Treatment of Cholelithiasis in Homoeopathy

[qaziosman]

Hi

This is Qazi Osman from pakistan, I am a homoeopathic physician and
I am looking forward to get the answer whether any one has cured a
case of cholilithiasis by homoeopathic medicines or not.

Because as
per my experiance and other physician I have never heard about a cure of cholilithiasis by homoeopathy - only surgical treatment.

So if any one has cured cholilithiasis, please share it with me.

Regards

QAZI OSMAN

[muthu kumar]

I have cured many cases. Most of the time it was using Graph, Calc,
Phos, Nux.vom ( eats a lot of fat, likes it and tolerates it well),
Puls on general and food tolerance indications. Once used Colchicum
based on typical nausea and vomiting.
I have also used some local remedies like Berberis, Cholesterinum,
Fel Tauri etc.

Suggest that you take a look at < fat food remedies, in women look
at the menses pattern as well.
--- In minutus@yahoogroups.com, "qaziosman" wrote:
cure of cholilithiasis by homoeopathy - only surgical treatment.

[H.T. Cotter]

Dear Dr. Osman,
I have been treating gallstone patients for over 30 years with a malic acid flush and homeopathic remedies. The flush is very simple and it clears both the liver and gallbladder. It is, in my opinion infinitely more desirable than Cholecystectomy which is fraught with morbidity problems and leaves the patient without a fine organ.
If the patient is cancer and Candida free, the malic acid can be supplied as apple juice as a supplemental drink for 3 to 5 days. For gouty patients, Cherry juice is more favorable. I usually just give my patients the malic acid capsules if they don't want to worry with the juices. About 1 ounce per day of unfiltered or fresh pressed apple juice per six pounds of body weight over three to five days is sufficient. On the last day, often helpful to be on a Friday, since the patient needs to be near a bath room for at least a while the next morning, the patient eats a normal breakfast, a light lunch and a citrus dinner. I usually recommend that my patients take 1/2 a bottle of magnesium citrate around dinner time, the a hour or so after dinner, take 1/2 cup of extra-virgin olive oil and the juice of three freshly squeezed lemons. This can be diluted with coke or other cola or citrus drinks and swallowed. The patient goes to bed for at least 30 minutes, laying on their right side in a fetal position. The next morning they drink the other half bottle (4 ounces) of magnesium citrate, so when they open their bowels they usually pass the stones and they feel marvelous. This can be repeated for severe cases, but it isn't often necessary to repeat more than once or twice a year. I take the flush myself every two or three years.
Cholesterinum in the isopathic elimination potency (4.9X) is helpful t.i.d. for a week or so. Best to temporarily eliminate all deep fried food, eggs, dairy foods including ice cream, chocolate, French fries, hush puppies. Cat fish is a popular dish in America and is especially hard on the stoned gallbladder.
The malic acid makes the stones more plastic so they tend to soften and extrude if necessary through the common bile duct. There's a theoretical risk of some stone lodging in the common duct, but has never happened to my patients.
Best wishes,
Dr. H. Thomas Cotter

[Sarvadaman Oberoi]

There is a history of curing cholelithiasis with homeopathy since 1903-1908. See extract references.
EXTRACTS

American Institute of Homoeopathy (Am_Inst_Hom) 1903 59th Session Fifth day

Friday, June 26, 1903.

Gall-stones and diseases of the bile-ducts (H. F. Biggar)

There is no one class of systematic diseases that more fully and richly repays the student than that chosen for this occasion. There is none that calls into keener exercise the knowledge of physiology, physiological chemistry, the laws of blood and nerve supply, all in the abnormal as well as normal aspects, than this. Nor is there one, in either its medical or surgical views of successful treatment, that demands more rigid exactness of differentiation of mechanisms involved, or the means to be employed to secure satisfactory results, than the gall-bladder and bile-ducts.

There is scant opportunity for a treatise on the subject, therefore I do not undertake it; but shall only give consideration to salient features, those lying in the way of the busy practitioner rather than in that of the specialist. And setting for myself the limit, let it be that of affections of the gall-bladder and its ducts, and of these again, cholecystitis and cholangitis, inflammation of the cyst in one case, and of the ducts in the other, and of a chief result cholelithiasis.

It will also be observed that I do not confine such consideration to either medicine or surgery as such; for the one might forever find limitation falling short of cure, and the other deal only with a last fixed stage, a hopeless incident. It is not that I discourage medication, - our best hope may lie there; nor decry operative measures in those cases demanding the knife; but I do plead for thorough and intelligent treatment of the same cases in their early stages with either medicines or the knife, or both in full view and easy reach.

With a warning that the surgeon's knife may be too frequently used, an eminent surgeon says: 'The domains of medicine and of surgery can never be separated. It may fail to gratify the physician to see surgery obtain quickly and by a few strokes of the knife what medicine had failed to accomplish, but, on the other hand, has not the physician to stay, and with advantage, the hand of the surgeon? The immunity with which the most formidable operations are now performed has given a confidence - might I not say a recklessness - possibly which renders the staying hand of the physician of priceless value. Especially is this true, when, as it sometimes happens, the inexperienced surgeon hurriedly resorts to a tentative operation to establish a diagnosis where one more experienced would see no reason for the procedure. I have more than once observed the meddlesomeness of a surgeon to be in indirect ratio to the measure of his experience."

It is their duty to become intimately acquainted with causes and clinical history and physic-chemical variations in these diseases, and their differential and specific tissue changes, that insure the position of vantage.

