CHOLECYSTITIS


CHOLECYSTITIS. A very bad morphine habit had been picked up through the years of pain, and the eradication of this was even harder to accomplish than the involution of the stone. He was constipated but relied on laxatives for relief, so deepening the atonic state of the colon continually, through frequent false stimulation and its resultant enervation.


I often wonder if anyone has even seen a case of cholecystitis that did not show the colon bacillus, with the usual pus generators. In forty-eight years or practice. I have seen no case that did not point to its origin in the putrefying and fermenting contents of this ordinarily foul sewer, the colon.

In dealing with this subject it is well to remember that the gallbladder is merely a convenient reservoir for the accumulation and storing and distribution of bile, and so far as is known no other function is demonstrable. Yet it is most convenient storehouse or sulsus for this purpose, and without it the bile would fail to function as was plainly intended by nature.

With the arrival of fats in the duodenum there is a contraction of the gallbladder, forcing out bile to begin the emulsification of this fatty material, the larger the amount of fat the greater the amount of bile extruded. Fats cannot be properly saponified and prepared for absorption till they have been first quite completely emulsified, and as this emulsification can be accomplished only by the bile, it becomes evident that without a sufficiency of bile most fatty material must escape absorption and metabolism, so lost as nutritive material.

The fact that one can live without the gallbladder is no evidence that its presence is not essential to perfect nutrition, for one can also live without a kidney or appendix, but not so fully or completely. Surgery is not justified in treating the gallbladder so lightly as is usual, for to extirpate this title sac is to place a permanent handicap on fatty digestion for the life of the patient. So far the only effect is to stimulate a little more respect for the gallbladder and to point to the origin of its troubles as the colon in every case.

Considering the fact that all materials except the fats absorbed from the small and large intestines must pass through the liver, via the portal circulation, it becomes easy to connect colon states or conditions with the various ailments of the liver and its ducts, including the gallbladder.

All know the intimate connection between colitis in its various forms and abscess of the liver, due to the facts recited. The chief function of the liver is an elaborator of materials delivered to it through the portal system of veins, and if it were not for this organ we would not survive the daily intoxication of the usual colon for more than a very few short hours, as has been demonstrated in the laboratory animals, by short-circuiting the portal circulation, allowing it to go direct into the general circulation by means of a by-pass. In every case convulsions and death resulted so promptly that it left no doubt of the essential function of the liver as a filter, whatever else may be its duties.

The tropical infections that result in liver abscess show first as a colitis, the toxic material developed there in all cases being the direct cause of the secondary infections of the liver, consequently of the gallbladder.

The toxins intercepted by the filter function of the liver are turned out into the bile ducts, there to contact the lining membranes of the gallbladder and bile ducts, and their breakdown is not surprising.

Since the colon is so plainly the origin of the infections that attack the liver and gallbladder, it is necessarily to the colon that we look when we seek to remove the cause.

Many will remember the surgery of the colon advocated and practiced by Dr. Charles A. L. Reed, of Cincinnati, Ohio, in his search for the cause of epilepsy, and the almost as drastic surgery of Sir William Arbuthnot Lane, of London. The latter has stated that ninety per cent of all the diseases that afflict this frail human stem from the colon, and his colectomies did show recoveries in many conditions not seemingly related to the colon anatomically.

Yet the colon, like the gallbladder, is a most convenient organ, if its presence is not necessary to life, and the wholesale colectomies practiced by these men seem hardly justifiable by even considerably improved general states of health.

Fortunately the colon is so situated that its care is a simple matter without its removal, and it is possible to almost sterilize the organ in situ.

For the past thirty-three years, or since I have been confining all my work to correction of abnormal nutritional states, the number of infected gallbladders coming under direct examination and treatment has been very many hundreds, the percentage complicated by stone very great, yet their recovery has occurred with monotonous regularity, even stones disappearing in one or two years in every case except one, at the end of whose second year of dietary and colonic regulation stones still occupied the gallbladder, but reduced in size from that of a pigeons egg to the size of well developed peas, and most had been passed or disintegrated without colic, leaving but a half the original number. With this one exception every gallstone had disappeared within two years, and in but two cases was the involution of he stones complicated by colic.

The acute infections of the gallbladder in many cases disappeared objectively in three days of drastic saline purging, meanwhile flooding the systems with fresh unsweetened fruit juices. In no case was any solid food taken during the three days of saline purgation, nothing but fresh fruit juices or vegetable juices being permitted.

