The most common cause of cirrhosis of the liver is long-continued indulgence in excess of alcohol. The use of highly seasoned foods may also induce it, more especially in children. It may also arise from chronic intestinal fermentation, resulting from the use of a diet which favours abnormal fermentative and putrefactive changes in the bowel. It is usually associated with some degree of chronic gastric catarrh.

The principles of dietetic treatment can be readily defined. Alcohol in every form must be avoided, until at least the later and incurable stage of the disease, when a stimulant may be advisable; all rich and stimulating foods should be withheld. Spices and condiments must be excluded from the dietary; fats and carbohydrates need to be restricted. The diet must be simple, and in the early stages should be largely a milk dietary, or a lacto-vegetarian regime. The bowels must be kept open by the judicious use of saline mineral water. The diet varies with the complications, more especially the presence of marked ascites. An appropriate diet sheet is here given for the early stages of the disease, and also for the later stages associated with pronounced ascites.

Cirrhosis Of Liver - Early Stages, Without Marked Ascites

Here milk should form the basis of the dietary. It may be necessary to give it diluted or peptonised, or in the form of skimmed milk or koumiss, depending on the degree of derangement of gastric digestion: -

6 A.M. - 10 ounces of buttermilk.

8 a.m. - 10 ounces of milk, thickened with white of egg; slice of toast 11 a.m. - Chicken or veal jelly; or soup thickened with sago, Farina, or barley. I P.M. - 10 ounces of beef-tea thickened with meat juice, with a dry roll; or pounded fish, or fish souffle. 4 P.M. - 10 ounces of milk. 6 P.M. - An invalid food - Allenbury, Benger's, Savory & Moore's.

9 P.M. - Cup of beef-tea thickened with Plasmon.

A course of six to eight days of this dietary will be of great value in relieving portal congestion, and inducing a healthier state of the whole digestive tract. At the end of this time the diet can be gradually increased.

Cirrhosis Of The Liver With Pronounced Ascites

Keeping in view the general principles previously laid clown, a dry diet planned along the following lines is recommended: -

8 A.M. - Cup of tea; sandwich of potted chicken or raw meat; or fish; or, occasionally, lightly boiled egg.

11 a.m. - 6 ounces meat soup, thickened with Plasmon. 1.30 p.m. - Fish quenelles; fish souffld.

Pounded chicken, or scraped steak mince with toast. A small glass of alkaline water. 4.30 p.m. - Cup of buttermilk, or freshly made tea with milk; dry sponge cake. 7 P.M. - An invalid food, or light pudding.

(Malt extract twice daily).

In recent years increasing attention has been directed to the occurrence of cirrhosis of the liver in children, under conditions in which alcohol in all its forms can be excluded. These are cases of subacute yellow atrophy, which are in all probability due to a chronic infection from the intestines, arising in association with a catarrhal condition of the duodenum. In these cases it should be kept in mind that an exclusive milk diet, or a diet consisting of bread and milk and milk puddings, is often more indigestible and therefore more prone to maintain a catarrhal state of the bowel than a protein diet made up of beef-teas, pounded fish or chicken, with puddings in the form of custard, rather than farinaceous puddings. In these cases it will be found that the protein diet laid down for cases of intestinal catarrh will prove of value (p. 356).