658 PRACTICE OF PHYSIC. 



occasioned by biliary concretions obstructing the biliary duct, 

 that we may commonly expect relief, and that our art may con- 

 tribute to the obtaining it. Such cases may be generally known 

 by the disease frequently disappearing and returning again ; by 

 our finding, after the former accident, biliary concretions a- 

 mongst the faeces ; and by the disease being frequently accom- 

 panied with pain of the epigastrium, and with vomitings arising 

 from such pain. 



MDCCCXXIII. In these cases, we know of no certain and 

 immediate means of expediting the passage of the biliary 'con- 

 cretions. This is generally a work of time, depending upon 

 the gradual dilatation of the biliary duct ; and it is surprising 

 to observe, from the size of the stones which sometimes pass 

 through, what dilatation the duct will admit of. It proceeds, 

 however, faster or slower, upon different occasions ; and there- 

 fore the jaundice, after a various duration, often ceases sud- 

 denly and spontaneously. It is this which has given rise to 

 the belief, that the jaundice has been cured by such a number 

 and such a variety of different remedies. Many of these, how- 

 ever, are perfectly inert, and many others of them such as can- 

 not be supposed to have any effect in expediting the passage of a 

 biliary concretion. I shall here, therefore, take no notice of the 

 numerous remedies of jaundice mentioned by the writers on the 

 Materia Medica, or even of those to be found in practical 

 authors ; but shall confine myself to the mention of those that 

 may with probability be supposed to favour the passage of the 

 concretion, or remove the obstacles to it which may occur. 



MDCCCXXIV. In the treatment of this disease, it is, in 

 the first place, to be attended to, that as the distention of the bil- 

 iary duct, by a hard mass that does not easily pass through it, 

 may excite inflammation there ; so in persons of tolerable vigour, 

 blood-letting may be an useful precaution ; and when much 

 pain, together with any degree of pyrexia, occurs, it becomes an 

 absolutely necessary remedy. In some instances of jaundice ac- 

 companied with these symptoms, I have found the blood drawn 

 covered with an inflammatory crust as thick as in cases of pneu- 

 monia. 



MDCCCXXV. There is no means of pushing forward a bil- 

 iary concretion that is more probable than the action of vomit- 



