TREATMENT OF SECONDARY AND FUNCTIONAL DISEASES OF THE LIVER.
Diet. Many hepatic disorders, and especially those that are exclusively or mainly functional may be corrected by diet alone. Prominent among dietary influences is the abundant supply of water. The succulent grasses of spring and early summer constitute the ideal diet, hastening and increasing elimination, and lessening the density of the bile, even to the extent of dissolving biliary calculi and concretions. Upon dry winter feeding such calculi are common especially in ruminants, whereas after a month or two at pasture they are extremely rare. In winter the same good may be arrived at by the use of ensilage, brewer’s grains, roots, fruits, or even scalded hay or bran. The two extremes of highly albuminous and highly carbonaceous or saccharine food are to be avoided or used only in limited amounts. In the one class are clover, alfalfa, sainfoin, vetches, cowpea, lespedeza, especially in the form of hay, beans, peas, cotton seed, gluten-meal, rape and linseed cake. In the other are wheat, buckwheat, Indian corn, sorghum, sweet-corn and cornstalks. Some agents like beets which are rich in saccharine matter may be actually beneficial by reason of their laxative and cholagogue action. In the carnivora the food should be largely of simple mush of oatmeal, wheat seconds, or barley meal, skimmilk or buttermilk. If it is needful to tempt the appetite in a fleshfed animal this should not be done by rich, fat gravies, highly spiced animal food, or rich saccharine puddings, but rather by the addition of a little pure juice of lean meat, or some well skimmed beef tea.
It is as important to regulate the quantity as the quality of the food as the heavy feeder will over-charge the liver as much by an excess of otherwise wholesome food, as will the ordinary animal by the indigestible and unwholesome articles. As a rule the improved breeds of meat producing animals, have acquired such facility in fat production that much of the surplus is largely and profitably disposed of in this way, and in their short lives little obvious evil comes of the overfeeding, but in cases in which this outlet proves insufficient, as in horses and dogs that are highly fed on stimulating or saccharine diet, and which are kept for the natural term of their lives, with little exercise, the evil tends to reach a point of danger. Nursing mothers and dairy cows find a measure of safety in the free flow of milk and the yield of butter, but breeding cows that have been improved till they have no longer a capacity for milking, but must have their calves raised on the milk of other and milking strains are correspondingly liable to suffer.
Exercise in the Open Air. As enforced idleness, on a full diet and in a warm and moist environment is a main cause of hepatic disorder, so abundant exercise in the open air and especially in a cool season is beneficial in a marked degree. Beside the bracing effect on the digestive organs and the improvement of the general tone of the system, the action of the muscles in hastening the circulation greatly favors the removal and elimination of waste matters. Still more advantageous is the increased activity of the respiration and the aspiratory power of the chest in at once unloading the portal system and the liver by hastening the progress of the hepatic blood into the vena cava and right heart, and in furnishing an abundant supply of oxygen for the disintegration of the albuminoids and amylaceous products. Such exercise must of course be adapted to the condition of the animal and its power of sustaining muscular work, but judiciously employed, it is one of the most effective agencies in correcting and improving hepatic disorder or hepatic torpor. Idle horses, the victims of obstinate habits of constipation, muco-enteric irritation, indigestion, nervous, urinary or cutaneous disorders will often be greatly benefited or entirely restored by systematic exercise. This is one of the great advantages of a run at pasture, as the subject secures at once the laxative cholagogue diet, an abundant supply of oxygen, a better tone of the muscular and general system, and a more perfect disintegration of albuminoids. Sea air with its abundance of ozone is especially advantageous.
In the carnivora while we cannot send them to grass, much can be done in the way of systematic exercise, and in the case of city dogs a change to the country, where they can live out of doors and will be tempted to constant exercise and play, will go far to correct a faulty liver.
