Olive Oil as an article of diet is invaluable, and it it a good rule when possible to make this fat take the place of butter, cream and the fat of meat. It may be freely used with salads and as a substitute for butter in various cooking operations.
Hepatic Colic.—The first indication is the relief of pain; when this is agonising and unbearable a hypodermic injection of Morphia ( to gr.) must be given at once, and it is advisable to always combine with it i min. Liquor Atropix. This latter drug does not prevent the pain-relieving action of the narcotic, but it probably neutralises the paralysis of the muscular fibres of the duct which follows when morphia is given alone. Hence this latter consideration should tempt the physician to withhold morphia when the pain is bearable on the chance of the stone being delivered into the duodenum. Chloroform affords complete relief, and during the absolute degree of relaxation following general anesthesia the stone may slip through the orifice of Vater. In mild attacks a large hot poultice or hot pack or stupe may be applied over the liver, but these measures are inferior to a bath in water as hot as the patient can tolerate —105' to Ile F.—and in this under the surveillance of the physician lie may be safely kept till signs of muscular prostration begin to show themselves, and during the subsequent relaxation of the tissues of the duct the stone may slip through.
Copious draughts of water as hot as can he borne by the mouth often afford relief, and when vomiting is present this treatment can be continued with the hope that if the stone be already near the orifice of the duct its expulsion may he facilitated by the mechanical pressure of the abdominal muscles and diaphragm as the spasm diminishes. The physician should always keep in mind that the entire phenomenon of hepatic colic is nature's method of expelling a foreign body, and though the relief of severe pain may be imperative it is not the best practice to, immediately upon the approach of suffering, fly to profound narcotics when these can be avoided.
By the addition of a little Bicarbonate of Soda the efficacy of the hot water is increased, and combines zo grs. Salicylate of Soda with 6o grs. bicarbonate in each pint of the hot solution to be swallowed in mouthfuls during the paroxysm.
Emetics sometimes give relief probably by their power of allaying spasm, and some patients in subsequent attacks discover this method for themselves and resort to lukewarm water draughts to effect emesis upon the approach of an attack. It is inadvisable to administer irritating substances like zinc sulphate, tartar emetic and mustard, as these are liable to induce swelling of the mucosa about the entrance of the duct; if the physician decides to produce emesis after tepid water has failed a hypodermic of Apomorphia is the best procedure.
Robson has found that i gr. Exalgin dissolved in a teaspoonful of hot water and repeated every half-hour for three or four times often relieves the paroxysm. Antipyrine or Antifehrin, and Opium, Ether or Chloro form in small doses may be given by the mouth; Adrenalin has been found to relieve the pain in some cases. When pain is continuous a Morphia Suppository may be employed.
The following combination of pain-relievers may be left in the hands of an intelligent patient for the treatment of expected attacks till the arrival of the physician: E. Liquor. Morphice Hyd. 3iv.
Tinct. Cannali. Ind. 3i.j.
Olei Menthce Pip. 5ij.
sp. _Ether. Snlph. 3iv.
Spt. Chloroformi 3vj.
Spt. 'Ether. Nit. ad Misce.
Ft. Mist. Signa.—"A teaspoonful with a tablespoonful of whiskey to be taken in a wineglassful of water when the pain comes on. To be repeated in 3o minutes if the pain continues and every 2 hours after wards till relief is obtained." Olive (W.—This drug, as will be mentioned later on, is employed as an agent to assist in the disintegration of gall-stones, but it is, moreover, recommended strongly as the best routine treatment for the relief of the severe pain during an acute attack of hepatic colic when given in closes of 5 or 6 oz. Some observers state that they never saw the oil vomited (the opposite has been the writer's experience). It may be given with a tablespoonful of whiskey or brandy, and 5 drops of Oil of Peppermint. It is claimed for it that it very often causes the rapid expulsion of the calculi, and greatly increases the flow of bile, and sometimes instantly relieves the pain. Blum injects 15 oz. of the warm oil into the rectum.