. Diseases of the gall-bladder and bile-ducts, including gall-stones . 5 o s ffi free border of the lesser omentum, by the side, or in front of,the common duct, and unless it be borne in mind that threeor four lymphatic glands normally exist here, they may be ANATOMICAL CONSIDERATIONS 21 apt to mislead, especially as they are not unusually consider-ably enlarged where there is gall-stone irritation. Frequentlythey are as large as beans, and at times the size of 2,809 Hunterian Museum shows these glands muchenlarged and melanotic (Fig. 6). The large peritoneal pouch (Fig. 7) shown
. Diseases of the gall-bladder and bile-ducts, including gall-stones . 5 o s ffi free border of the lesser omentum, by the side, or in front of,the common duct, and unless it be borne in mind that threeor four lymphatic glands normally exist here, they may be ANATOMICAL CONSIDERATIONS 21 apt to mislead, especially as they are not unusually consider-ably enlarged where there is gall-stone irritation. Frequentlythey are as large as beans, and at times the size of 2,809 Hunterian Museum shows these glands muchenlarged and melanotic (Fig. 6). The large peritoneal pouch (Fig. 7) shown in the diagram—bounded above by the right lobe of the liver, below bythe ascending layer of the transverse meso-colon covering theduodenum internally, externally by the peritoneum lining. Fig. 7.—Peritoneal Pouch on Right Side of , Deepest part of the pouch ; 5, stomach. the parietes down to the crest of the ilium, posteriorly by theascending meso-colon covering the kidney, and internally bythe peritoneum covering the spine—has been long recog-nised, but perhaps not sufficiently appreciated in gall-bladdersurgery. Mr. Rutherford Morison drew attention to it in a paper inthe British Medical Journal for March 3, 1894. It is possible to drain this pouch satisfactorily by means ofa long glass tube, but it is probably safer on the whole tomake use of a lumbar drain. The author referred to places 22 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS such reliance on the ease and safety with which it can bedrained that he does not advocate much time being spentin suturing incisions in the gall-bladder or bile-ducts. It isinteresting to note that it is capable of holding nearly a pintof fluid before it overflows into the general peritoneal cavity,through the foramen of W
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