GALL-STONES AND DILI AH Y COLIC. 297 



throbbing of the temples, and fluttering at the heart. It will even succeed when 

 these symptoms are associated with derangement of the womb, piles, dyspepsia, or 

 constipation. It must be admitted, however, that sometimes it fails in the very 

 in which we should have expected that it would do good. The dose is five 

 grains three times a day, and it may be taken in the form of pills or dissolved in 

 water as a mixture. Should the valerianate of zinc fail, tincture of valerian taken 

 in water in tea-spoonful doses three or four times a day may be employed with a 

 fair prospect of success. 



Oxide of zinc pills (Pr. 66) have been highly recommended in the treatment of 

 these distressing symptoms. One or two should be taken three times a day. 



GALL-STONES AND BILIARY COLIC. 



Gall-stones are usually formed in the gall-bladder, but occasionally in the sub- 

 stance of the liver. Sometimes they occur singly, and sometimes in considerable 

 numbers. When they are solitary they are usually globular or oval, or pear-shaped. 

 When there are several, they commonly have numerous polished facets, the result of 

 mutual pressure and friction. Sometimes they are found accurately fitted to each 

 other, and then they are said to be articulating. They vary in size from a small 

 seed to a hen's egg. Their weight is inconsiderable ; when fresh they are heavier 

 than bile or water, but when dried they readily float. They vary in colour from a 

 pearly-white to a deep black, but most commonly they are of reddish-brown tint. 

 They consist of a substance known as cholesterine, with a certain amount of colouring 

 matter. On cutting them open, they are usually found to have a nucleus or core. 

 In exceptional cases, this nucleus may be some foreign body, such as a dead round- 

 worm, a piece of a needle, or even a plum-stone. The body, or that part of the 

 concretion between the nucleus and the crust, is marked with lines or furrows, 

 consisting of radiating crystals of cholesterine, or it presents concentric rings or 

 laminae, or is formed of an irregular mixture of cholesterine and colouring matter. 

 The outer crust can often be separated from the body like a shell ; it consists of 

 concentric layers of different thickness, made up chiefly of cholesterine. 



The tendency to gall-stones is rarely manifested before the age of thirty, though 

 in rare instances they have been known to occur in children. Women are more 

 liable to suffer from them than men, probably from their sedentary habits. Excess 

 in eating often predisposes to the formation of these bodies, and so does the habit of 

 taking only one meal in the twenty-four hours, in consequence of which the gall- 

 bladder is not emptied with sufficient frequency. 



As long as a gall-stone remains in the gall-bladder, it as a rule does no harm ; 

 but should it be forced into the narrow bile-duct, it causes the most exquisite pain, 

 and the patient suffers from what is known as biliary colic. The pain that attends 

 the passage of a gall-stone through the duct is agonising. Perhaps there is no pain 

 to which the body is subject that is more severe. Women who have had families 

 say that the pains of child-birth are nothing in comparison. We can hardly wonder 

 at this when we reflect that through a tube, of which the natural ske scarcely exceeds 

 that of a goose-quill, there sometimes passes a stone as big as a walnut. 



