In cases of cholecystotomy, when there is an external biliary fistula and 0-all-stones still remain in the common eholedoch-duct, the injection of olive oil into the gall-bladder has been recom mended so as to enable it to directly ex ert its solvent action on the calculi still remaining. A case is reported by Morris in which a cure by this means took place after six weeks' treatment.
Calomel, followed by salines, may be of use in emptying the gall-bladder and expelling the calculi if they are very Butte!. recommended to be taken in larg,e quantities instead of olive-oil for the prevention and cure of gall-stones. Fifteen to 20 grammes (4 to 6 drachms) of butter spread on biscuits are to be given each morning. Felix V011 Oefele ("Artzliehe Poindschati," '96-'97).
Enemata of olive-oil recommended for the treatment of cholelithiasis. A more direct action on the liver is obtained by this mode of administration, while there is less danger of affeeting the stomach. This is an addition to mir present means of treatment of eholelithiasis. 13Iume ("Verhiindliingen (ler C'ongress f. inner° Aled.," Wiesbaden, '97).
The most effective remedy for biliary colic is an hypodermic of 1/, or V, grain of morphine with / 1, 120 grain of atropine. Hot applications applied lo cally afford some relief, and a weak, hot solution of bicarbonate of soda taken into the stomach in large quantities has been recommended.
Olive-oil in from 5- to 10-ounce doses is said to shorten an attack. Glycerin is also credited with value when em ployed in the same manner.
— _Much has been accomplished within the last few years in the improvement of older meth ods and in the introduction of new plans of operation on the more difficult cases of gall-stone surgery.
Cases have, front time to time, been reported in which a diagnosis of chole lithiasis had been made, and when op erated upon gall-stones have not been found. In some of these recovery has taken place in a remarkable way.
The arguments in favor of removing gall-stones at the earliest favorable. moment after the diagnosis has been made may he summed up as follows: The operation is, as a rule, easy and safe and all stones are quickly removed. The remote dangers of gall-stones are either avoided or lessened. These are: serious. disabilities, grave emergencies,
and malignant disease. If the diagnosis of gall-stones proves to be wrong, other lesions may be discovered and remedied: lesions perhaps more serions than those of gall-stones. Late operations upon gall-stones are, aS a rule, difficult and dangerous. Operations made imperative by progressive and lethal symptoms must be performed under great disad vantages and dangers; the gall-stones are generally more inaccessible, the dis seetions deeper, and the patient's power of resistance lessened. The arguments against early operation are: There is some danger in the operation. though it is hilt slight. The diagnosis may be wrong and the exploration unnecessary. There is the possibility of hernia in the sear. There is the possibility that the gall-stones may recur. There is the pos sibility of spontaneous cure. There is also the possibility that, after' offend ing enoligh to prove the diagnosis, the gall-stones may give no further trouble. The last and decisive attacks of binary colic may have been caused by the last remaining gall-stone, exploration show ing that none of them remains. :NI. H. fiichardson (Boston Med. and Stag. Jour., .Sept. 5, 1901).
In 720 operations the mortality was 15.5 per cent. From these operations, however, 1S5 ean be. deducted. either on account of operations at the same time on the stomach or intestines, the pan creas, Ole liver. etc., or because there \vas inoperable carcinoma of the gall bladder, gall-duct, or liver, or diffuse purulent nephritis, peritonitis, or cys titis. This leaves 535 operations solely for gall-stones, with a mortality of 3.5 per cent. It mitst be remembered in these statistics that all patients who died within one hundred days of the operation are included. Death in many of these cases cannot be ascribed in any way to the surgeon's intervention. lu the case of sepsis and carcinoma with a mortality of 97 per cent. the operation is justified because such patients are certain to die, and if 3 per cent. are saved it is a considerable gain. )Iore over, error in diagnosis sometimes oc curs, and it is found at the °proration that the condition is not so severe as was suspected. II. Kehl. (Miinchener med. Wochen., Oct. 28, 1902).