In cases of this kind, the obstruction is not usually to be found within the liver itself, but in the ducts after their exit from the hepatic organ. The seat of the obstruction, too, is much more frequently found near to, or at the termination of the common duct, than close to the liver. The obstruction may be of three kinds:-- {40} Firstly,--A congenital deficiency of the bile-ducts. Secondly,--An accidental obstruction in the course of the ducts, as from gall-stones, hydatids, or the entrance of foreign bodies from the intestines. Thirdly,--From closure of the outlet of the common duct, as, for example, from the pressure of the pregnant uterus, or distended transverse colon, or from organic disease of the pancreas, or neighbouring organs. First, as regards cases of jaundice from congenital deficiency of the ducts. Cases of this kind are rare. The best with which I am acquainted is the one that was brought before the Pathological Society last year, by Dr. Wilks. "The child had never passed any meconium, the motions always being of a white colour. When a fortnight old, jaundice came on, and continued until death, at the age of six weeks. After death, the liver was found of a dark green colour, and, apparently, the gall-bladder was absent. On further examination, however, the cellular tissue, which appeared to occupy its place, was found to be occupied by a small canal, just large enough to contain a bristle; to this, however, no outlet could be found, and on endeavouring to discover the hepatic ducts, these, in like manner, could not be made {41} out. The opening of the common duct in the duodenum was natural, but no hepatic duct could be found joining the pancreatic. It appeared, therefore, as if the larger ducts had become shrunken and obliterated."[14] [Footnote 14: "Medical Times and Gazette," 29th March, 1862.] Through the kindness of Dr. Wilks, I had the opportunity of making a microscopical examination of the liver. The hepatic cells were very small in size, much broken up; very few possessed nuclei, and all were deeply tinged with brownish yellow colouring matter. Scattered throughout the hepatic tissue, I found numbers of well-formed cholesterine crystals, like those represented in Fig. 3.