On the morbid conditions of the bile and gall bladder / by Edwards Crisp.

  • Edwards Crisp
Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: On the morbid conditions of the bile and gall bladder / by Edwards Crisp. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Figure No. 2. in the plate, represents a gall-bladder in my museum from a woman aet. 60, who died of jaundice and ascites ; there were a great many calculi in the gall-bladder, which was distended with an albuminous fluid, probably its own secretion. The calculi, figures 1 and 4, are also in my museum. The first weighs 225 grains, and the liver in this case was granular and dense. Figure 4. represents a gall-stone weighing 203 grains, taken from a fat woman aet. 72, who had generally enjoyed good health ; but six months before her death she had vomiting, and pain in the region of the gall-bladder, and was intensely jaundiced. From the immense size of the common duct, it was supposed that a large calculus had passed into the duodenum. These preparations were in the museum of the late Mr. Langstaff, Nos. 1231, 1233, and 1240 in the printed Catalogue. Figure 3. is a gall-bladder I took from an old gentleman; the cystic duct was obliter- ated, and the calculi divided by membranous septa. Treatment.—As regards the treatment during a paroxysm of pain, I have nothing to add to my former statement, except that I think that the inhalation of chloroform might be used with advantage. I am not, however, acquainted with any case in which it has been tried. The remedy of Durande, before spoken of, I have only employed twice: in one instance the hepatic symptoms appeared to be relieved by it, but no calculi were found. The other case is now under treatment. Dr. Duparque {Rev. Med. 1844, vol. 1.) states in five cases of gall- stones, he administered a mixture of Jii. of Castor Oil, and 3L of Sulphuric Ether, a tablespoonful to be taken every half-hour. In four cases, calculi were expelled under the influence of the remedy; in the fifth case no effect was produced by it. Martin-Solon (Z’ Union Medi- cate, 1849, p. 543.) gave a man 24 years of age, in whom he had detected calculi by the touch, ten scruples of Oil of Turpentine, and five of Sulphuric Ether, in dandalion Tisane, and five calculi passed; the detritus of calculi was also found in the excrement; after this, no crepitus nor fulness could be felt over the gall-bladder. It is difficult to understand how this, or any other medicine can effect such an immediate influence on the contents of the gall-bladder, and the expulsion of these stones may have been coincidences only. When a calculus has attained a large size, there is no chance of reducing it, or of effecting its expulsion by solvent medicines (so called,) and it must be borne in mind, that the gall-bladder after a certain age, when it contains gall-stones, is so altered in size and structure, as to have lost its contractile power, and that if the magni- tude of the stone could be diminished, it would only add to the danger of the patient. I think that by great attention to diet, and exercise, the formation of these concretions may be prevented, and when present, if not of large size, they may be got rid of. A diet consisting chiefly of vegetable matter and fruits, with the avoidance of malt beverage, are the chief prophylactic means. It is difficult to persuade patients who have been accustomed to good living to adopt this regimen, but if fully carried out, I believe it will generally be found beneficial. Stomach and liver complications may exist, which will require a different treatment; but I speak of those cases of gall-stones which appear to depend chiefly upon a sluggish liver, and stagnant and fatty bile. 21, Parliament Street, October 20, 1851.
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