508 MORBID ANATOMY.
2403. A calculus, from the hepatic duct, 2 in. in length, and 8 or 10 lines in diameter. (See No. 2369.) 1855.
Dr. Z. B. Adams.
2404. A calculus, about in. in diameter, and with marked ' fa^ettes, that was taken from the duct just within its open- ing into the intestine. The ducts generally were dilated, and the gall-bladder nearly obliterated.
The patient was a woman, forty-three years of age, who had been under the care of Dr. D. D. Thaj-er, and subject for about twenty years to attacks of pain, that were relieved by vomiting ; these attacks being perhaps owing to the passage of calculi, as the present specimen was the only one found, and its form showed that there must have been others. The orifice of the duct also readily allowed the passage of a common blow-pipe. In Nov., 1866, she was taken more sick, and never again did any work, though not confined entirely to the house. Through the winter she had frequent chills and heat. Pain in the epigastrium, and extending to the region of the gall-bladder, was from the first, and so long as she lived, a constant and often severe .symptom. In January, 1867, she became jaun- diced, and remained so ever afterward, and sometimes very deeply so. In Feb., 1868, she had epistaxis for three weeks, that threatened her life ; and in Nov., 1868, another severe attack that proved fatal about the fifth day. No trace of coagulum was found on dissection ; but the blood was very thin and pale, and a portion of it that was re- moved in a phial showed on the following day a yellow serum only, with a small amount of red sediment.
The tendency to hemorrhage has been shown in many other cases of jaundice that have occurred here, and in not a few has been the cause of death.
In regard to the calculus, it was thought that it may have passed down into the common duct in Nov., 1866, as there was never after that time any one great change in the course of the biliary symptoms. 1868.
Dr. J. B. S. Jackson.
2405. A dark-brown and nodular calculus, more than an inch in diameter. It passed into the intestine, and caused fatal obstruction. (See No. 2400.) 1858. Dr. C. Ellis.
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