Diuretics have been used extensively and with benefit. They may prove injurious in a kidney that is already the seat of irritation and yet after all be the least of two evils. In some cases instead, the resulting dilution of a dense and irritating urine is directly soothing to the tender kidney. Saltpeter (10 to 15 grs.), acetate of soda (15 to 30 grs.), squills (1 to 2 scr.), may be repeated so as to keep up a free action. Pilocarpine (subcutem) (¹⁄₁₀₆ to ¹⁄₃₀ gr. daily), has removed the ascitic fluid in 14 days (Zahn), but its action is always to be dreaded in a weak system, or with a diseased heart, or lungs.
A supporting bandage on the abdomen is always useful as counteracting the tendency to vacuity and further transudation.
A course of bitters and iron, and a supporting diet, and out door life (sunshine) are important elements in treatment.
DISEASES OF THE LIVER.
In veterinary and medical works the diseases of the liver have been accorded a minor place, ill in keeping with the great physiological importance of the organ. If the function of the liver were circumscribed by the mere secretion of bile there would be some excuse for the apparent neglect, as the gland is so deeply situated and so much enveloped in surrounding organs that physical exploration is difficult and somewhat unsatisfactory, and the one symptom of jaundice was long relied on as indicating hepatic disorder.
Taking into account all the varied functions of the liver we realize the wide-reaching nature of its physiological influence and the extensive and varied effect of its disorders. We can also deduce, with greater or lesser certainty, the existence of hepatic disorders from the morbid conditions of the blood or of organs, the functions of which are inter-dependent with those of the liver. To elucidate the subject it is well to trace some of the most prominent functions of the liver; the following considerations are submitted.
SANGUIFICATION IN THE LIVER.
Glycogenic function. Glycogen derived through glucose and laevulose from starch, glycerine, milk and cane sugars. Less from proteids. Peptones as a source. Its use in cell growth and heat production, in white blood cells, in contracting muscle, becoming lactic acid. Excess dissolves red globules, setting free hæmoglobin. Ammonia carbonate and asparagin increases it. Arsenic, phosphorus or antimony arrests glycogenesis. Liver increases leucocytes, and reduces size of red globules. Reduction of proteids. Fibrine formers reduced, urea formed; liver inactivity means less of soluble urea, and more of less soluble and more dangerous products. Urea increases with hepatic circulation. Hepatic disorder and suppression of urine dangerous. Red globules probably destroyed. Bile: Amount, uses, oil solvent, helps endosmosis, deodorant, stimulates glycogenesis, excretory. Source of bile pigments, tests. Bile acids, dissolve blood globules, antiseptic, tests. Bile increased by; bile absorbed from bowel, olive oil, salol, salicylates, benzoic acid and benzoates, turpentine, terpene, terpinol, euonymus, alkalies, arsenic, ether. Agents lessening biliary secretion, starvation, excess of fat, alkaline iodides, atropia, strychnia, hepatic diseases, septic duodenal fermentation. Arrest in liver of copper, iron, iodides, bromides, nicotine, quinine, morphia, curare, toxic bile products, ptomaines, toxins. Reduces toxicity of peptones, casein, ammonia salts, indol, phenol.
The liver is the goal to which most of the products of gastric and intestinal digestion are carried by the portal vein. In the hepatic cells large quantities of glycogen, 6 (C6H10O5) + H2O, are stored up after each meal. This is believed to be derived largely from the transformation of glucose, (C6H12O6) and laevulose (C6H12O6) which have been produced from starch in the alimentary canal and conveyed by the portal vein to the liver. By the liberal use of starch, glycerine, or the sugars of milk, fruit or cane, (but not mannite, or glycol, or inosite) the glycogen is very greatly increased (to 12 per cent. in the fowl), but it is diminished on a purely albuminous diet. Yet it can be produced from albuminous food, as it is always increased in the dog after a meal of flesh, and is largely present in the livers of carnivorous animals that have been fed for a month on flesh only (Landois). The peptones are therefore decomposed in the liver with the production of glycogen and such waste products as leucin and tyrosin, which are finally resolved into urea. A purely fatty diet diminishes it enormously and during prolonged abstinence it practically disappears. It passes, not into the bile, but into the hepatic veins, and the general circulation, where it serves in its decomposition to generate heat, and probably to hasten cell growth. In the vegetable and animal world, in the germinating seed, and in cartilage, muscle and epidermis of the fœtus and in the amnios, glycogen and glucose are found in abundance. The liver, too, the great center for the production of glycogen, is relatively much larger in the young and growing animal, and also in the adult animal which has great power of assimilation.
Glycogen is always present in the white blood globules so long as they maintain their vitality and amœboid movements, but when they die, it is replaced by sugar (Hoppe-Seyler). The red blood globules give up a ferment which rapidly transforms glycogen into sugar.