There are some facts in the surgical history of cholelithiasis, or gall-stones, that are suggestive. The era of gall-bladder surgery began in 1879, when there were in England one hundred and seventy-two deaths. In 1889, after ten years' experience, there were four hundred and eighty-eight fatal cases. Kehr of Halderstadt, who has performed more operations for gall stones than any other operator, gives a series which shows that a certain per cent demand reoperation, either from the "first operation not being complete or to a return of the disease." It is a well known fact that after operations for the removal of biliary calculi other stones are frequently passed, and even after the removal of the gall-bladder stones have been found in the bile ducts. In adults one out of ten have gall stones, of the old one out of four, and four times as many women affected as men. Only one of every thirty eventually requires the knife.

It is concluded, therefore, that while in the simplest cases the mortality may be as low as one (1) to three (3) per cent, it is in complicated cases as high as five (5) to thirty (30) per cent. In the experience of Mayo Robson a published series shows sixteen and six-tenths ( 16.6) per cent of recoveries.

In view of such a record, many of the cases being without doubt not in the class of last resort, we may carefully heed a remark of Treves, that "the operation for gall-stones is an excess of zeal on the part of some of our colleagues." At all events we are impelled to return to a more searching review of the conditions the premonitions of which are gall-stone formation, and thus on to the radical cure of the diseases of which they are the expression.

What is a gall stone? A crystalline, friable mass, composed of cholestrine, lime, iron and various bile salts and resins, precipitated and caught up and bound together in a matrix of albuminous material.

How formed? Irritation of the mucous surface of gall-bladder, hepatic, cystic and common ducts, their obstruction by swelling or plugs of mucus causes retention of liver products, and therefore the precipitation of their solids with excess of cholestrin; which caught up as above described become inspissated and solidified in the familiar concretions.

Their location, either as sand or larger stones, is in either duct or gall bladder or ampulla of Vater, a dilatation of the common and pancreatic ducts at their entrance into the duodenum. Outside of the gall-bladder, the cystic and common ducts are the most frequent locations of impacted stones. If there is permanent obstruction great distention occurs, and the more persistent the impaction the greater the liability to ulceration and possible perforation into the adjacent organs. The gall-bladder may be actually inflamed, where there is danger of occlusion of the cystic duct.

The causes are indigestion, intemperance and worry; and it is further predisposed by disproportionate amounts of fats and animal foods - beginnings of menstruation and pregnancy are prolific of these cases.

The diagnosis in simple cases is easy; but to differentiate in complicated or obscure cases it may be very difficult. The shape, density, position, condition of superficial veins and intestinal canal, all demand consideration. One point I must not fail to notice: A distended impacted gall-bladder can be distinctly felt between its normal position and the umbilicus; and here it swings as from a fixed point in the arc of a circle, convexity downwards. This is diagnostic. When the diagnosis is doubtful we need not hesitate to resort to exploratory operation, for then no doubt can remain and it is attended with comparatively little risk.

The greatest difficulty presents itself in inflammatory types of the disease. The most prominent are cholecystitis of the gall-bladder, and cholangitis of the ducts, generally due to some infection; but when concretions are also found, these types distinguished as the non-calculous and calculous forms. The type may be catarrhal, suppurative, or phlegmonous; and may result in gangrene, perforation, and localized or general peritonitis. There may be repeated attacks.

In cholangitis the type of inflammation may also be catarrhal, suppurative, phlegmonous, the results similar to the calculous form. If impaction is in the cystic duct there may follow gall-bladder dropsy, or infectious inflammation which runs an ordinary course. If in the common duct, it is distinguished by jaundice of more or less intensity which persists for a year or more, splenic enlargement, slight or no enlargement of the liver and gall-bladder, with or without ascites. The inflammation, at first catarrhal, becomes chronic and thus passes into the suppurative type for the contents makes a fertile culture medium. Osley recognizes three class of cases: "(1) Complete obstruction with mild catarrhal cholangitis; (2) incomplete obstruction with a severe grade of catarrhal cholangitis in which recovery is possible; (3) incomplete obstruction with 'suppurative' cholangitis in which death is inevitable."

Cholecystitis and cholangitis of catarrhal type may be present with or without jaundice, but is usually accompanied with cholemia and increasing leucocytosis resulting in toxemia.

Pyloric stenosis is differentiated by the deficient motility of the stomach and rejection of food.

If an enlarged gall-bladder can be palpated when jaundice is present, malignancy or internal pressure may be diagnosed. But if jaundice is present with a contracted bladder gall stones are probably in evidence.

Malignant growths have the pain, wasting cachexia, anasarca so characteristic; cholelithiasis presents a history of repeated attacks, pain, jaundice, vomiting, and often tumor formation. At times stones may be palpated, or crepitus felt when many are present.

Lymph nodes, as described by Hartman, may so form about the ducts as to cause obstruction, and cannot be differentiated from new growths.

Pain and tenderness at Boas' point at the costal border of the twelfth dorsal vertebra is a very important symptom of all diseases of the biliary passages.

Thus the difficulties of differentiation are strongly emphasized, and the more so as complications arise. In either form there may be required surgical exploratory measures to make the diagnosis certain.

Differentiation must also include appendicitis, which the symptoms may exactly simulate; acute intestinal obstruction, since pain and tenderness may not always be in the region of the gall-bladder; renal colic, gastralgia and enteralgia, are usually so defined by location and other characteristics as to make their diagnosis easy, but in rare cases negative symptoms and discharges of urine and feces will have to be depended upon. Note should be made of pancreatitis. Pancreatic calculi are rare and ordinarily diagnosed as gall-stones. There is no jaundice; the pain due to expulsion of the stone is colicky, but is located at the left costal border to the back, with glycosuria and fatty diarrhea. "If calculi composed of calcium carbonate or phosphate can be recovered from the stool after the attack the diagnosis is confirmed."

