GALL-STONES AND THEIR CONSEQUENCES CHOLELITHIASIS. 737 



tients die of the results of biliary obstruction, with the symptoms of 

 marasmus, or of acholia. 



TREATMENT. We should try to preserve patients, who have had 

 one or more attacks of gall-stone colic, from new attacks, and from the 

 other consequences of biliary calculi. The more frequently the attacks 

 have been repeated, and the more the surfaces, angles, and facettes of 

 the calculi passed induce the belief that there are others remaining in 

 the gall-bladder, the more imperative are the rules for insuring protec- 

 tion. Experience shows that, under the use of the Karlsbad waters, 

 immense quantities of gall-stones are evacuated, with proportionately 

 little difficulty. The same is true of the use of other alkaline mineral 

 waters, of the waters of Vichy, Marienbad, Kissengen, etc. We can- 

 not explain this fact. We do not know whether their efficacy depends 

 solely on the rich formation of a thin, fluid bile, by which the gall- 

 stones are readily washed downward, or whether the bile is rendered 

 so strongly alkaline by the use of these waters as to dissolve the color- 

 ing matter and lime, or the cholesterin ; but we should not delay pre- 

 scribing the treatment till its mode of action can be explained. In the 

 treatment of the states induced by gall-stones, Durande's remedy also 

 enjoys a great reputation; this consists of ether 3 iij, and oil of tur- 

 pentine 3 ij. According to the original prescription, half a drachm of 

 this is to be given in the morning, and the dose is gradually increased 

 until about a pound of the mixture has been taken. The fact that 

 ether and oil of turpentine dissolve biliary calculi placed in them does 

 not justify the hope that they will dissolve any concrements in the 

 gall-bladder, if they are introduced into the stomach. Hence, if Dit- 

 rande's remedy has a favorable influence on the conditions induced by 

 gall-stones, as we must suppose it has, from the recommendations of 

 numerous and good observers, this can only take place in some other 

 way, which is entirely unknown to us. Recently various substitutes 

 for JDurande's remedy, and variations from the original dose, have been 

 proposed. There is a popular mixture of oil of turpentine, 3ij, with 

 spirits of ether, 3 j, which is prescribed, in drop-doses, by Rademacher 

 and his followers, not only for gall-stones, but for all possible liver- 

 diseases, whether we know what they are or not. 



In the treatment of gall-stone colic, the bold employment of opium 

 deserves the most reliance. We may give twelve drops of laudanum 

 or a quarter of a grain of acetate of morphia at a dose, and repeat it 

 every hour or two till there is slight narcotism. If the patients vomit, 

 so that they cannot retain medicines given by the stomach, we may 

 give subcutaneous injections of a strong solution of morphia, or ene- 

 mata of laudanum, or let the patient carefully inhale chloroform. Warm 

 baths, also, as well as warm narcotic compresses over the liver occa- 

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