the second book. No notice of the lapis fellis tauri is to 1000 p. year Chr. Avicenna wrote about and after the nat.; his works were translated by Gerard, of Cremona, about 1114. About 200 years after this date we find another notice of gall-stones in the Liber Pandectarum Medicinæ,' by Sylvaticus ("Matthew Moretus Brixianus, Bononie in medicina et astronomia legens"), originally published in 1317. The beautiful edition of this work contained in the College of Surgeons' library is not paginated, and dated 1474. In this edition the 533rd chapter contains this passage:-" Massatum c. lapis qui invenitur in felle bovis." Gesner says in the place last quoted that Sylvaticus also terms the gall-stone "guers," and that both "massatum" and "guers are Arabian expressions. Like most words in Sylvaticus they are perhaps unintelligible, as is also the alleged Arabian word "haratzi," mentioned by Scaliger. Neither "massatum," nor" guers," nor "haratzi,' nor the "alcheron" of Rhazes, is contained in the lists of expositions of Arabian words given by Andreas Alpagus Bellunensis. On these doubts about the expressions of Sylvaticus, see Freind, Hist. of Physick,' 1750, ii, 265; also Reinesius, Variar. lection., libr. tres,' Altenburgi, 1640, 4to. Seventy or eighty years after the pandectarian Sylvaticus the first observations of gall-stones in the human subject were made by Benivenius (Ital., Benivieni), a celebrated physician at Florence. He wrote a treatise On the Hidden Causes of Diseases,' which illustrates better than any other I am acquainted with that part of the first aphorism of Hippocrates, which maintains that experience is fallacious and judgment difficult. The work was not published until several years after its author's death, which took place in 1502. Perhaps the carliest edition is that which was published at Florence, in quarto, in 1507, under the title A Bâle 'Anton. Benivenius, De abditis morborum causis.' edition, in quarto, of the year 1528, is the last of four uniform tracts contained in the library of the Medical Society of London. For the following quotations I have used the edition, with annotations, in Remberti Dodonai Medicinalium observationum exempla rara' Amstelodami (dated on titlepage erroneously 1521, should perhaps be 1621, the dedication and preface to the reader being dated respectively 1584 and 1581, in which latter year the first octavo edition of the same work seems also to have been published). Dodoens was professor at Leyden, and flourished about the year 1588. Cap. III." Stones found in the membrane surrounding the liver. A certain noble lady had been suffering greatly and for a long time from a pain in the situation of the liver, and although she had consulted a great many physicians, she had not been able by any remedy to get rid of her malady. For this reason she was pleased to try our aid, together with that of others. We met several physicians, and discussed at great length on all sides what might be the hidden causes of the disease. However, as happens frequently in doubtful matters, we could not agree to a verdict, for some had supposed an abscess of the liver, others a degeneration of that organ; we ourselves, however, believed that the fault was with the covering membrane. When she, after a few days, during which the illness increased upon her, had departed this life, as we had, from the certain signs, foretold by common consent, we procured the opening of the dead body. And there were found small stones, differing in shape and colour, which had been collected in the lower part of the membrane of the liver. Some stones were round, others angular, others quadratic, as position and accident had effected it; some had red spots, others were distinguished by blue-and-white ones. By their weight they had formed of the covering of the liver a small sac, of the length of the hollow of the hand, and of the width of two fingers. As we believed these to have been the cause of death, we judged it vain and useless to dispute on obscure matters." Annotation of Dodonæus." It sometimes happens that stones are found in the gall-bladder, as is stated below in the 94th chapter; but that the membrane of the liver becomes relaxed, and stones are hanging down in that, is one of the rarest occurrences. I recollect to have seen the livers of some who had fallen from icterus into ascites so hard, and so full of little stones everywhere, that they could not be cut through with the knife. Andreas Vesalius, in his letter to Roelants, on the China root (smilax, a kind of sarsaparilla), relates something similar of a certain Belloarmatus, a Senensian, whose liver was found entirely white, and not of an even but of a very uneven surface, and roughened with projecting tubercle; the front part, however, and