[Footnote 24: Nitric acid at first turned the urine green, but on the application of heat it became red, and after prolonged boiling, of a pale straw colour. Hydrochloric acid changed the colour of the urine immediately to a deep olive-green tint.] The facts here elicited were interpreted as follows:-- 1st,--The quantity of urea which might be said to be normal, was considered a favourable sign, as it indicated that the stomachal digestion was unimpaired. 2nd,--The quantity of uric acid being below the average, was likewise regarded as favourable, tending as it did to negative the idea of cancerous disease of the liver; the uric acid being in such cases usually increased. 3rdly, and lastly, the presence of the biliary acids, as well as the bile pigment, in the urine, showed that bile was still being secreted, but re-absorbed, and this led at once to the diagnosis that the case was one of jaundice from obstruction. Here, then, was an important step gained. The next point was, if possible, to ascertain the cause of the obstruction. Taking into account the absence of any tumour, and any history of gall-stones, together with the fact of the sudden disappearance of the enlarged gall-bladder, my {76} first idea was that it might be a case of hydatids blocking up the common gall-duct, and that on one occasion, some large cyst had ruptured, and discharged itself through the intestines. On talking the case over with Dr. Prance, however, that idea was abandoned, and we were forced to content ourselves with the simple fact that the case was one of jaundice from obstruction of the common bile-duct, complicated with occlusion of the pancreatic duct, which fact had been previously ascertained by the discovery of the fatty acids in the fæces. About this time the patient took three grains of benzoic acid, in the form of pill thrice a day, and it was thought, with the advantage of slightly diminishing the jaundiced state of the skin. But no permanent benefit was obtained, and after a time this remedial agent had to be discontinued, in consequence of its having induced slight dyspepsia. In the letter I received informing me of this fact, it was also noted that there was much less both of the oily matter, and albumen in the stools. There was, at the same time, a considerable deposit of urates in the urine. The specific gravity continued to be about 1018. The quantity in twenty-four hours about forty ounces. On the 29th of November, the patient was again brought to me, and we made a careful examination of the size, shape, and exact position of the {77} hepatic organ. The measurements were found to be 5 inches at the extreme right, 4 inches at a line drawn perpendicularly to the nipple, and 2¾ inches midway between nipple and sternum. Beyond the centre of the sternum the liver did not reach. As regards the size of the liver then, there was still nothing very remarkable.