What does surgery offer in these cases? Something, it is true, but in view of radical cure it is inadequate. They are essentially non-surgical. Exploratory procedure may clear up a doubtful diagnosis; or removal of impacted stones, mere products, may relieve suffering and prolong life; in suppurative inflammation the presence of gall stones is not inconsistent with long life; as shown in most mortem records where they have been found in gall-bladder and ducts in eighteen (18) to thirty-six (36) per cent of the cases. Kehr states that only one in thirty having them, ever suffer from biliary colic or other symptoms of the disease. Besides this, an experience of a third of a century confirms the statement that a large number who have so suffered have recovered with medication and without surgical interference.

A modern authority has said: "It is evident that it is not gall stones themselves that constitute the disease; but the inflammatory condition from which they originate and with which they are so often found associated. Some of the ablest surgeons have even admitted that, if all inflammation is subdued and the stones kept at rest, the patient is as effectually cured as if the stones themselves were recovered; and furthermore that by the removal of inflammation and setting the stones at rest, is not only as effectual but more radical than anything that is ever likely to be accomplished by gall-bladder surgery."

So I say, extirpate the gall-bladder if you will - it never was the initial factor of the disease, only an intermediary - and the disease remains active as before. Obliterate sac and ducts alike and establish new bile channels into the intestine if you can - but to what end? What step toward cure is gained? It is also to be admitted that the original disease either by infection or idiopathic, bile secretion still abnormal, faulty transformation of liver products - and therefore their precipitation still goes on. Surgery is more often palliative than it is curative.

Drainage of the gall-bladder which will also drain all the ducts will relieve the diseased liver and rest the mechanism of bile secretion and is therefore indicated in all these allied conditions, especially if infective or accompanied with progressive cholemia or toxemia.

However, notwithstanding the zeal of lesser operators which is counteracted by the conservatism of the more skilled, and the preponderance of successes at the hands of medical men, it still remains that cholelithiasis is a surgico-medical disease; surgical when the obstruction is imperative, a palliative measure, and medical when time and circumstances admit considerations of cure. Kehr has pointedly drawn the lines between one and the other, and I fully agree with him in every particular, both in respect to the medical and surgical treatment. He says:

"Medical treatment is indicated (1) in acute obstruction of the common duct as long as it takes its normal or favorable course; (2) in inflammatory processes in the gall-bladder, where they seldom or at least not too frequently recur; (3) in frequent attacks of biliary colic followed by the passage of, or still frequent and followed by no passage of stones; (4) in cases already operated upon.

"Surgical treatment is necessary (1) in acute purulent cholecystitis or pericholecystitis; (2) for adhesions between gall-bladder and intestines, stomach or omentum, provided they cause serious trouble; (3) chronic obstruction of the common duct or of the cystic duct - dropsy or empyemia of the gall-bladder; (4) for all these manifestations of cholelithiasis that beginning in a mild form in their further course resist all treatment, and through constantly recurring pain or other symptoms deprives the patient of all comfort and renders the pursuit of his occupation impossible; (5) purulent affection of the ducts and abscess of the liver; (6) in perforation through the walls of the biliary passages and peritonitis; (7) for the gall stone morphia habit."

It becomes clear enough, then, that cholecystectomy should not be performed as routine practice for gall stones. It does not prevent the formation of stones in the ducts, does not increase the efficiency of drainage, but does involve added risk. It is indicated, however, in gangrene, sepsis, malignancy and new growths.

The means used to accomplish a cure are internal medication and diet, mainly.

We undertake (a) to stimulate the cells of the liver; (b) to stimulate the muscular fibers of the gall-bladder and bile ducts; (c) to relieve the catarrhal or congested state of the orifices of the common bile ducts; (d) to remove from the intestines substances which have been passing into the portal vein and depressing the action of liver cells; (e) to stimulate the intestinal glands which drain the portal system; (f) to control inflammation and promote absorption of inflammatory deposits.

It is not necessary to restrict the diet "when there is anything wrong with the liver." for by so doing "there is a decreased flow of bile and the bile secreted instead of passing directly into the duodenum, is stored up for future use in the gall-bladder when there is a long interval between meals. This applies to the earlier stages of gall stones. In later stages, when there may be obstruction at the pylorus or dilatation of the stomach this injunction does not necessarily apply."

"In the early stages of gall stones the patient should have frequent and hearty meals; and in this place late suffering may be prevented by late suppers."

The diet should therefore be generous. It is a mistake to lay on limitations and restrictions. The patient almost always craves acids and fruits; other things equal let him satisfy his craving. It is the same with nitrogenous foods generally. The object is not to suppress free flow of bile, but to encourage it, thereby to wash out the biliary channels.

The internal remedies naturally arrange themselves into groups. The first, applicable to the disease proper, is composed of china, ceonanthus, chelidonium, hydrastis, andpodophyllum. Each, as indicated, should be persisted with until results indicate change.

Another group, standing midway between the persistent conditions and exacerbations or other acute incidents, includes dioscorea, berberis, carduus, belladonna, and nux vomica. In some cases the chronic condition appears to be favorably influenced by these drugs, in others not at all, even if symptomatically indicated. There more favorable action, however, may be expected in acute phases of the disease.