In not one case was there perforation or other of the dreaded complications, and in case of adhesions these seemed to have ceased to cause pain or discomfort, even though the fluoroscope showed marked distortion of the sac.

Sluggish or non-functioning gallbladders were speeded up in their work, after even this short detoxication with the simple salines. This may be accounted for by the marked detergent effects of drastic saline purging, which renders the blood nascent and an excellent absorbing medium for all sorts of materials of inflammatory nature previously deposited in the tissues or the fluids of the body.

The treatment of both acute and chronic cholecystitis has always begun with this drastic saline purging, as an easy approach to rapid detoxication, during these thirty-three years of nutritional practice, not that recovery would not occur without this rather shocking preliminary, but merely to greatly shorten the time of treatment. This period of three days is followed by three daily high colonic irrigations, using ten to twenty gallons of water a little below body temperature, and containing two ounces of bicarbonate of soda to the gallon.

Following the complete emptying of the colon by the voluminous irrigation method a daily or twice daily enema of plain water is taken at a temperature of 80 F. or less, to make sure that no material is allowed to remain in the colon for longer than twenty-four hours, while it is well proven that the average habit of one stool per day represents at time schedule for the colon of seventy-two hours from the time food is eaten till it is completely voided from the body.

Twenty-five years ago I checked a series of one hundred cases with history of one movement per day, and who did not consider themselves constipated, using fixed colors, a different color with each noon meal for three days, during which it was clearly established that forty-eight hours was required to show peak of passage, and at seventy-two hours the color was still evident in the stools.

Five years later Friedlander and Alvarez of the Mayo clinic performed the same experiment, again on those who were the proud possessors of a once-daily habit, and who did not think themselves constipated. Their experiment was a little more exact and better controlled, as they used one hundred small colored beads of six different colors, one color fed with each of the three usual meals over a two day period. Each patient pursued his usual dietary habit without change of any character, so as to form an estimate of his rate of passage of food residues.

Each stool was washed and sieved, the beads collected and counted, to make the test as fool-proof as possible, and the published results were the same as in my previous experiment, twenty-four hours for first appearance of color, forty-right hours for peak of passage, and seventy-two hours still showing the color ingested three days previously.

Their results were published in the J. A. M. A., and their only comment would seem to indicate that they accepted this rate as normal. It was average, no doubt, but averages and normals bear very little relation to each other.

I firmly believe that foods eaten today should be entirely cleared from the colon tomorrow, and those cases who are willing to submit to a normalizing of the dietary habit and who keep the colon up to date every day by means of the tepid or cool two- quart enema, are in every case rewarded by a twenty-four hour schedule in time, the length of time depending on the age of the subject, the length of the history, and just how far the normal resiliency of the colon has been impaired by the usual practice of taking daily laxatives.

If a case of cholecystitis presents for treatment, whether acute or subacute, or whether simple or complicated by the presence of lithiasis, do not wait until search for a similimum has yielded fruit, but empty the whole man by means of the drastic saline purge, flood the tract with fresh fruit juices, but no other food, empty the colon completely by means of the high colonic irrigation followed by daily enema of plain tepid or cool water. Meantime search for the proper remedy, of course, but do not waste the first day or two of a chance to cut short the whole inflammation surely and always harmlessly by such simple means as the purge and the emptying of the colon.

Afterward restrict the use of animal fats to a daily maximum of two ounces of butter fat, though the same restriction need not apply to the fats of vegetable origin, which do not deposit a cholesterine or cholesterol during metabolism.

I often wonder at the evident reasoning of the surgeon who is content with drainage or removal of a diseased gallbladder. Operation is merely fussing with an end result, shutting the surgical eye to the causes underneath. To drain a gallbladder, to remove concretions, to extirpate the sac, cannot by any possible stretch of even the usual surgical imagination be considered constructive treatment.

To give present relief from pain and discomfort without insuring against a repetition of the cause is a childish objective, and if diseased states of the gallbladder originate in the character of the colon contents then surely any means that will not change the contents of this sewer cannot be considered as anything but temporarily expedient.

The same rates of the colon that caused the disease originally will cause its return, and if the gallbladder is not present to register the resulting disease this will show in other evidences of intoxication, and perhaps of much more serious character.

