PATHOLOGY. 173 
rion, the duffs were found free, and the gall-bladder 
empty, and no external tumour was difcovered; but in 
the liver there feemed to be a great accumulation of 
blood ; it was much increafed in fize, had a loole texture, 
and was in every part deeply tinged with bile. 
Schirrhous tumours of the contiguous parts, as of the 
head of. the pancreas, of the pylorus, fcrofulous enlarge¬ 
ments of the lymphatic glands in the capfule of Gliffon, 
and fteatomatous fwellings of the omentum, are often fo 
lituated as to obftruft mechanically the paflage of the 
bile into the inteftines; tubercles of the liver have 
fometimes alfo operated as extraneous caufes, and from 
their local fituation. Hopped the natural courfe of the 
bile. But the liver is often much enlarged by colledlions 
of large tubercles, which yet leave, in their interlaces, a 
perfect freedom for the aflion of the veffels and the paf- 
fage of the biliary duffs; and fcirrhus of the liver is 
hot ufually a general difeafe, but is confined to particu¬ 
lar fpots, which are often out of the way of the biliary 
paffages ; fo that it has been found, on diffe&ion, 
to have made confiderable progrefs without inducing 
jaundice. 
Tympanites is often accompanied by jaundice, a cir¬ 
cumftance which is to be deemed very unfavourable. In 
a cafe mentioned by Dr. Powell, the accumulation of air 
was fo great, that, very fpeedily after the appearance of 
jaundice, the ccecum was burft by it, and the patient de- 
ftroyed. 
From whatever caufe the obftruffion of bile may arife, 
the abforbents carry back that fecretion into the blood 
with the ferum ; and with which it becomes fo intimately 
mixed, that it is received into the minuteft of the white 
veffels, as in the eye and white of the nails. All the folid 
parts of the body, except the medullary fubftance of the 
brain, as fome have affirmed, even the bones themfelves, 
the fat, and the cartilages, have been obferved to be 
deeply tinged of a yellow colour. The fecreted fluids 
are generally alfo deeply tinged. In cafes of fome dura¬ 
tion, the perfpirable matter is coloured ; fb likewife is 
the faliva, which has a very bitter and bilious tafte : but 
the urine is much more highly impregnated with bile, 
and more fpeedily, than any other of the fecretions. In¬ 
deed the milk is the only exception which is made by 
authors; for the affeftion is fuppofed to extend even to 
the femen. 
The affirmation that the bilious tinge extends to the 
humours of the eye, has not been detedled by modern in¬ 
quirers, and is probably without any foundation. But 
Galen, Hoffman, Boerhaave, and Sydenham, all affert 
that they have occafionally witneffed the circumftance ; 
and Lucretius fays; 
Lurida prseterea fpeflant quaecunque tuentur 
Arquati. Lib. iv. ver. 333. 
On the other hand, Dr. Heberden, and other phyfi- 
cians of much obfervation and experience, have never 
found fuch a change of vifion in any patient; nor have 
we ever met with any living practitioner by whom it had 
been detected. It is not, indeed, animpoffible cafe, parti¬ 
cularly where the difeafe has been of very long continuance 
and great intenfity, when, fhould the cornea or humours 
of the eye become impregnated with bile, the light would 
pafs through a yellow medium, and objects thus be 
tinged of that colour. But thefe parts are not ufually 
found impregnated with bile. 