According to its physiological action, as well as experimentally, belladonna is a most excellent remedy for attacks of biliary colic, during the stage of spasm. Its dosage is determined by the effect desired. Drug effects are required to bring about relaxation of the circular fibers of the canal; contractions of which are responsible for obstruction and pain. Given internally, in doses sufficient to produce atropism if necessary - even to thirty minims of the tincture every hour, or until the throat becomes dry and the pupils dilated. Another method of administration is to apply extract of belladonna one drachm. iodine ointment (U. S. P.) one ounce, smeared on lint sufficient to cover the affected part. In many cases the attenuated drug is sufficient to relieve.

A third group partially or wholly palliative, are the following:

Olive oil with some is disappointing - possibly on account of impure oil, or too large doses. Give a tablespoonful of pure olive oil in a glass of hot milk at bedtime. It increases the flow of bile. Becoming glycerized in situ it relaxes the circular fibers of ducts and adjacent muscular tissues. For the same reason the efficacy of olive oil in stenosis of the pylorus and duodenum following ulcer or fissure of the stomach has been fully demonstrated.

Eunatrol, a combination of olive oil and soda, is said to be useful.

Durand's remedy, turpentine ten minims, and ether fifteen minims, may be worthy of trial. I have not proved it conclusively.

Muriate of ammonia, from five to fifteen grains, three times a day, is a most excellent remedy for diseases of the mucus lining of gall-bladder and ducts.

Sodium salicylate, sulphate, benzoat, bicarbonate, phosphate succinate and potassium sulphate, have all been advocated by various authorities.

Alkaline mineral waters are useful because "they antagonize the development of acid tendencies and aid in the solution of mucus."

Another explanation is that "for the time being an astringent has a soothing effect on the lining membrane of the biliary passages, relieves the spasm, and allows the stone to pass." "The Cure" at Carlsbad is valuable, often very efficient. Another excellent water is that of Contrexéville, which if to be used for home treatment is better than Carlsbad.

Out-door exercise, horse-back riding, both judiciously controlled, are valuable adjuvants. Gymnastic exercises should be flatly forbidden. "Physical Culture" may have times and places, but not here.
Gleanings

The gall-bladder, except as a reservoir for bile, has no apparent use or function, and when removed gives rise to no consequences whatever. It is absent in rodent, camel, deer, elephant, ostrich and some fish. It has been found absent in man.

Bile is secreted by the liver cells. During periods of digestive repose it is forced into the gall-bladder and forced out again when digestion is resumed.

Cholesterin is present in the bile contained in the gall-bladder from one-tenth to one per cent. Is also found in the sputum, in fatty degeneration of the spleen, kidney, in tubercular tissue, carcinoma, sarcoma, infectious inflammation of mucous and serous surfaces and in pus.

Bacterial infection in numerous cases is the most promising theory of gall stone formation.

Catarrhal cholecystitis is due to the invasion by the colon bacillus. Gilbert in 1886 demonstrated their presence. In 1897 Mignot, Gilbert and Fournier produced gall stones by inoculation with the bacillus coli communis and shortly after with the bacillus of typhoid fever.

Biliary stasis of the bile ducts is the first factor in the formation of gall stones.

Many cases of enteric fever are followed by gall-stones.

Gall stones in the gall-bladder do not cause trouble unless cholecystitis supervenes.

After removing the gall-bladder stones have reappeared in the bile ducts.

Venous oozing during the operation or post-operative is a serious complication and possibly may be avoided by administering calcium chloride a few days previous to the operation. The dosage is twenty grains three times a day. It hastens coagulation.

For any hemorrhage the following formula is of great value:

????? Normal saline sol 100 c. c.

Sol Gelatin (21/2%) 60 c. c.

Mix and sterilize.

Sig: Inject entire quantity subcutaneously to control post-operative hemorrhage.

Post-operative pain may be due to adhesions. The early establishment of peristalsis may prevent adhesions. The morbidity following operations for gall stones is a strong argument that surgical intervention is not always curative.

The circulation is depressed during an attack of gall stone colic.

Phosphate of soda is often valuable - a drachm in a glass of water once, twice or even three times a day.

With some doctors gall stones are their "surgical benefactor."

Impaction of ascending and hepatic flexion of colon has been mistaken for a full gall-bladder.

The migration of gall stones the cause of the trouble.

The X-Ray has assisted me in the diagnosis.

May be mistaken for a floating kidney or appendicitis or pancreatic disorders.

Buttermilk, strained, good diet.

To a glass of milk add one-third teaspoonful of baking soda - shake twenty-five times; to this add one egg - one tablespoonful of Malted Milk - then shake fifty times. Drink three or four glasses a day.

A persistent inflammatory disease of the biliary passages frequently results in malignancy.

Cholecystendysis is a dangerous operation.

Murphy's modified button for drainage in cholecystotomy.

Murphy's button of proper size or Boari's button for cholecystenterostomy.

Cholecyst-duodenostomy relieves pancreatitis.

We have no single positive symptom indicative of gall stones and yet there is something about a case in which we suspect gall stones that, when operated on, confirms the suspicion.

The gall-bladder occasionally has a distinct mesentery formed by a double fold of the peritoneum.

Dr. David Thayer recommended China 6X given twice a day for five days, then every other day, then one dose every third day, then once a month.

Dr. John H. Clarke gives calcarea carb. 30X at fifteen minute intervals during the attack; if this fails, then berberis.

Gall stones are rare under thirty years of age - still children are not exempt; infants have been successfully operated.

I have seen a convalescent patient who had one thousand and sixty gall stones removed.

A tongue-like enlargement of the liver, Riedel's lobe, may be mistaken for the gall-bladder.

Hydrops of the gall-bladder due to the chronic obstruction of the cystic duct presents but few symptoms.