One of the most difficult cases of lithiasis it was ever my misfortune to attend was in a physician in the late forties who had suffered much from gallstones, finally had the thing drained surgically, in two years was in the same condition, lost his gallbladder, and two years later had a severe type of obstructive jaundice with intense pain, a stone lodged in the common duct, where it had evidently formed gradually for two years.

Obstruction was not complete, else he would not have lived three months, as he had done in great pain. A very bad morphine habit had been picked up through the years of pain, and the eradication of this was even harder to accomplish than the involution of the stone. He was constipated but relied on laxatives for relief, so deepening the atonic state of the colon continually, through frequent false stimulation and its resultant enervation.

He had abjured the enema as something habit-forming, not realizing that of all the means used for emptying the colon the enema alone is not habit-forming. Therefore the cause of his cholecystitis and later his lithiasis was continually operative.

Sterilization of the colon and correct dietary habit corrected the entire condition, but he was warned to used animal fats sparingly as long as he lived.

The usual type of gallstones is merely inspissated bile, though admixture of many chemicals difficult of solution is frequent, calcium perhaps predominating. The former are easy to remove through disintegration, the latter much harder and requiring a longer time. But a reversal of the chemical processes that caused the evolution of the stone will just as surely guarantee its involution, if the colon is kept up to the twenty-four hour schedule by means of the enema, and if the food is chiefly of the base-forming varieties, with considerable reduction in the usual fat ration of the food.

The so-called bilious temperament is merely an evidence of intoxication, chiefly of colonic origin, and in little children who in their first few years develop the frequent so-called acidosis attacks, the correction of the daily dietary and also the complete emptying of the colon every day will so completely change the picture that the parents will be able to say that the child has evidently not inherited the bilious temperament of either side of the house. After all, the type of treatment here suggested is merely a removal of evident cause, and not a specific treatment of cholecystitis or “torpid liver”. STROUDSBURG, PENNA.

DISCUSSION.

DR. STEVENS: I would like to ask what the members feel about the use of saline cathartics. It is something I almost never use except in a few cases, and I have had a very bad heart reaction following it, as something very weakening indeed. I would like to know what the other members feel about it.

DR. BRYANT: I have been through much of what this paper describes.

I was in San Francisco in 1928, on my way to Europe with a homoeopathic professor when I came down with a very severe attack of gallbladder trouble, accompanied by infection. I did not have to have saline laxatives, nor did I have to have any enemas, except on occasional postoperative. The remedy that finally relieved me and gave me lasting benefit was Lachesis.

It was a surprise prescription. I went south to Los Angeles and from there to Coronado, and was suddenly taken with a chill.

Dr. Polhemus, whom I think some of you know, in San Diego, came to see me. By the time he got there, this chill had become so violent that I asked somebody to please hold me. Even then they couldnt control that horrible shaking and I said , “If somebody would sit on me, I think I would get relief.” They piled on me all the covers they could find and surrounded me with hot water bottles. Dr. Polhemus said, “What a wonderful thing for you to stay. There is one of the keynotes for Lachesis. Patients with violent chills beg to be held down by sheets and even put in straitjackets.”.

I made an immediate recovery, and Lachesis has proved to control that condition completely. I left for home shortly after that, and then saw a patient with puerperal infection, and was able to verify that symptom on that patient. She had exactly the same condition and begged somebody to hold her, and asked her husband to please sit on her abdomen. Lachesis cleared that up very quickly.

That is a further evidence of what we all see, these modalities we must depend upon and find so valuable, and the new book of Dr. James W. Ward is going to bring us so much quicker to those. We have had to search so long. I had Gentrys old Concordance Repertory that I never really feel entirely confident about. I didnt feel it was sufficiently proven, but I have an entirely different feeling about Dr. Ward and I think most of you who see his book will realize what a masterpiece he has created for us.

A dark haired widow, aged forty-six years, stenographer, has had a cough with wheezing in the trachea for several years.

Aggravation from lying on either side, from laughing, from speaking.

Expectoration greenish, with salty taste.

Chest feels weak and empty after coughing.

Rawness and tickling in the larynx.

Awakes in the morning in profuse sweat, weak and exhausted.

1913, March 29. One powder Stannum 1M. B. & T.

May 18. Her cough is gone and strength is returning rapidly. New symptoms have appeared:.

Faint gnawing sensation in the stomach at 11 a. m.

Constipation with ineffectual effort to stool.

One powder Sulphur 1M. B. & T. completed the cure.

Clinical Experiences, ERASTUS E. CASE, M.D.

W H Hay