SYMPTOMATOLOGY. 207 



case as one of intermittent fever ; indeed, the eminent 

 Frerichs himself frankly acknowledges having fallen 

 into this error by treating a case of this kind for some 

 months with Quinine, whilst a " post-mortem " revealed 

 numerous calculi about the size of a bean lying in the 

 hepatic duct. 



(6) Numerous calculi may be present in the gall- 

 bladder for a length of time without producing any 

 morbid derangements, particularly if the concretions be 

 small and smooth on the surface. If the concretions 

 are large and numerous, they tend to set up a catarrhal 

 or plastic inflammation, with pains of a dull or pinch- 

 ing character about the epigastrium, which extend to 

 the right shoulder, lumber region, and hip. The gall- 

 bladder becomes distended, is easily mapped out by 

 palpation, and, if the concretions are large, they may be 

 clearly recognised both by manipulation, the naked ear, 

 or the stethoscope, when a grating or rattling noise may 

 be distinctly heard. The appetite becomes impaired, 

 there is indigestion and constipation, but there is no 

 jaundice. These symptoms are not always present ; 

 there may be a total cessation of all signs, but they are 

 particularly apt to supervene after great exertion, riding, 

 driving over rough roads, and excesses in diet. They 

 however disappear to a very great extent under the 

 influence of rest in the recumbent posture. 



(c) When stones of any size leave the gall-bladder 

 and enter the cystic duct, they cause a group of 

 well-marked and severe symptoms, known as HKPATIC, 

 BILIARY, or GALLSTONE COLIC. These symptoms 

 usually commence about two or three hours after 

 a meal, or about the time that the contents of the gall- 



