GALL-STONES (Cholelithiasis).
Preventive treatment is a practical consideration, since many individuals are to be met with who are known to have passed gall-stones with the feces, and preventive measures are as clearly indicated in those who have had operations performed for the removal of these calculi in order to prevent their return. The causes which tend to the production of gall stones must be realised; some of these are removable; others, though permanent, may nevertheless be minimised. The most potent factor is, however, one over which the physician has little control—i.e., infection of the gall-bladder and biliary passages by the typhoid bacillus and B. coli, and possibly by other organisms. The next most important cause is stagnation of the bile, due to displacements of the liver by tight lacing or to ptosis of the organ in Glenard's disease—conditions which must be met by judiciously selected corsets, mechanical supports or abdominal belts. As stagnation of the bile is also induced by sedentary habits, free muscular exercise, gymnastics, swimming exercises, especially in fresh water, open air life and outdoor active occupations are essential. In the obese and those who for other reasons are prevented from such exercises, the only resource will be found in thorough abdominal massage preceded by bathing, douching or other hydropathic measures. This treatment should be prescribed for all so-called "bilious" subjects, in whom there is often an undoubted family predisposition to the formation of biliary concretions.
Constipation is to be avoided, and free saline purgation should be effected once or twice a week in order to keep the intestinal tract in as healthy a state as possible and to insure a complete evacuation of the contents of the gall-bladder. Hence an occasional full dose of Calomel or Blue Pill every week or ten days is a useful adjuvant to treatment. Intestinal antiseptics are clearly indicated, but as the action of all such drugs hitherto used for the purpose of disinfecting the alimentary canal is very unsatisfactory little advantage can be expected from their routine administration. Continuous small doses of Calomel are obviously out of court in a condition so thoroughly chronic as the one under consideration.
An occasional course of Urotropin is believed by some enthusiasts to retard the growth of organisms in the biliary passages, but as the drug is so rapidly eliminated in the urine it is doubtful that it can effect any such result in the gall-bladder.
Salicylates are believed to act upon the bile and render it more fluid; the same remark applies to Benzoate of Soda, Soaps made from soda and oleic acid and to Bile Salts, and these agents are therefore also indicated when there is reason to believe that calculi have already formed.
Diet is of great importance, but as in most other diseases a fanciful restricted regimen based upon chemical theories does more harm than good. The diet should be as varied as possible, over-eating being for bidden, but as much meat (especially white meat) as is necessary for the support of the body may be permitted; highly spiced or rich seasoned dishes should be avoided. Animal fats and carbohydrates should be limited, and greasy cooking should give way to plain boiling and roasting. Alcohol in every form its injurious. It is a well-recognised fact that the greatest tendency towards cholelithiasis is often met with in spare eaters. This is probably due to the small amount of fluid which such individuals imbibe and the obstinate constipation which is thereby engendered.
An abundant supply of fluid is undoubtedly the most important in gredient in the diet in every case, hut the increase of fluid should not consist of milk, as this article bad better be indulged in to a moderate extent only, unless skimmed milk or buttermilk be substituted for it. Effervescing Kali, Soda, Seltzer or Apollinaris water may be freely taken between meals and in moderate amounts at meal-times. Tea made by the Russian method with lemon and a little sugar without cream, only the China leaf being employed, is the best routine diluent, and since so little of the China leaf is necessary it may be freely partaken of at all times, and it may be taken in the early morning instead of the usual mawkish draught of warm water on rising. The writer strongly advises all patients suffering from a tendenb; to gall-stones to avoid meals in bed when possible.