Nonsurgical Treatment of Gall Stone.
Related entries: Gallstones: ElTh-links
W. E. KINNETT, M. D., PEORIA, ILL.
Treatment. This is the most important part of the procedure. The treatment, by medicinal measures, of these cases has not been wholly satisfactory. Some have been entirely relieved, and others have had the attack return at intervals of three or four months. I have looked for specific indications for remedies in each of these cases, but have failed to note any group of symptoms that could be relied upon. I have pursued various plans of treatment. The one I now employ is the following:
When called to a patient suffering with an acute attack of the passage of biliary calculi, I administer at once morphia sulph. and atropia sulph. hypodermically to relieve my patient of the severe pains. Sometimes I apply hot fomentations over the region of pain. This will, as a rule, give the patient ease in a few minutes. After the stone has passed and the patient is somewhat over the effects of the opiates, I adopt the treatment given by Dr. J. W. Babbitt. He says:
"I have suffered from the presence of gallstones as persons seldom suffer. For fifteen weeks, almost every day, one or more calculus passed, and consequently the pain and anguish was every day increased, to that extent that the inhalation of chloroform appeared to me to be the only thing to keep body and soul together. Chloroform gave only temporary relief. I have inhaled it over a hundred times; used every remedy in the materia medica, that promised any relief, as prescribed by our most learned and experienced doctors, but without relief from any of them. Finally, upon the advice of Dr. Pitchers, of Detroit, I took the (then) new remedy, which relieved me of over one hundred crystallized globes as large as a marrowfat pea, at one evacuation. I have since treated more than a score of sufferers with the best results, and to the satisfaction of all concerned.
"The remedy is sweet (olive) oil, six to eight ounces. First, empty the stomach, by an emetic or by fasting; the latter way preferable. Twenty or thirty minutes after swallowing the oil, which will give time for it to pass into the duodenum, lie down on the right side, with the hip higher than the shoulders. The oil will find its way down the ductus communis, and reach the enemy in its castle, to-wit: the gall bladder. Every calculus will be lubricated and will slide out of the fount and through the intestines. Now, to be certain that the desired result has been obtained, let the stools be dejected into a vessel half full of water, and the little green globes will be found floating upon the water. No cathartic will be necessary. I have experimented extensively upon cholesterine, but have never discovered a solvent that could be safely introduced into the stomach. Our supposition is that with the occasional use of the oil, as above, the cholesterine will not crystallize in the human system.
"As to treatment to prevent their formation, I will say that any treatment that will aid nutrition will be helpful. We are told that chloroform will prevent their forming; but so far I have not found a single patient that could take it; they could not retain it in their stomach."
One writer says: "In regard to gall-stones I can say but little from personal experience, as it is a rare disease, as you well know. If I was treating a case of gall stones, I would give sulphuric ether and chloroform, in equal parts, three or four times a day—all the patient would stand of it; as near a teaspoonful as the patient could take. I have confidence in the ability of that mixture to dissolve the formations, and believe it does it." Why this writer should believe this mixture will "dissolve the formations," when he has not tested it, I am unable to say.
Another writer says: "I have usually had my patients take what is termed a 'cholagogue cathartic,' from time to time, to keep up a free flow of biliary matter. I have had but few cases in the nineteen years of my practice." If any one can tell what medicine he meant for me to use, when he says, "chologogue cathartic," I should like him to inform me. Another says "I know of no specific remedy to prevent the formation of biliary calculi. Chloroform and sweet oil are good to aid their passage, and chloroform is thought to prevent them."
Another says: "Phosphate of soda, one drachm three times a day, is the best preventive."
Another says: "Inject one-fourth of a grain of the sulphate of morphia hypodermically. I cured a case in this way three or four years ago; it has never recurred. I don't think solvents or prophylactic medicine worth anything."
Another says: "Give calomel and podo phyllin in large doses to move the bowels freely. During the pain of passing the stones, use the following:
|Sulph. ether||oz. 1|
|Oil terebinth||oz. ½|
M. S. Half a teaspoonful every half hour.
The curative treatment is nitro-muriatic acid dil. fifteen to twenty drops in water, before meals through a glass tube. Persist in the use of the acid, and you will have very little use for other remedies.
I have found as a special remedy the chionanthus virginica to be the best preventive I have tried, especially if there is any jaundice.
Possibly the alkaline carbonates will be useful. The exclusive use of soft water for drinking is suggested. Attention to the diet, etc., no doubt, aids the treatment.
[I published in August of last year and reproduced in June of this year, an article by Dr. Webb on the treatment of biliary calculi without operation. A few days after the June number was circulated, I received a letter from Dr. W. E. Kinnett, of Peoria, Ill., which called my attention to the fact that in October, 1888, he sent me an article on this subject for publication in The Medical Times, which presented almost precisely the same treatment which Dr. Webb claims to have thought out for himself, more recently. On looking the article up I found that Dr. Kinnett was correct, and that in addition to the treatment which is very similar he makes some specific suggestions which are valuable. I therefore reproduce the portion of his article which gives us the facts concerning the treatment. It will be seen that Dr. Kinnett presents the methods of other writers as well as his own. However the method lacks the definiteness and clearness of Dr. Webb's method.—ED.]