To fum up more clofely the fymptoms of jaundice, we 
may obferve, that it is marked by a yellow colour of the 
whole furface of the body, which is fir ft feen, and is molt 
corifpicuous, in the tunica eonjunttivu, or white part of 
the eyes, and at the roots of the nails. The urine is 
thick, of a deep yellowifli-brown colour; and tinges 
linen and other white fubftances, immerfed in it, of a 
yellow hue; and this indeed is confidered by many a 
pathognomonic fign. The bowels are often coftive, but 
fometimes loofe j and the ftools are commonly of a very 
pale and clay-like appearance both in confiftence and co¬ 
lour, from the abfence of bile, and have not the ufual 
feculent fmell. This difeafe is accompanied with a fenfe 
of much lalfitude and languor, and a great inaptitude 
to exertion ; with lownefs of fpirits, and a feeling of pain 
and tenfion, or weight and opprefllon, about the praecor- 
dia; there is alfo frequently much anxiety, and fome 
degree of difficulty of breathing, as well as a trouble- 
fome fenfe of itching over the fkin, unattended by any 
eruption. Many fymptoms of indigeftion are generally 
prefent; fuch as naufea, vomiting, flatulency and eruc¬ 
tations, and lofs of appetite : folid food taftes bitter in 
the mouth of fome patients ; and in fome ftates of the 
difeafe hiccup occurs, and occafional paroxyfms of ri¬ 
gour or chillinefs. The ftate of the pulfe varies much; 
in general it is fornewhat quicker than natural ; but in 
fome cafes, and particularly under the circumftances juft: 
mentioned, it is flower. The pain is fometimes extremely 
acute in the epigaftrium, or pit of the ftomach, or in 
the right hypochondrium, efpecially during the paflage 
of a gall-ftone. Moreover the latter circumftance much 
increafes the fymptoms. 
A pain, which is often moft acute and fevere, fo as to 
be hardly fupportable, but fometimes moderate, is pro¬ 
duced, and is often accompanied by Ihiverings, which 
afterwards occafionally recur. The pain is leated at the 
pit of the ftomach, and 1'eems generally to be confined 
to that point of the epigaftric region which correfponds 
to the fituation of the opening of the common dudt into 
the duodenum, and from this part it appears to dart 
through to the back ; the pulfe at the fame time conti¬ 
nues nearly as flow as is natural, and has none of the 
hardnefs attendant on inflammation. By an attention 
to the feat of the pain and this natural ftate of pulfe, Dr. 
Heberden obferves, that it is not difficult to foretel the 
outward yellownefs in many cafes, fome days before it 
appears. The breath, during the continuance of the 
pain, becomes fliort and hurried ; there is great general 
anxiety and reftleffnefs, fometimes amounting to deli¬ 
rium, and at laft great depreflion and fainting; the fto¬ 
mach is affected by naufea and retching; and there are 
often irregular fpafmodic twitches in various parts of the 
body. There are often profufe fweats, which are, how- ' 
ever, fometimes ahfent; and they do not depend at all 
upon the lhiverings, for they are fometimes prefent 
when no fhivering has occurred. Thefe fymptoms do 
not continue long in all their violence; for although the 
patient, during the paflage of a gall-ftone, is never free 
from fome pain, yet it increafes, by paroxyfms, to a ftate 
of acute fuftering, and fubfides again into one of com¬ 
parative eafe, during which there is a fenfe of deep-feated 
forenefs and fulnefs of the epigaftric and right hypo¬ 
chondriac regions. The greateft relief from pain is ex¬ 
perienced by bending the body forward upon the knees, 
in which pofition the relaxation of the abdominal muf- 
cles leaves the affeCted parts fubje&ed to the leaft pref- 
fure. Another fit, perhaps of equal or greater violence 
than the firft, then comes on, and alternates with another 
remiflion; this may occur feveral times in an hour; but 
fometimes the duration of the paroxyfm is much longer. 
At fome early period of thefe attacks, the jaundice 
makes its appearance; and it continues fora confidera¬ 
ble time after the violent fymptoms have difappeared. 
When the concretion has paffed, however, and the more 
urgent fymptoms have ceafed, the yellownefs may foont 
be perceived to diminilh in its intenfity; but, before it 
can entirely difappear, it requires that the whole quan¬ 
tity of the tinged ferum be removed by a gradual opera¬ 
tion of the excretory glands, and a frefli fupply in a na¬ 
tural ftate be introduced. 
The duration of the attack, including the whole time 
of the paflage of the concretion, is as various as its inten¬ 
fity; fometimes a few hours, fometimes feveral days, or 
even weeks, elapfe, before it is expelled. In the former 
cafe, the paflage is often fo rapid as not to allow time for 
