Etiology

There are many causes given by authorities on the subject. According to my way of thinking, the simplest and most correct explanation is that, as a necessary condition for the formation of gallstone, there must first be a primary period of catarrh of the gall-duct and gall-bladder. This must be aided by the gouty diathesis, and then by the habit, on the part of the patient, of eating too much of foods that carry mineral into the system, and too little of foods that eliminate. Excessive eating of starchy foods, sugar, and fat, and overstimulation with alcoholics, cause a sluggishness of the liver. First, the liver becomes hyperemic from an oversupply. This interferes with the nutrition of the organ, and enervation is established. Then we have retention of waste products. In those who eat foods that are potentially acid, to the neglect of those that are potentially alkaline, and then, as stated before, add a gouty diathesis, there is developed a condition that favors the building of stone in the gallbladder. This is further aided by a catarrhal thickening of the gall-duct, which to a certain extent impedes the passage of bile. With partial obstruction of the gall-duct, the gallbladder is inhibited in its housecleaning, so to speak. Every canal and cavity of the body will become diseased, if the process of natural cleaning is interfered with; and, as the flow of bile is somewhat inhibited by the catarrhal thickening of the mucous membrane of the gall-duct, this favors the retention of gall in the gall-bladder, and this again favors concentration. The thinner fluid will find an exit through the gall-duct, while the heavier will be retained. This gives a start for the formation of gallstones. It is said that experimenters have succeeded in producing gallstones by injecting micro-organisms into the gall-bladder of animals. Another experiment has been successfully tried, within my professional experience--that of introducing a small bit of chewing gum into the male bladder, after which a stone as large as a hen's egg was taken out. It required only about three years for the stone to reach that size. Hence--this being positively true--chewing gum must be the cause of stone in the urinary bladder, if micro-organisms injected into the gall-bladder produce gallstones in that cavity.

Without joking and without irony, any foreign substance finding lodgment, accidentally or otherwise, in closed cavities, especially the gall-bladder and the urinary bladder, has a tendency to become the nucleus around which stone forms into calculi of varying size. In some cases the gallbladder may be filled with one stone; in other cases there will be numerous stones. I have heard of as many as sixty to sixty-five being taken out of one gall-bladder.

It stands to reason that the food and water which carry the greatest amount of mineral will be most favorable to the development of stones in the body.

Symptoms

In many cases there are no symptoms further than attacks of indigestion, and at times a slight jaundiced yellowness of the skin; but in many cases of fully developed stone in the gall-bladder there will be no decided symptoms whatever. To the educated eye, patients who have this disease will always present symptoms of deranged digestion.

No one will develop gallstones and at the same time have the appearance of perfect health. The first symptom to arrest the attention of the patient is a feeling of fullness or weight, or a feeling of oppression, in the region over the stomach. The majority of cases will not be suspicious of anything wrong until they are taken with a pain so severe that it doubles them up. This they ascribe to indigestion. They will think that something they have eaten has thrown them into a colic. The disease is called gallstone colic. Previous to these attacks of severe pain there will be attacks of indigestion, weeks, and sometimes months, apart. When indigestion is accompanied by urticaria, or nettle-rash, it is well to be suspicious enough to investigate in the line of gallstones. It may be that the skin trouble has been produced by a sluggish state of the liver; but certainly, if there is much pain over the stomach, and a sensitiveness to pressure to the right of and a little above the umbilicus, the probabilities are that the disease is gallstones. Some cases will suffer very greatly, and remain sore for one or two days after they get over the gallstone colic. Patients recover from this affection, and sometimes run along for months--or, again, may not run along for more than a week--before they have another attack. It depends altogether upon how soon another stone will become lodged in the gall-duct. It is the passage of the gallstone from the gall-bladder into the duodenum that creates the suffering. These stones are usually rough and jagged, and cause great pain as they are forced through the passage.

It is not necessary, in going over the symptoms, to take up the various complications, such as ulceration, suppuration, and the dangerous perforation that follows these complications; for such cases must be put into the hands of physicians. Nothing short of an operation will prevent death in case of peritonitis from perforation. In complete obstruction of the gall-duct it may be that surgery will be the only procedure which promises relief. Such extreme symptoms are exceptional and belong to the province of the surgical specialist.

Treatment

No treatment whatever should be given to gallstones--the patient must be treated. It matters not what the deviation is from the normal, he must be brought back. Hence, to treat a case of gallstone successfully, the patient must be examined, habits must be inquired into, and everything necessary to correct the eating and care of the body must be done.

Constipation must be overcome by laxative foods. If the patient is suffering, and has been suffering a great deal, a fast must be insisted upon. No definite length of time can be given. It should, however, be prolonged until all pain and discomfort have passed away. During the fast, hot water should be taken freely--a pint every three hours, or even more. As soon as all discomfort has vanished, the patient should live for one week on fruit--any kind of fresh fruit--morning, noon, and night. No eating should be permitted between meals. Fruit must be eaten at the regular mealtime, and nothing at all between meals. The second week: fruit in the morning, and a combination salad, with one or two cooked, non-starchy vegetables, at noon. One of these vegetables should be spinach or onions, and they should be cooked properly--in very little water, so that there will be none to drain off. Spinach should be one of the raw vegetables in the salad. Lettuce, tomatoes, cucumbers, and spinach, with a small piece of onion for flavoring, makes a nice salad. Dress with salt, oil, and lemon juice. The evening meal should be one or two glasses of buttermilk. This should be the style of eating for the first month. The second month: fruit in the morning; toasted bread and fruit at noon, or rice dressed with salt only, and any kind of fresh, uncooked fruit; occasionally biscuit, butter, and honey, if so desired. If any drink is taken at the mealtime, it should be teakettle tea with the starch meal and fruit meal. Milk is not to be taken with meat.

The dinners may be meat every other day, with two cooked, non-starchy vegetables and a combination salad. The alternate days have potatoes, navy beans, corn bread, or any of the decidedly starchy foods in place of meat. Patients must give their bodies thorough attention by way of bathing, dry towel rubbing, etc. A hot bath of three to five minutes' duration should be taken every morning, with a quick cold sponge bath, to be followed with dry towel rubbing, and then dry towel rubbing at night before going to bed. This should be done daily. The skin must be put into good condition, so as to prevent catching cold; for the gallstones depend upon catarrh of the gall-duct and gallbladder. Unless the constitutional derangement that should be known as catarrh is cured, it will be impossible to relieve the patient permanently of gallstone formation.

Exercise regularly. Passive exercise should be practiced daily, besides being in the open air and sunshineeither walking, driving, or just enjoying the freedom of the out-of-doors. Old habits must be given up--such as eating between meals, eating candy, desserts, etc.