206 SYMPTOMATOLOGY. 



obstruction is greatly distended, and below empty. There 

 is obstinate constipation and vomiting first of food, then 

 of bile, and afterwards of stercoraceous matter ; there is 

 pain and tenderness of the abdomen, and other promi- 

 nent symptoms of peritonitis, which continues till death, 

 or until the stone makes its exit into the large intestine. 

 SYMPTOMATOLOGY. In considering the symptoms 

 arising from the presence of gall-stones in the liver, I 

 shall review them under the following heads : 



1. Those which arise from the presence of concretions 

 in the substance of the liver, and in the radicles of the 

 hepatic duct. 



2. Those which arise from the presence of stones in the 

 gall-bladder. 



3. Those which arise from the presence of stones in 

 the cystic duct. 



4. And those which arise from the presence of stones 

 in the common duct theductus comimmis eholedochus. 



(a) The symptoms appertaining to tin- first 

 rule <>f an ol.scure and indefinite <-h;ira I -Miallnrss 



oi the concretions, and the depth oi'tlu- suhstancir \vh 

 found, accounts I'm- this obscurity in a g] 



of dull j>ains in the liver, which some- 

 times extend upwards to the shoulder-Made and down- 

 luinU'i re-ion, and 01 tt portion 



of the abdominal region ; there is more or, less stomach 

 derangement, easily aggravated by slight errors in diet, 

 which give rise to nausea, retching, and vomiting, with 

 pains in the right hypochondrium. At other times 

 severe attacks of rigors set in, followed by heat and 

 perspiration. These, in the absence of jaundice and 

 other hepatic symptoms have led many to view the 



