MEDICAL TREATMENT.—Some writers, particularly those who do gall-stone surgery, consider remedial measures of a medicinal character altogether futile. It is quite certain that valuable time should not be taken up after the failure of drugs if jaundice and fever are pres ent, as the patient may soon be beyond surgical help. The administration of alkaline waters, especially of Carlsbad salts, has been, in many cases, followed by good results.
Naunyn (quoted by Krauss) says: "I have not the slightest doubt but that the Carlsbad cures have the best influ ence on the course of cholelithiasis. I have seen a considerable number of dan gerous gall-stone incarcerations, which have lasted a long time, terminate favor ably." Krauss states that the cures can be taken at home and should last from four to six weeks. A bottle of Carlsbad should be taken each day as follows: TWO tumblerfuls in the morning before breakfast warmed to 140° or 150°, at an interval of fifteen minutes. In the even ing one tumblerful should be taken cold. If the water does not produce a free evacuation of the bowels, Spriidel salt shonld be given in addition. Kranss attaches great importance to diet. As a rule, he forbids: fat, vinegar, hot spices, pastry; vegetables, both dried and lin boiled; roasted potatoes, and cheese. He recommends the following, diet in or dinary case,::— Breakfast: A cup of tea or coffee, little milk; little sugar, if any; and two or three pieces of rusk or toast, one or two soft-boiled eggs, or some fish or cold meat.
Midday meal: Fish (salmon and eels excepted), roasted meat without sauce, green boiled vegetables or mashed pota toes, stewed fruits without sugar. Drink plain or slightly-effervescing' water, red wine (one or two glasses), or weak whisky.
Supper: Cold or hot meat (fresh roasted), tea, wine, or whisky (small quantities). He usually limits the bread to from four to six ounces a day.
The use of olive-oil has still many ad vocates.
Olive-oil is useful in g-all-stoue, if properly administered. Not more than 1 to 2 ounces may be given. Its action produces a watery flow from the mu cous membranes, and therefore helps to increase the flow of the normal duodenal secretions, namely: the binary, the pancreatic, and the secretion of Brun ner's glands. Quite good results have
been reported. Indications for surgical interference are: (1) when there is con tinued fever not traced to other toxins: (2) complete occlusion of the cystic duct, usually by a sing,le large calculus: (3) in cases of chronic obstructive jaun dice from impaction by one or more cal culi in the common duct. W. II. Thom son (New York Med. Jour., April 19, 1902).
..As a rule, too little water is taken in these cases. Alkaline saline waters stimulate peristalsis and increase the flow of blood to the abdomen.. the bile passages being massaged by the former and the diseased mucous membrane benefiting by the latter. These salines do not dissolve the stones, for sue!! allowed to stand two weeks in a 1-per cent. solution of sodium salicylate. ben zoate, phosphate, sulphate, bicarbonate. or chloride; potassium sulphate, or ammonium ehloride suffered no lo.ss of weight. Allowed to stand in olive-oil.
however, a gall-stone lost 68 per cent. of its weight in two days and then dis integrated. The solid matter of a stone becomes viscid in a few hours in a 5 per-eent. solution of animal soup. Large doses of oil probably do not reach the gall-stone directly, but, by producing an increased proportion of fat. fatty acid. and soap in the bile, cause it to have a solvent action on the choltherin of the stone. For this method of treat ment from 2 to 10 ounces of oil should he given daily, and the results are.very questionable. "Massage of the gall-blad der would, in many instances. be useless or harmful. During a gall-stone attack relief is urgently demanded. A pint of water taken as hot as possible, with hot fomentations over the liver, may give relief, or 1 cubic centimetre (15 minims) of spiritus mtheris in 2 teaspoonfuls of ehloroform-water every quarter of an hour. Exalgin, 0.06 gramme (1 grain), every half-hour for three or four doses is also of service. These failing, !mor phine must be used. Mayo Robson (All butt's "System of 'Medicine"; :Medical News, March 29, 1902).