The gall-bladder may contain a retention cyst.
Doyen's method for resection-choledochorraphy.

When the stone is impacted in the duct, jaundice rapidly follows, with the usual yellow skin, and dark bile stained urine with the pipe clay feces.

Chills and fever occur sometimes with malarial regularity and due to gall stones.

In cholecystotomy the gall-bladder is sutured to the inner aspect of the abdominal wall and at the upper angle of the wound.

Stones are removed most quickly and safely by scoops of different sizes.

When the stone is impacted in the ampulla of Vater the transduodenal route is preferable.

The position of the gall-bladder is not constant.

The gall-bladder may be bifed hour glass shape, or absent, and the ducts merely fibrous cords.

Displacement of the gall-bladder may be due to outside adhesions to the stomach, abdominal walls, omentum, appendix or intestine.

Catarrhal conditions of the mucous membrane of the gall-bladder and ducts may be due to the presence of microbes and produce cholesterin and calcium salts.

Enteroptosis predisposes to the formation of gall stones; other causes are indigestion and constipation.

Jaundice is not necessarily associated with gall-stones, for the stone may not interrupt the flow of bile - its action may be ball-valve.

Lawson Tait has operated for gall stones and found only a cancer of the pylorus.

I have operated for appendicitis and found only the gall-bladder filled with twenty-seven large stones. And have operated for gall stones with the positive evidence of their presence and found only a pancreatic cyst.

Intuitive impressions must not be ignored by the surgeon or physician.

Milk should be sipped slowly and if the stomach rejects then add a few grains of carbonate and phosphate of soda.

Milk should be well shaken before taken.

When in doubt give full and if necessary frequent doses of castor oil to remove any suspicious impaction.

It is stated that seven-tenths of diseases of the abdomen have origin in the liver.

It is stated that gall stones are more frequently found in the insane than in sane women.

Inflation of the intestines per rectum may differentiate between a mobile kidney and a distended gall-bladder.

The pancreas is the next evolution of surgery.
Bibliography

Keay: "The Medical Treatment of Gall Stones." - Kehr: "Gall Stone Diseases." - Mayo Robson: "Gall Stones." - Osler: "Practice of Medicine." - Goodno: "Practice of Medicine." - Mausser: "Medical Diagnosis." - Anders: "Practice of Medicine." - Cowperthwaite: "Practice of Medicine." - Burnett: "Diseases of the Liver." - Hare: "Practical Therapeutics." - Farrington: "Clinical Materia Medica." - Quains: "Dictionary." - Coopers: "Surgical Dictionary." - Hales: "New Remedies." - Baehrs: "Practice of Therapeutics." - Thudicum: "A Treatise on Gall Stones." - Harley: "Diseases of the Liver." - Legg: "On the Bile, Jaundice, etc." - "Sajous's Annual and Analytical Cyclopedia of Practical Medicine." - "Reference Handbook of Medical Science." - Frerichs: "Diseases of the Liver." - Naunyn: "Gall Stones." - Osler, Neurer, Quincke, Hoppe, Seyler and Packard: "Diseases of the Pancreas, Supra-renal Capsules and Liver." - Wyeths: "Anatomy." - Robson-Moyniham: "Diseases of Pancreas." "Gynecological Transactions." - Greig Smith: "Abdominal Surgery." - Miller's "Practice of Surgery." - Jacobson: "Surgical Operations." - Warren: "Surgical Pathology and Therapeutics." - Smiths: "Surgery." - Reynolds: "System of Medicine." - Grauvogl: "Text Book of Homeopathy." - Pepper: "System of Medicine." - Erichsen: "Science and Art of Surgery." - Keen: "Gall-Bladder Perforations." - Turck: "Hepatic Duct Stones (Annals of Surgery)." Senn: "Practical Surgery." - Deaver: "Cholelithiasis (Phila. Med. Journal)." - Gregg: "Affections of the Gall-Bladder and Bile Ducts (North Am. Journal Hom.)." - Ferguson: "Surgery of the Gall-Bladder and Ducts (Journal Am. Med. Association)." - W. B. Van Lennep: "Surgical Clinics (1902-03)." - Helmuth: "System of Surgery." - Fisher and MacDonald: "Text Book of Surgery." - Dennis: "System of Surgery." - Holmes: "System of Surgery." - Park: "Surgery of American Authors." - Moullins: "Treatise on Surgery." "American Text Book of Surgery." - Wyeths: "Text Book of Surgery." - Ashurst: "International Encyclopedia of Surgery." - Weisse: "Practical Human Anatomy." - Bryant: "Operative Surgery." - Alberts: "Surgical Diagnosis."
Discussion