the entire left lobe were indurated like a stone." The cases of Dodonæus look more like cases of cirrhosis than instances of liver-stones. The description of Vesalius also, as here given, of a case of indurated liver, would appear to have no reference to gall-stones. But it is extraordinary that this quotation from Vesalius is not complete, inasmuch as the account of the eighteen gall-stones found in the gall-bladder in the same case is omitted. This could not have occurred had Dodonæus quoted from the work of Vesalius directly. Donatus, in repeating the first case of Benivenius and the first part of the annotation (Scholion) of Dodonæus omits all mention of the reference made by the latter to the passage in the letter of Vesalius, and he consequently already judged that this passage of Vesalius had no reference whatever to gall-stones, and, like Dodonæus, he did not read the passage in the work of Vesalius. If the account of Benivenius's first case might make the reader suspicious that he was ignorant of the existence of a gall-bladder in man, and mistook it, filled with calculi, for a morbid formation, this suspicion will be set at rest by the perusal of his second case, which in Chapter 94 is thus related: "A calculus in the gall-bladder.-There died in these days a noble lady, of the name of Diamantes, struck down with the pain of stone (in the bladder). But as she had not before suffered any injury from it, the physicians thought well to open the body. And there were found very many stones; none, however, in the (urinary) bladder, as was believed, but, with the exception of one, of a black colour and the size of a dry chestnut, which was contained in the gall-bladder, all the others were in the skin by which the liver is covered, out of which they had formed a little sac, in which they were hanging as in a bag. As we believed that this was the cause of death, we concluded that it was the prudence of a wise man to make himself no opinion at all about the uncertain and occult diseases." Annotation of Dodonæus.-"Calculi which have been formed in the gall-bladder we have ourselves also observed. Those (who suffer from them) become of a yellowish colour, are troubled with nausea and disinclination to food, and are long in bad health." A similar case is recorded by Peucerus, the son-in-law of Philip Melanchton, and a most learned man ('Lib. de Præstig. mediocr.,' p. 316):-We recollect that a large stone was taken out of the liver of a friend (who had died at Paris and been eviscerated), which by its livid-yellow colour showed that it had been coagulated in part from phlegm, in part from melancholic humour." He recorded the same or another case in his commentary (De divinationum generibus'), and gave an account of it to Kentmann. In this case of Hieronymus Scriba, who was tutor to Count Valerius Cordus, and died at Paris in 1547, three calculi were found in the liver. One of these stones, says Kentmann (Libell. de Calculis') was of about the size of half a pigeon's egg, entirely angular, of a livid colour, and made up of phlegm and melancholic humour. The calculi adhered to the flesh of the liver, so as only to be covered by the covering of the liver; all were moderately hard (Schenckius, edit. of 1609, p. 453). Andreas Vesalius, in his epistolary treatise entitled 'Radicis Chinæ usus,' 1546, already referred to (I quote from the Leyden edition of 1547, in the library of the Medical Society of London, p. 249), gives the case of Belloarmatus, an eminent advocate, as an illustration that the spleen could perform the function of the liver. The advocate had listened to a lecture by Vesalius on the obstruction of the hepatic and cystic ducts, had then consulted the great professor in the library, where he was sitting with his students, and had proposed to come to the dissecting-room the next day, and to observe diligently those parts. He was, however, suddenly taken with illness and died. On dissection, Vesalius found that he had succumbed to hæmorrhage into the peritoneum, proceeding from an abscess, which had corroded the caudex of the portal vein. The liver was found as above stated, and softened near the abscess. The gall-bladder was unusually yellow, and in it were contained eighteen calculi, very light, of a triangular shape, with even edges and surfaces everywhere, green by colour, and somewhat blackish. But when they were dry they looked more ash-grey coloured, and by their bulk reminded of chick-peas. The spleen was very large. Vesalius relates another no less remarkable case, namely, that of Prosper Martinus, a Florentine noble, who had for many years suffered from jaundice. He had at last died rather suddenly. Vesalius was riding past his house, in which some surgeons had already begun the post-mortem |