. Diseases of the gall-bladder and bile-ducts, including gall-stones . l peritoneum,and internally by the peritoneum covering the right side of thevertebral column and passing up to the foramen of Winslow(Fig. 48). Morison-f has found this pouch to be capable of holdingnearly a pint before it overflows into the general peritonealcavity. He advocates drainage of this pouch and non-suture * Johns Hopkins Hosp. Bulletin, 1898. t British Medical Journal, November 3, 1S94. GALL-STONES, OR CHOLELITHIASIS 257 of the ducts, if there be any difficulty in securing the marginsof the opening. Mr. Frederic
. Diseases of the gall-bladder and bile-ducts, including gall-stones . l peritoneum,and internally by the peritoneum covering the right side of thevertebral column and passing up to the foramen of Winslow(Fig. 48). Morison-f has found this pouch to be capable of holdingnearly a pint before it overflows into the general peritonealcavity. He advocates drainage of this pouch and non-suture * Johns Hopkins Hosp. Bulletin, 1898. t British Medical Journal, November 3, 1S94. GALL-STONES, OR CHOLELITHIASIS 257 of the ducts, if there be any difficulty in securing the marginsof the opening. Mr. Frederick Page,* on the other hand, advocates carefulsuture of the opening in the duct, and closing the abdomenwithout leaving in a drainage-tube. He gives four cases insupport of his views. The late Mr. Greig Smith said that drainage is alwaysadvisable, and in this view we fully agree, as although inseveral cases there has been little or no discharge from thedrainage-tube, in others the bile-stained discharge for a fewdays has proved that the closure of the opening was not. Fig. -Transverse Section through Centre of Pouch described. perfect; and it must be borne in mind that, although theducts appear to be clear, it is impossible to be absolutelycertain, as was proved in Case 141, where under the supposi-tion that the common duct had been effectually cleared ashrivelled and mutilated gall-bladder was removed and thecystic duct ligatured, with the result that septic bile becameextravasated into the peritoneal cavity. A small gall-stonewas found obstructing the orifice of the duct where it wasopening into the duodenum. The same difficulty was ex-perienced in one of Fengers cases and in several of Kehrs.* Lancet, December 5, 1896. *7 258 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS Statistics of Choledochotomy.—As this is, perhaps, the mostdifficult and prolonged of the operations on the bile-ducts,the mortality is necessarily greater than that of simplecholecystotomy. In 1892 Martig ha
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