1 28 PRACTICE OF MEDICINE. 



condition of the pulse is extremely variable, and the skin is usually 

 dry, with a sense of itching or stinging. 



The morbid appearances found in persons who have died with 

 jaundice depend on the causes which have produced the disease; 

 and they may be deduced from the enumeration of those already 

 given. 



Treaiment. — The treatment of jaundice requires much discri- 

 mination on the part of the medical attendant. As it almost always 

 depends on some affection of the liver or neighbouring organs, the 

 chief attention should be directed to the cause of the malady. 



When the jaundice depends on excessive secretion of bile, 

 local depletion over the region of the liver, with diaphoretic 

 medicines, and demulcents, will be found useful. If the liver itself 

 be inflamed, the treatment must be the same as that indicated under 

 the head of "hepatitis." 



Jaundice from congestion of the vena portce should also be com- 

 bated on the same principles. Finally, when the disease depends 

 on some chronic affection of the liver, it is a symptom of compa- 

 ratively little importance, as our whole care should be directed 

 towards the organic lesion whence it originates. For jaundice 

 depending on spasm of the biliary ducts, full doses of opium, aided 

 by warm bath, and hot fomentations to the abdomen, will be found 

 advantageous. 



GALL-STONES. 



Gall-stones may exist in any part of the biliary passages; they 

 are also extremely various both in size, number, and shape. The 

 causes of gall-stones are obscure, but their formation is frequently 

 connected with imperfect assimilation of the nutriment. They are 

 composed of the colouring matter of the bile, and of cholesterine. 



Symptoms. — Biliary concretions often pass into the duodenum 

 without causing any disturbance; on other occasions, the patient 

 is suddenly seized with acute pain in the right hypochondrium, 

 increased on the slightest motion, and shooting backwards under 

 the scapula; the pain is increased after meals. There are also 

 nausea, vomiting, distention of the abdomen, and alternations of 

 diarrhoea and constipation. The paroxysms occur at irregular 

 intervals; the pulse is commonly natural, and the skin cool. 



Treatment. — The treatment of biliary calculi, or rather of 

 the irritation produced by their passage into the duodenum, is 

 merely palliative. Opium, or its salts, should be freely admi- 

 nistered, to relieve the agonizing pain which is frequently the most 

 prominent S3'^mptom, and warm anodyne fomentations should be 

 applied to the abdomen. Dr. Prout recommends large draughts 

 of warm water containing carbonate of soda in solution. The 



