In the August, 1907, number of the THERAPEUTIST, I reproduced from the Virginia Medical Monthly, an article by Dr. Charles S. Webb, with the above title. I have received requests for sample copies of this number of the journal until I have but a few copies to spare. Furthermore, the subscribers for the present year are desiring to know the details of Dr. Webb's method. I have therefore thought it best to reproduce that method is this number of the journal. The plan of this journal is not only to present the best things but to keep them before the readers in such a way that they can always have immediate access to them, whenever required.
The doctor's idea is to overcome the pain and to produce relaxation by the internal use of chloroform and compound spirits of ether, then he depends upon position, and the use of castor oil. He presents the plan as follows:
|Olive Oil||ozs. 2|
|Mucilage acacia||ozs. 2|
Mix. Shake well. Dose: two teaspoonfuls every four hours. These doses may be varied somewhat as to quantity and interval, if the conditions seem to require it. After taking this mixture for about forty-eight hours, let the patient fast for ten or twelve hours and then give the following dose:
|Spts. eth. co.||dr. 1|
|Olive oil||ozs. 8|
Mix and shake well. Take all at one dose. The patient is then directed to lie on the right side, with hips slightly elevated (about four inches) for one hour; then, on the left side, with hips elevated about twelve inches, the spinal column being kept as straight as possible, so as to form the hypothenuse of a triangle of which the perpendicular is twelve inches and the base a smooth mattress. This position is kept, if possible, for one hour and a half. After this, the patient may sit up, or walk around the room, if so disposed.
"After three hours," the Doctor says, "I give a full dose of castor oil and await results. The discharges should all be saved, well diluted and strained through a wire sieve. The stones are mostly of an olive green, or dark golden brown color, and vary in size and shape according to their impaction. Any careful observer who has once seen and examined gall stones will have no difficulty in identifying them, against the "fatty concretions" and foreign substances sometimes mistaken for them. I cannot too strongly urge that the success of this treatment depends on the accurate observance of every detail.
"If the patients ask, as they sometimes do, if they will be forever free from biliary colic after treatment, I simply tell them that no reputable physician can guarantee them against a second attack of anything, not even smallpox. I can say, however, that all the cases I have treated have had a long respite, and I know of only two who have ever had a return.
"This is my idea of the rationale of the treatment. The chloroform (as in the first prescription) relaxes the involuntary muscles. We are told by anatomists that there is no muscular fibre in the bile ducts, but there is in the duodenum. The hepatic duct and the cystic duct unite at an acute angle and form the common duct, which descends through the right borders of the lesser omentum and behind the descending portion of the duodenum to the inner side of that intestine, where it terminates by passing obliquely between the muscular and mucous coats, and opening on the summit of a papilla, which is common to it and the pancreatic duct.
"The papilla is situated near the lower part of the descending portion of the duodenum at the inner side, and the duct is constricted in size during its passage between the coats of the intestines." (Wilson's Anatomy.) This author also says that a few smooth muscular fibres have been observed in the biliary ducts, but there is no special muscular coat.
"The chloroform, administered at four hour intervals produces general relaxation, and the biliary ducts partake of it. Notice also that the 'common duct is constricted in size during its passage between the coats of the intestine,' that is, between the muscular and mucous coats. This part of the duct, therefore, is also enabled to dilate or expand because of the relaxation of the muscular coat of the duodenum. The compound spirits of ether given with the final dose of olive oil also helps this dilatation.
At this stage of the treatment the position is everything. When lying on the right side, with the hips elevated four inches, the oil glides out of the stomach into the duodenum and backs up as in a reservoir.
When the position is changed to the left side, as described, the oil finds its way into the common duct and perhaps into the gall bladder and so the tubes are lubricated, the calculi are oiled up, and when the patient assumes the upright position the oil flows out by the force of gravity and brings the calculi along with it.
"This is my theory as to how the whole thing is done and it seems to be reasonable, for if a gall stone can come out of the tubes, why cannot the oil go in, if the position is favorable, like pouring liquid into a bottle? This is the only way in which I can account for the facts which have now been observed too often to be considered a mere accident or a post hoc."
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.