. Diseases of the gall-bladder and bile-ducts, including gall-stones . on round worms werevomited and also found in the motions. The child ultimatelydied, and post-mortem examination revealed dilated bile-ducts, with multiple abscesses in the liver. Mertens supposition, that the worms were enabled toenter the common duct from the duodenum by reason of theducts having been dilated by the previous passage of gall-stones, seems to be the most likely explanation of theirpresence in such an unusual situation. Malignant Disease is a common cause. There is an excellent example {i,30Ja) in St. Thomass
. Diseases of the gall-bladder and bile-ducts, including gall-stones . on round worms werevomited and also found in the motions. The child ultimatelydied, and post-mortem examination revealed dilated bile-ducts, with multiple abscesses in the liver. Mertens supposition, that the worms were enabled toenter the common duct from the duodenum by reason of theducts having been dilated by the previous passage of gall-stones, seems to be the most likely explanation of theirpresence in such an unusual situation. Malignant Disease is a common cause. There is an excellent example {i,30Ja) in St. ThomassHospital Museum, where the ducts throughout the liver aredilated and filled with pus, the infective cholangitis beingdependent on malignant disease of the papilla of the commonbile-duct (Fig. 12). Case 12 is that of a man, aged forty-two, who suffered from * Deutsche Med. Wochenschrift, 1898, No. 23. 56 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS deep jaundice, with intermittent fever and ague-like gave relief, but the patient died a few weeks. Fig. 13.—Inflammation of Gall-bladder and Bile-ducts in in seventh week. (No. 1,395, Guys Museum.) after, when a growth of a malignant character was found inthe common bile-duct, and the ducts throughout the liverwere inflamed and filled with pus. INFLAMMATORY AFFECTIONS 57 Typhoid Fever furnishes the museums with several specimensof infective cholangitis and cholecystitis. No. 1,395, Guys, is a specimen from a patient of Dr. HaleWhites, and shows inflammation of the bile-passages andcholecystitis without any obstruction in the ducts. Deathoccurred in the seventh week (Fig. 13). No. i,594A in the Middlesex Museum shows inflammationand ulceration of the bile-passages in typhoid fever. Influenza is not generally recognised as a cause ; but caseshave occurred in which the symptoms have been quitecharacteristic, and have come on within a few weeks after anattack. The causes mentioned may truly be termed
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