[Gallstones and "liver obstruction" in medical texts of antiquity]

Gallstones are rarely mentioned in the medical texts of antiquity. The physician, Alexander of Tralles mentions-for the first time-stones in the gallbladder as a possible cause for obstructive jaundice. This designation is found in his textbook on medicine under the heading "obstruction of the liver". Based on that observation, we describe the ancient history of hepatic obstruction and investigate the connection with the rare reference of gallstones in the medical texts of antiquity.

First, we evaluated the medico-historical literature on bile-stones and liver obstruction in antiquity, which has been published since 1900. The identified ancient sources we have analyzed for the purposes of etiology, diagnostics and therapy. Second, we searched for additional ancient sources with a combined keyword search in Greek and Latin text databases to check the completeness of the mentions of gallstones and liver obstructions known from the research literature.

There are two mentions of stones in the liver and gallbladder: Aristotle probably describes stones in the liver of slaughtered sacrificial animals and the late-antique physician, Alexander of Tralles, in the gallbladder of humans. The mechanical obstruction of the bile ducts as a cause of jaundice has been known since Diocles of Karystos (4^th century BC). For the first time, Galen of Pergamon describes the disease pattern of a liver obstruction (2^nd century AC). This was due to the coagulation of the yellow bile, one of the four humors of ancient humoral pathology.

Although gallstones were rarely mentioned, the clinical presentation of gallstone disease was known to ancient authors of medical texts and was referred to as liver obstruction.