Volume 2

A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With ... prescriptions, ... bibliography ... formulae / [James Copland].

  • James Copland
Date:
1832-1858
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With ... prescriptions, ... bibliography ... formulae / [James Copland]. Source: Wellcome Collection.

    78/344 (page 392)
    commended in.) — Rigal, in Mem. de TouJouse, 1788. — Portal, Cours d’ Anatomie Méd. t. i. p. 21. (An tnstance of coma from narrowing of the carotid arteries.) — Seltz, in Brugnatelli, Bibliotheca Fisica, v. ii. — Brewster, Edin. Philos. Trans. for 1817. (Id*opath. coma from congestion.) — Cooke, Treatise on Nervous Diseases, v. i. p. 372! (Idtopath. lethargy.) — J. Frank, Praxeos Med. Univ. pre. cepta, par. ii. vol. i. sect. i. p. 367. — Bahn, in Encyclopad,. Worterbuch der Med. Wissenschaften, b. viii. p. 107. — (Bonet’s Thesaurus Med. Scrip. t. i. p. 715., and his Mer- curius, &c. p. 616. ; also Manget’s Bibliotheca Med. Script., art. Carus, and Ploucquet’s Medicina Digesta, art. Coma, may be consulted by the curious ; but little information ot importance will be obtained.) CONCRETIONS, Biukry’— Syn. Cal- cculi or Lapilli Cystici ; Calculi Fellei; C. Biliares; C. Biliarii ; Cholelithi ; Hepatalgia Calculosa; Var. Auct. Concrementa Biliaria, Soemmerring. Chololithus, Good. Culculs Biliares, Fr. Die Gallenstein, Ger. Gall-stones. Crassir. 1. Class, Codliaca; 2. Order, Splanchnica, Gen. iii. (Good). I. Crass, Il. Orver (Author). 1. Derry. Concretions formed in the bile-pas- sages, and occasioning in many instances more or less disturbance, with paroxysms of pain commonly referred to the right epigastrium and hypochon- drium, reaching to the back, &c., with increased suffering whilst passing into the alimentary canal, and often giving rise to sickness or vomiting, to Jaundice, and severe attacks of colic. 2. Biliary concretions were first noticed by Benzventus, Fariopius, VEsAtus, KENTMANN, and Frernexius, who were nearly contemporaries. They were afterwards more accurately described by Guisson, Horrmann, Morcacnt, Brancut, Borruaave, Van Swieren, and particularly by Harter; and the more recent researches of HEBERDEN, SOEMMERRING, THOMSON, THENARD, Bostock, Merart, and Curvrevt, have greatly advanced our knowledge of their nature and pathological relations. Notwithstanding the fre- quency of these concretions, and the very serious symptoms they occasion, but little attention has been paid to them by practical writers since the appearance of SopmMERRING’s Treatise ; and they have been nearly overlooked by the majority of systematic writers. Hatter remarks (what every pathologist will acknowledge), that they are in- finitely more frequently found in post mortem researches than calculi of the urinary passages ; and Hrprerpren agrees with him in admitting that, while urinary calculi are much more com- mon in the male, biliary concretions are most frequent in the female sex —probably in the proportion of one in the former, to four or five in the latter. 3. I. Duscription.— Biliary concretions vary remarkably as to form, size, number, and colour, as well as composition. a. T'hey may exist in any number — from one to a thousand, or even more. Morecacni, Warrer, and Barixiie, have found the latter number; and Sormmerrrye, with many of the authors referred to at the end of the article, have observed from fifty to several hun- dreds, and even upwards, either in the gall-blad- der, or in the ramifications of the hepatic ducts. When thus numerous, they are usually very smal] —- the size of pin-heads, or but little larger — of a dark brown, green, or greenish yellow co- and occasionally slightly agelutinated by thick bile. More frequently, however, a small num- ber, or two, three, or four are detected, and very often only one. When only two or three are found, they sometimes are jointed into each other, or have their opposite surfaces smooth or flat. In rare instances they seem divided by a septum. b. When one, two, or three only exist, they are usually large, but they seldom reach the sizeof a hen’s egg, or are much larger than a walnut. Dr. Saunpers, however, has found one of the bulk and figure of the gall-bladder, which it filled. They are not infrequently as large as a pigeon’s egg, or as a hazel nut; and are often found from that size downwards. c. Their colour varies through every shade of black, green, brown, yellow, white, &Xc., that of the surface often dif- fering from the centres and certain of their layers. They are often beautifully mottled or marbled; sometimes white and shining like spermaceti ; at other times dull like wax ; occasionally lamel- lated ; often crystallised or striated, either with or without distinct centres, which are frequently different in colour and composition from the por- tions crystallised or collected around them. They are also more or less opaque, or slightly translu- cent. d. Their form varies from a round, oval, or oblong — when they are solitary — to a cone, a cube, pentagon, polygon, &c., when more nu- merous. They are usually smooth, sometimes polished, particularly the surfaces that have been in contact with each other; more rarely rough or glabrous, and occasionally they appear as broken into fragments. e. Their consistence also varies from what is barely sufficient to preserve their form, to that which does not yield to the pressure of the finger, and is divided by a knife with difficulty. f. Their specific gravity is much more frequently below, than above, that of water ; consequently, they are commonly found swim- ming on the surface of water when the evacu- ations are mixed with it. 4. Situation and Composition. — Biliary con- cretions have been found in every part of the biliary passages: — Ist, In the radicles of the hepatic ducts; 2d, In the hepatic duct, and its ramifications; 3d, In the cystic duct; 4th, In the gall-bladder; and, 5th, In the common duct. They have been likewise found in every part of the intestines, in their passage out of the body ; and, in rare instances, in the stomach, whence they have been observed to have been ejected by vomiting, These concretions are often the result of obstruction to the course of the bile; and are then generally found to consist of an admixture of inspissated bile with mu- cus. But more frequently they are a conse- quence of an alteration of this fluid from its healthy constitution, as respects either the pre- sence of elements foreign to it, or the super- abundance of those which are the least soluble, and which are precipitated during the retention or accumulation of bile in the ducts and gall- bladder ; the latter being most commonly the case. Of this description are the concretions formed of a crystallisable fatty matter described by Poutrermr pe 1a Sate and Fourcroy, under the name of adipocire, afterwards hy Mar- cet, Bosrocx, &c., and named cholesterine by Cunvreut, Some biliary caleuli consist almost entirely of this substance. Others are formed of mucus and the thickened yellow matter, or the resin, of bile; and many are composed of choles- terine, the yellow matter, and the resin. Instances