Gall Stone—A Case.
(Reported to the Illinois State Eclectic Medical Society.)
J. A. MCDONNEL, M. D., CHICAGO, ILL.
About Thanksgiving time, when one of the patriotic birds of America is seen on every table, this patient of mine ate two very large dinners, both of them turkey. He ate one about 2 o'clock and the other about 7 p. m. At one o'clock the following morning he was taken with intense abdominal pain. He simply rolled and tumbled and pitched and tossed around on the bed, and got no ease whatever. A physician was called, who gave him a hypodermic injection. The hypodermic did not appear to do much good, but he took a terrific vomiting spell. Immediately after that the pain stopped. He was then about 50 miles from home, and he returned to his home in Chicago. I was called to see him the next morning. He gave me the above history, as I have given it to you.
On putting my hand over the gastric region, it came in contact with a round, tolerably regular enlargement. A tumor of some sort seemed to be welling up from beneath the sheath of the liver. This swelling was hard, but not very painful to the touch, but it did create a little reflex irritation in the stomach. I asked him a few questions in regard to his past history. He gave a negative history, with the exception of having had typhoid fever away back in the 50's. Now he is a man 73 years old, well preserved, never, you might say, had had any sickness. He always was a hearty eater.
Time rolled on. He got over his trouble for the time, until about one month ago. He came home one night, ate his usual dinner, took his paper and went up one flight of stairs to his room, lit his pipe, like all us good old men do before we retire. After he had smoked a little while he commenced to be nauseated. He felt, soon, as if there was a desire to defecate, and in attempting to retire to the closet, he staggered from one side of the hall to the other. He was conscious all the time, but could not control himself, and gradually slipped down on the floor. If a man ever thinks of his wife, it is at the time when he is sick, so he called his wife. She came up and got him off the floor, and got him to the closet. By this time another member of the family had called me.
I had to pass by the closet to go to his room. They told me downstairs that he was in the closet, but he had gone to his room. I looked into the bowl, and there found the bowl filled with blood. I came to the conclusion that he had a spontaneous rupture. I went and examined the man, and found him bathed in cold, clammy perspiration, the lips livid, along the carotid I found that along the whole tract there was a livid condition. There was cold, clammy, sticky perspiration. The pulse was extremely slow, down almost to 20.
After seeing that he was restored and the circulation a little better, by giving him nothing but getting him down lower in the bed, I went to examine what was in the bowl in the closet.
After pouring, very gently, some cold water over it, in order to separate what little solid matter there was away from the debris, I think there was a good half cup full of stones. They were of all sizes and all shapes, from the ordinary gallstone up to the size of a hazelnut. I counted and they were so numerous I stopped. I counted over 500. For two weeks he still continued to pass stones. I had all the excrements emptied into a sieve, then put to dry on paper, so as to get some estimate if possible of the amount of weight.
Just about the time you think you have something of that sort completed, somebody that knows more about cleaning up than taking care of gallstones threw a good deal of my paper out, and they were lost; This is the history of the case.
The man did very well for the first two weeks. He had very little fever. Kept getting better. He walked about the house. He had no more hemorrhages; no pain. They finally gave him a steak, some potatoes and such solid food. About 6 or 8 hours after, he was taken with a very severe chill, and this was followed by a second and third one, and the temperature went up to 105.5° F., and stayed along in the neighborhood of a degree lower for some days, then subsided a little until it reached 102°, then down to 101° F.
All the latter part of the trouble there was some albumen and some pus in the urine, and this developed after the severe chill and high temperature. The question that you might ask is, "Was there no condition existing before?" and I can answer you positively, there was not. I had a male nurse there, and every day saved the urine, and also the amount and kept a record. That is very necessary in these cases, especially in people in advanced life.
Of course he had that condition of the heart known as arteriosclerosis, which follows in aged people, and something relative to some disease of the bladder and the prostate that you meet with commonly in senility. Otherwise he was a healthy man.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.