C. E. Walton, M. D.: If I were disposed to be complimentary and somewhat careless in the selection of adjectives, I would say that this is a most masterly paper. I do not say any such thing. Dr. Biggar has not told us half that there is to be said about gall-stones. He has not told us half that he knows about gall-stones. He has not told us one-quarter that is known about gall-stones. Consequently, any paper that does not fill those requirements cannot be said to be a masterly paper. But he has furnished us with a very interesting paper, and one which will furnish us, possibly, a topic for discussion. Dr. Biggar never appeared to me before, until he wrote this paper, as a straddler. You cannot tell now whether he is in favor of medication for gall-stones or whether he is in favor of operative interference for gall-stones. I shall take up, however, some of the statements that he has made. He tells us, and quotes some authority, that the knife is too frequently used in gall-stones. Why doesn't he tell us something about the cases where the knife is used too seldom. He tells us that in certain conditions medicines are useful. I believe it. When you are not sure whether you have got any gall-stones or not, fool along with medicines. When you are sure that you have gall-stones, better think about your knife. It is a matter, possibly, of information to be told that a certain proportion of people have gall-stones and never know it. What do we care about those people? It is the people that have the gall-stones, and the gall-stones are trying to get out, and raising the dickens, that calls for our interference. It is a matter of very great interest. He might have told us that the horse has no gall-bladder and that the ox has. That is a matter of pleasing information, but it is a matter of no importance when it comes to speaking of gall-stones. When your patient has gall-stone, how do you know it? You know it by the presence of gall-stone colic. You know it by the fact that he has called you out some time at night in dire distress, and he wants relief. What are you going to do? Are you going then to consider that possibly there is a pathological condition here, a pre-gall-stone condition, which may be reached by dioscorea, or china, or something of that sort? If you don't relieve that fellow's pain pretty soon he will say, "Doctor, you can go; I will get somebody else." Well, what is the condition there? Is that a condition for headaches? Well, possibly! It is not every case of gall-stone that calls for operation; we know that. We sometimes will diagnose a case which simulates gall-stone, which can be relieved temporarily; the patient never has another attack. We put down in our notebook that we treated J. L. T. at a certain time; he had gall-stone; we gave him china, or so and so, and he was cured. How do you know? You don't know anything about it. He had the symptoms of gall-stone. He might have had a mucous plug in the common duct or in the cystic duct, which gave you all the symptoms of the presence of a gall-stone. Then sweep out, and that is the end of it. It is well enough to use your medication when you have that condition which you suppose to be in inflammation of the gall-bladder or of the gall-duct; but when you have stones there, which are the cause of the symptoms, you have not necessarily a pathological condition, but you have a mechanical condition. The pathological condition has preceded it; the mechanical condition is there present. What are you going to do with it? The gall-stones may become quiescent, but suppose they do not? If you have recurrent attacks the only way to treat that condition is, not to palliate it, but use your knife and cure it. The paper says that frequently we have a re-formation of gall-stone. How do you know? There have been gall-stones found after an operation, but simply because the man that made the operation did not take all the stones out. How does he know they will be re-formed? As a matter of fact, if you take out all of the stones there will be very few cases of re-formation. How many ever operated a second time for a stone in the bladder? Once in a very small proportion of cases there is a re-formation; but very seldom. If you empty the gall-bladder and leave one hanging up there in the hepatic duct there will be a re-formation of the trouble, but no re-formation of the stone. The stone has been there all the time. I do not want to weary you too long about this, but I want to call your attention to some of the medications which have been advised. He talks about belladonna, a good deal like sending a boy to the mill. Never send a boy to mill when you expect him to bring home more than a man can carry. You would better, instead of giving belladonna, give atropine, giving 1-50th of a grain of the sulphate. In this way you get quick effects, and your patient, who is suffering all the time, does not have to wait two or three hours in which you are firing into him 30-drop doses of an indeterminate tincture, hoping that he may be relieved before you get back. If he is not relieved in the course of two or three hours, then you will know that you have something to do with your knife. That Durand's mixture is a sort of fizzle. It will certainly be a fizzle if it is made according to the way Dr. Biggar told you, because that is not the way Durand made it, if Dr. Durand knew what he was talking about, and some people say they do not think he did. One great peculiarity about Dr. Durand is that he can cure all his cases with his method, but nobody else has ever been able to compete with him in the exhibition of the same remedy. The Durand mixture is composed of one part of turpentine and sixteen parts sulphuric ether. Once in a long while it will do some good, but simply because we know that chloroform, or ether, if put in a bottle will dissolve a real accommodating gall-stone after it has been taken out of the body and put in the bottle, but it does not signify at all that you can pour enough chloroform into a man's stomach to run up that man's cystic duct and dissolve his gall-stone. The only way to get rid of the gall-stones is to go in there with a knife and remove them.

J. W. Hayward, M. D.: While the younger men were talking, although they are subjects of great interest to me, I did not feel like opening my lips. But since the boys of my age are on the floor, I feel as if I might say a word. I have lived in the days when surgery was not thought of for the cure of gall-stone. I had the fortune to be under the tuition or with a practitioner who was zealous in whatever he undertook. He insisted that china would cure every case of gall-stone. I followed him. I had a large reputation in my neighborhood, extending from Maine to San Francisco. I have sent china to Chicago, to Detroit, to San Francisco and to a great many other places. I have seen gall-stones disappear under the use of china. I have this fact: I have the gall-stones. I know they came from the bowels. I know that patient after patient has never had another attack after the persistent use of it. I have in mind one now, who came from a neighboring city. I gave her china, nothing but china. She had had repeated attacks for over twenty years. I was called while she had an attack simply because her physician was not there, and told her that she had gall-stones. "It cannot be," she said; "Dr. So-and-so," and "Dr. So-and-so," giving the names of eight different physicians, all of them better men than I, and yet none of them had mentioned gall-stones to her, therefore this could not be gall-stone. I said, "Let me have your urine." The next morning I was there, and in the afternoon again. The next morning I saw the husband coming up the hill, puffing, and into my office. I said to myself, "I have got to go again," but instead of that he said. "What was it, Doctor?" He had three beautiful specimens. He had obtained them in the very way I told him to, and I have them now at home. But there are cases where I have operated for gall-stones, and I have cured them - no, I won't say that; I have seen numerous cases; I have given china; I have seen numerous cases where there had been repeated attacks, without having another attack after using china for a certain length of time. Atropine will generally, if given hypodermically, relieve the attack, but it does not prevent re-formation. I have seen gall-stone colic and gall-stone appear after the surgical operation, six months afterwards.

