Licence: Public Domain Mark
Credit: A periodical painful affection. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![hepatic region, but otherwise appears to be in usually good health—so much so that he imagines every ittack is certainly the last, until experience induces iiim to be skeptical of the most favorable symptoms. If relief is not afforded, these attacks, which at first only last a few minutes, will gradually increase in duration to several hours, or even days, with but very slight interruption. The pain in these\rttacks is described as burning, boring, cutting, shooting, aching, throbbing or lan- cinating, generally, however, of the character of the first two, sometimes described as a “ coal of fire in their right side.” It is confined almost entirely to the hepatic region, at times almost entirely to the front and right side, and at others extending around to the back, but sel- dom any ]jain is complained of on the left side. A |)hysical examination reveals a normal or but slightly accelerated pulse, and a normal temperature, a moist, although at times a slightly furred tongue, little or no headache. Occasionally there is a .slight sallowness of the skin in the advanced stages of this disease, but there is seldom jaundice. The appetite is usually g\od, although at times it is irregular, and occasionally it is poor. Now and then there is vomiting, which generally comes on during a severe attack of pain, when present at all, I having seen it in only one case, and Dr. Craig in but a few. An examination of the liver reveals but slight en- largement at any time, and often none at all; and but little tenderness even during the attack, and little or no tenderness in the intervals except in cases of long standing. There is no perceptible hardening of the gland or tendency to a nodulated or so-called “hobnailed” condition.](https://iiif.wellcomecollection.org/image/b22312742_0006.jp2/full/800%2C/0/default.jpg)
