grs. The bladder was nearly empty, only two or three drops of bloody urine escaping from it. On tracing down the ureter, its upper portion was dilated to the extent of more than an inch. A coagulum of blood plugged up the lower end of this portion, and on removing it by the division of the tube, a few drops of bloody urine escaped, then some clearer fluid, then a white fibrinous coagulum, and, above all, some twenty drops of clear urine. On allowing the latter to fall into a watch-glass, without any admixture of the bloody urine, and then adding nitric acid, it was found to be very highly albuminous, instantaneous coagulation being produced by this test.

Exp. 7. The left kidney of a middle-sized rabbit, in rather good condition, was removed, and found to weigh 54 grs. The aorta was then tied, without any accident occurring, and was followed by the usual paralysis. This animal seemed to recover from the shock of the operation more quickly than some former ones; it was killed at the end of two hours. The right kidney weighed 85 grs.; it contained six or seven ecchymoses of various extent, in different parts of its substance, but chiefly on the surface; its colour was much lighter than in those experiments in which the engorgement of the organ was produced by venous obstruction. The bladder contained about a drachm of urine, which was bloody and albuminous.

AN ACCOUNT

OF

AN UNUSUALLY LARGE BILIARY

CALCULUS,

VOIDED FROM THE RECTUM.

BY JAMES ARTHUR WILSON, M.D.,

PHYSICIAN TO ST. GEORGE'S HOSPITAL.

READ FEBRUARY 14TH, 1843.

CASES truly clinical are often best distinguished by their missing symptoms. The Biliary Calculus, large as a full-sized walnut, which I now lay before the Society, on its passage to the bowel, induced jaundice, yet gave no pain.

It was voided with fluid fæces from the rectum of a gentleman aged 73, after many days of exhaustion by hiccough and vomiting. The early symptoms in this case were constipation, loss of appetite, and sickness, succeeded by jaundice in the latter days of November of the present year, 1842. In less than a fortnight from the commencement of the attack, the urine and fæces had recovered their natural appearance; the skin was no longer yellow, and the patient began to occupy himself with his

usual pursuits. On the night of December 9th, he was attacked, while in bed, by sudden and profuse bilious vomiting, with a "feeling of soreness" in the lower belly. His moral energies were much depressed, and the bowels again became slow. Shortly after this gush of bile from the stomach, a large quantity of highly foetid, dark-coloured fluid was ejected, likewise by vomiting. This offensive discharge soon became black as "coffee-grounds,” and continued at intervals for about thirty hours. Alternating with the fits of sickness, there was intense clammy thirst, with frequent and protracted hiccough. Until this period of the complaint, when, by the removal of obstruction from its excretory ducts, the bile had again found free access to the bowels, there had been no local suffering in any part of the abdomen. The pain, of which the patient now first complained, was at no time severe, and seemed to track the long pent-up bile and putrid fluid in their progress along the intestinal tube. After a short interval of remission, on December 14, all the urgent symptoms returned, with frequent grievous aggravation of the hiccough. Food in the smallest quantity was refused instantly by the stomach, and for two days the case appeared to be fast verging to a fatal termination. On December 17, the bowels, long previously inactive, under large and repeated doses of calomel and other purgatives, began spontaneously to relieve themselves, and soon gave passage to the smooth globular substance, which is now submitted for inspection to the Society. The

shining central radiated portion of this concrete mass is evidently cholesterine. Its brown laminated outer crust, interspersed with particles of crystalline matter, is supposed by Dr. Prout to consist principally of inspissated bile. It was examined by this distinguished physician and chemist, on the request of Dr. Latham, with whom I consulted on the case, at the most critical period of its character. Upon the event of this excretion, all the urgent symptoms gradually and entirely subsided. During their continuance there was no evidence of fever; the tongue was but slightly coated, and the pulse maintained it usual average of from 60 to 65 beats in the minute. The subject of this case, an old gentleman of cheerful temperate habits, resided in the West Indies during the greater part of his early life. For the last five and twenty years he has been much harrassed by a loud, inveterate stomach cough, accompanied by profuse expectoration, and frequent vomiting of a thick tenacious mucus. About ten years ago he voided more than twenty feet of tape worm, after a dose of turpentine, which he took on my prescription.

I have been reminded by this case of another instance of biliary concretion, analogous by its size and extent of pressure, as by the negative character of its symptoms.

On the examination, post mortem, of a female patient, aged 47, who died comatose, with jaundice, while under my care in St. George's Hospital, in October 1833, a round calculus, described in a note

of the same date as "enormous and large as a walnut," was found impacted in the ductus communis hepaticus. A smaller concretion of irregular shape was lodged in the duct, where it passes obliquely through the coats of the duodenum. The gall-bladder was small, nearly empty, and contracted to an hour-glass shape by partial adhesion of its inner central surface. It contained a small calculus in the cavity thus formed at its convoluted extremity. The ductus cysticus, the ductus hepaticus, and the bile-ducts generally throughout the liver, were exceedingly dilated by accumulation of their proper fluid behind the obstruction on its current to the bowel. The patient in this case had complained much of weight in the upper abdomen, but never of pain. There is an inference from these cases that may be remembered with advantage in our diagnosis of jaundice and constipation. The progress of gall stones, (even when inordinate in their dimension,) through the ducts, is not disproved by the absence of pain from the epigastrium.

Dr. Bence Jones has since favoured me with the following analysis of the substance in question :

"This calculus was lighter than water, and consisted of two parts, a central white crystalline radiating matter, which cut like wax, and an exter