Dr. Walton: What is the life of a gall-stone?

Dr. Hayward: I do not know, sir.

Dr. Walton: I thought you did not.

Dr. Hayward: I do not know, sir; but I know pretty nearly the length of the gall-duct. Now, I think medicine and surgery are handmaids. They should go together. The surgical operation does not prevent the formation when the condition which produces the gall-stone is present. Notwithstanding the scalpel may be in the left hand of the patient or in the right hand of surgeon. He may open the gall bladder and he may take it out, and yet the condition which produces the gall-stone is not removed. I say the thing to do is to remove the gall-stone and then give them china.

A Member: What strength?

Dr. Hayward: I do not think it is so material what the strength is. I have never given it lower than the third decimal. I believe this will do just as well.

A Member: Dr. Thayer gave this?

Dr. Hayward: Dr. Thayer was the physician to whom I referred.

A Member: He gave the sixth.

Dr. Hayward: He gave from the third centesimal to the two hundredth; that is, selecting one dilution and giving it for a time, following it by a higher and still higher, and going back again to the lower, and so dropping back and forth. I guess that is a pretty good way to do.

I. O. Moss, M. D.: I have been somewhat interested in this discussion on gall-stones, not only with the admirable paper, but otherwise. But so far as the removal of gall-stones is concerned, I think the same conditions that produce them the first time might reproduce them. A number of years ago in our town there was a man who had suffered severely two or three years with gall-stones. They sent to Boston, to the city in which we now sojourn. Dr. Richardson, a surgeon of quite a little fame, came down and operated on that man. He removed three or four large gall-stones and cleared out the gall bladder entirely; we have no doubt about it. I had a little conversation with his brother following that, and he said: "The gall-stones are removed; he never will have any more trouble." Within six months of that time he was attacked with gall-stones, and went to Dr. Richardson of Boston. Dr. Richardson did not consider it necessary to operate a second time. He sent him off on the Atlantic, saying he thought he would give him the benefit of a voyage. He traveled down to South Carolina, and was taken with another attack. He went into port there, and he died the same night. An examination of the cadaver in the dissecting room at the college showed that the gall-bladder was literally filled with gall-stones. I presume that if there was one, there were a thousand. It was very largely distended, and there was no secretion whatever; it was literally gall-stones, and I feel positive that the scalpel by removing it does not remove the disease. The same conditions, I believe that produce them the first time will cause their recurrence.

W. L. Hartman, M. D.: I have been much interested in Dr. Biggar's Paper, also in Dr. Walton's discussion.

I would like to ask the gentleman who has lauded the china treatment what thirtieth and two hundredth would do with a gall-stone half the size of a hen's egg. Now this china question and the removal of gall-stones puts me in mind of a patient that I had about ten years ago. He was suffering with gall-stones and would not have an operation. There was a man in Rochester, N. Y., who had the reputation of removing gall-stones, and his time was but three or four hours from the time he gave his remedy. His remedy was large doses of olive oil. This dissatisfied patient of mine went to see the illustrious gentleman, and he gave him his famous treatment. The next day he came to me with a bottle about 8 oz. in size half filled with what was supposed to be gall-stones, and he said to me: "What do you think of those gall-stones?" Well, of course, they did look like gall-stones somewhat, but I had my misgivings of the exact nature of the little lumps he had in his bottle, so I remarked to him that if he would leave them on my desk over night, I would give him an opinion in the morning. Next morning my happy patient (or the other fellow's happy patient) came to me in great glee for my opinion and I handed him the bottle of olive oil which had dissolved during the night, but as for gall-stones, there were none. It was simply olive oil, and nothing else. Speaking of curing gall-stones - I have a case in mind at the present time where china and all other remedies mentioned had been given. The patient was a woman who had been having attacks repeatedly every month; sometimes every week, for twelve years prior to this, but who for four years had had no attacks at all. They had watched for stones, but never found any, watched very closely until suddenly one day she had a very hard attack and they found a stone. About ten days after this, I opened the gall-bladder and removed fifteen stones. They were the size of chestnuts, and smooth as pebbles on the beach. Therefore, when a patient ceases to have these attacks, it does not necessarily follow that they have no gall-stones. I operated upon a patient a few days ago where china had been given, but the stones were there just the same, and to my mind, I do not think that china would have dissolved them, for they were as smooth as glass, and I took 247 out of the gall-bladder. They were about the size of a marrowfat pea. I never saw so many stones together that were so near of a size. It would have been almost impossible to manufacture them any better if made to order. I believe that in a great many cases irritation from gall-stones in the bladder is the cause of the malignancy that we get arising in that portion of the anatomy. Now, what other troubles do we have here, what danger do we have in gall-stones - empyema of the gall bladder, and I believe malignancy is very often caused by constant irritation of this foreign substance. I saw a case last summer where the patient had intestinal indigestion. She had suffered from it for a good many years. She had colicky pains, not what we would call a true attack of gall-stone colic, but simply what we would get from the passage of a sandy deposit down through the duct. I was called to see the patient one night and she supposed she was dying with cancer of the liver, as she was told so by a supposedly eminent physician. I diagnosed the case as empyema of the gall-bladder due to gall-stone. The next day I cut down and found just one stone, which was about the size of a robin's egg, with four or five ounces of pus in the gall-bladder. Now we see a lot of these cases that get on without any trouble at all. It has been said that even after operation we have a return of this trouble after a period of three, four or five years, but it is not better to operate once in three or four years than to allow them to have repeated attacks of gall-stone colic once a week or once in two weeks when the operation itself does not entail any more pain, and perhaps not as much, as a single attack of gall-stone colic?