Laxatives. Cholagogues. When a free action of bowels and liver cannot be secured by succulent food and exercise, we can fall back on medicinal laxatives. These are advantageous in various ways. Some laxatives like podophyllin, aloes, colocynth, rhubarb, senna, jalap, and taraxacum act directly on the liver in increasing the secretion of bile. These may be used for a length of time in small doses and in combination with the alkalies. Other aperients act directly on the bowel carrying away the excess of bile, the albuminoids and saccharine matter that would otherwise be absorbed, and by a secretion from the portal veins, abstracting nitrogenous and saccharine elements which would otherwise overtax the liver to transform them. Thus indirectly these also act as cholagogues by withholding the excess of material on which it has to operate, and by rousing its functions sympathetically with those of the bowels. Thus sulphates of magnesia and soda, and tartrates and citrates of the same bases, given in the morning fasting, dissolved in a large quantity of warm water and conjoined with sodium chloride, ammonium chloride, sodium carbonate or other alkaline salts, or with one or more of the vegetable cholagogues above mentioned, may be continued for a length of time until the normal functions have been re-established, and will maintain themselves irrespective of this stimulus.
Calomel (and even mercuric chloride in small doses), though it is not experimentally proved to be a direct cholagogue, is one of the very best correctives of impaired hepatic function. It expels the bile from the duodenum and bowels generally, thereby preventing its reabsorption; it proves antiseptic to the ingesta; it eliminates much of the peptone, saccharine and fatty matter from the intestines and portal system thus relieving the liver materially; and it is supposed further to modify the other liver functions by a direct action on the hepatic cells, and by reducing the cohesion of fibrine, and promoting the disintegration of albumen. Certain it is that calomel gives most substantial relief in many torpid and other disorders of the liver and as it is not in itself an active liver stimulant but has rather a soothing action on that gland it can be safely resorted to in states of hepatic irritation in which the more direct cholagogues would prove more or less hurtful.
In some forms of hepatic disorder where a speedy and abundant secretion is demanded, pilocarpin may be employed, with great caution so as not to reduce the strength unduly by the attendant diaphoresis, diuresis, salivation or diarrhœa.
Alkalies have long been recognized as of great clinical value in hepatic disorders. Though carbonate of soda decreases the secretion of bile, (Nasse, Röhrig), yet the alkalies generally appear to promote oxidation, and to hasten the disintegration of albumen and the albuminoids. They increase the disintegration of sulphur compounds materially adding to the sulphates and urea in the urine. They further tend to increase the hippuric acid, carbonate of soda (2 drs.) even determining the abundant excretion of this acid in man (Nasse). It may be concluded that the acknowledged value of alkalies in these diseases, is largely due to their hastening of the metabolic processes in albuminoids. Small doses of sodium carbonate further stimulate the gastric secretion and may thus benefit by rendering the process of digestion more complete and satisfactory.
Chlorine, Iodine, Bromine and their Salts. These halogens are of great value in many hepatic disorders. The universal craving for sodium chloride indicates the need of its elements in the animal body, and whether this is mainly the supply of chlorine for the hydrochloric acid of the gastric juice, or to fulfill its uses in favoring the oxidation and disintegration of the nitrogenous matters in the blood and tissues, or for other more or less obscure uses, it is well to recognize and act upon the indication. The various mineral waters which are held in high esteem in liver affections contain a large proportion of sodium chloride. As a medicinal agent ammonium chloride maintains an equally high position. Large doses thrice a day, so as to induce diaphoresis and diuresis greatly relieve hepatic congestions. This agent determines a great increase in the urea eliminated so that it is even more effective in the same direction, than sodium chloride. Free chlorine is also effective in hepatic torpor and congestion, and to this in part may be attributed the great value of nitro-muriatic acid.
Bromide and iodide of potassium have been found to be effective in reducing hepatic enlargement and thus in conducing to a more healthy activity of the liver.
Ipecacuanha, Euonymus, etc. These agents are more or less hepatic stimulants and may be found beneficial as combined with the laxative or alkaline agents in securing a better functional activity in cases of torpor or deranged function.
Tonics, Bitters. Tonics are often useful when the health has been undermined by long continued hepatic disorder. The iron tonics are as a rule contraindicated as tending to check secretion of bile, unless they can be given with alkalies. Iron sulphate or chloride, combined with sodium or potassium carbonate so as to establish a mutual decomposition will obviate this objection. The vegetable bitters (gentian, cascarilla, calumba, salicin, serpentaria, aloes, nux vomica) combined with alkalies are often of great value. Quinia, like opium, checks secretion and is to be avoided or used with judgment and in combination with cholagogues.