Those who tolerate milk well, may continue to take a glass at seven in the morning, at eleven, at three in the afternoon, and at seven in the evening. At nine in the morning a cup of coffee with Zwieback may be taken with a little fruit. At one in the afternoon a milk soup, an egg, and a simple vegetable are allowable, and at five in the afternoon a supper of milk soup, an egg, or sometimes fish or oysters, Zwieback, a vegetable, and fruit may be had. String-beans, peas, and mashed or baked potato may be permitted in small amounts. Lettuce, tomatoes, chicory, carrots, turnips, spinach, salsify, and artichokes are the best. Meats should be avoided as long as possible. When their use is commenced, fish, oysters, squab, and breast of chicken are to be preferred.

Starches and sugars are especially to be avoided. Vegetables and fruits containing much of them, potatoes, beets, other root vegetables and preserved and dried fruits, are not to be eaten freely, and not at all unless the case is progressing favorably and there is no indigestion. Condiments, rich sauces, fats, fried food, pastry, and sweets must be forbidden.

A quiet out-of-door life should be led. Wearisome exercise must be avoided, as must also mental cares and worries. The skin should be kept active by warm baths and by rubbings. The bowel movements should be kept regular and copious, and the urine abundant. When ascites demands it, puncture of the peritoneal cavity must be resorted to, if necessary, repeatedly. However, a milk diet, about six glasses daily, rest in bed, laxatives and usually cardiac tonics will cause ascites often to disappear. The quantity of milk then can be increased and fruits also can be eaten but care must be taken not to overtax the heart and liver. Toward the close of life, and especially in hypertrophic cirrhosis, hygienic treatment must be the same as in obstructive and grave jaundice.