Now, I have tried china. I read Dr. Thayer's article and was very enthusiastic, supposing that I was going to cure every case of gall-stones that came to me. I had three or four cases and promised them a great deal - that I would cure them right away, but as Dr. Walton has said, "The other fellow got the cases after a little," for I did not cure them. Perhaps I did not prescribe properly, but I prescribed all the doses mentioned, and they had gall-stone colic just the same. On the other hand, I think when these patients run five years without an attack of colic, when previously to that they had had colic every month, but that does not signify that there were no stones there, however.

Speaking of jaundice in that paper, jaundice is not a good symptom of gall-stone, in fact, in jaundice there is a greater liability of a catarrhal condition than there is of stone. Unless there is a stone down in the duct which obstructs it, we will not have jaundice, and as a usual thing the stone will pass through before we have jaundice appearing. I believe that it is held at present by our best authorities that jaundice is not a reliable symptom in the diagnosis of gall-stone. In the treatment of these cases, the doctor mentioned a great many mineral waters. I believe that, if we urge our patients who are suffering from this malady to drink large quantities of water, it is as good treatment as we can give them. The olive oil treatment is one that I have tried. I have given olive oil a great many times and found that in some cases it would relieve. Whether or not the time had just arrived when the stone had slipped out of the duct I am unable to say, but I do not believe that it ever occurs. If we are positive that gall-stones exist in the gall bladder, I believe that we are not doing our duty if we do not operate. Now, as I said before, this patient upon whom I operated about ten days ago had been suffering for twelve long years with gall-stones and she would have suffered for the next 112 years (if she had lived) if the stone had not been removed mechanically. I believe that as long as there are gall-stones existing in the gall-bladder there will be an irritation, and as long as we have the irritation we are liable to have colicky conditions.
ALLEN H. C., The Materia Medica of Some Important Nosodes (al2)

Cholesterinum

[cholesterinum (c26h44o)]

Description

- To the late Dr. Wilhelm Ameke, of Berlin, we are indebted for the first mention of this remedy. From him Dr. Burnett obtained the suggestion and used the lower potencies with more or less success for several years, a description of which he gives us in his Diseases of the Liver.

- Unfortunately the remedy was either given in alternation or followed by other remedies in such a manner as to greatly mar the validity of its clinical work.

- Swan appears to have taken his hint from Burnett's work and potentized the remedy, using a gall-stone for his preparations. Like many of the rest of the nosodes originally introduced by Swan, the work was necessarily empirical, yet he affirms after much experience that it is "almost a specific for gall-stone colic; relieves the distress at once".

- And this after failure with Nux, Cinchona, Carduus, Podophyllum and other apparently well-selected remedies.

- Yingling reports some cures of gall-stone colic and other diseases of the liver in the Medical Advance, page 549, August, 1908, and arrives at the following conclusion: In gall-stone colic the patient suffers so severely that it is almost impossible to obtain symptoms. In such a case, when I cannot give a well-selected remedy, of late I rely on Cholesterinum, and thus far it has never failed. It should have a proving. Until then it can be used instead of Morphine in cases where the symptoms cannot be obtained for the proper selection of a remedy. Where a case of routine work is necessary, as it is sometimes, I believe the homoeopathic guess should be given the preference. It is very improbable that a person suffering from gall-stone colic will wait very long for the physician to study the case.

- Clarke says , it is found in the blood, in the brain, the yolk of eggs, seeds and buds of plants, but is most abundant in the bile and biliary calculi. It occurs in the form of crystals with a mother-of-pearl lustre, and is fatty to the touch. It is soluble in both alcohol and ether.

- Ameke claimed to have derived great advantage from its use in cases diagnosed as cancer of the liver, or in such obstinate engorgements that malignancy was suspected.

- Burnett claims to have twice cured cancer of the liver with it, and "in hepatic engorgements that by reason of their intractable and slow yielding to well-selected remedies make one think interrogationally of cancer." In such conditions, where the diagnosis is in doubt, especially if the patient has been subjected to repeated attacks of biliary colic, Cholesterinum, he claims, is very satisfactory and at times its action even striking.

- Yingling reports the following cases: Woman, age 60.

- Frequent attacks of gall-stones, involving liver and region of stomach.

- Attacks come suddenly and cease suddenly.

- Pain is pushing in region of gall duct.

- Vomits much odorless hot water.

- Very pale, then became yellow.

- Marked acidity of stomach since last attack.

- Erratic rheumatism; pain aggravated in damp, rainy weather.

- No appetite; food nauseates.

- Region of liver sore, sensitive to touch or jar, aggravated lying on the sides.

- Before the attacks profuse urine; scanty and dark since.

- Tongue coated dirty, yellowish white.

- Heart becomes very weak, can hardly feel pulse.

- Very weak, unable to breathe deeply.

- This woman was practically cured in a year, under various potencies of Cholesterinum, from the 2m. to the dmm.

- Man, age 64, for three years has been passing gall-stones.

- Vomits bile and becomes very yellow.

- Has received Morphine which causes such disastrous after effects that he is away from business nearly a week. With one attack was in bed several weeks, and required a long time after to recover from bad effects.

- Liver, very sensitive and sore; pressure in front or behind very painful, worse in region of gall duct.

- Bending or any sudden motion aggravates.

- Had severe attacks of ague in Wabash Bottoms when young. Is a large, portly man.

- Cholesterinum 2m. not only promptly relieved acute attacks, but has effected a practical cure.