. Diseases of the gall-bladder and bile-ducts, including gall-stones . Aug. work, entitled Medical and Surgical Observations,published in 1793 : Enormous Gall-stone removed after Death. — Concerningthis case Richter writes : There was a stone in the ductuscholedochus which, on account of its uncommon size, I havecaused to be engraved in the annexed figure. It weighed3 ounces 5 drachms. All round the stone was fluid bile, sothat this fluid had evidently passed by the stone into theduodenum. It fell into three pieces on being taken external surface resembled a very firm extrac
. Diseases of the gall-bladder and bile-ducts, including gall-stones . Aug. work, entitled Medical and Surgical Observations,published in 1793 : Enormous Gall-stone removed after Death. — Concerningthis case Richter writes : There was a stone in the ductuscholedochus which, on account of its uncommon size, I havecaused to be engraved in the annexed figure. It weighed3 ounces 5 drachms. All round the stone was fluid bile, sothat this fluid had evidently passed by the stone into theduodenum. It fell into three pieces on being taken external surface resembled a very firm extract ofliquorice. On some places there were evident marks ofother stones adhering to it. The thick end of the stone wasin the duodenum ; the most pointed was turned towards theneck of the trail-bladder. GALL-STONES, OR CHOLELITHIASIS 151 They may be round, egg-shaped, barrel-shaped, elongatedwith pointed ends, or angular, the surface being smooth,mammilated or irregularly faceted. Gall-stones, when large,are often single, but when small or moderate in size they are. Fig. 43.—Largest Gall-stone ever described. usually numerous, and several hundreds may be found; forinstance, in Case 67 there were successfully removed bycholecystotomy no less than 720 gall-stones from the gall-bladder and dilated cystic duct of a woman aged fifty-six. Their 152 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS colour is variable; in some cases it is white or gray, in othersvery dark, or even quite black, but the usual colour is a darkyellow or brown. In consistency they are ordinarily firm,but as a rule may, without much difficulty, be fractured bypressure between the thumb and forefinger, the fracture beingcrystalline ; they may, however, be as hard as a lithic acidcalculus, or as soft as half-set putty. The chief constituentof gall-stones is cholesterin, which always occurs in thecrystalline form; but bile-pigments, bile-salts, lime, mucus,degenerated epithelium, and rarely foreign bodies, may enter
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