. Diseases of the gall-bladder and bile-ducts, including gall-stones . Fig. 23.—Gall-stone in Act of Extrusion into Duodenum,the Edges of the Opening being ulcerated. (No. 2,826, Royal College of Surgeons Museum.) Nearly all the museums have in them examples of gall-bladder duodenal fistula. Specimens Nos. 2,827 and 2,828in the College of Surgeons Museum are good examples. No. 2,826 shows a gall-stone in the act of extrusion, andit will be seen that the margins of the opening are ulceratingto allow of the passage. Death occurred after six weeks ofsuffering (Fig. 23). No. 1,399 in Guys Museum i
. Diseases of the gall-bladder and bile-ducts, including gall-stones . Fig. 23.—Gall-stone in Act of Extrusion into Duodenum,the Edges of the Opening being ulcerated. (No. 2,826, Royal College of Surgeons Museum.) Nearly all the museums have in them examples of gall-bladder duodenal fistula. Specimens Nos. 2,827 and 2,828in the College of Surgeons Museum are good examples. No. 2,826 shows a gall-stone in the act of extrusion, andit will be seen that the margins of the opening are ulceratingto allow of the passage. Death occurred after six weeks ofsuffering (Fig. 23). No. 1,399 in Guys Museum is a specimen of Dr. HaleWhites, showing a gall-bladder duodenal fistula 1 inch fromthe pylorus, large enough to admit the finger; and 33 inches INFLAMMATORY AFFECTIONS 87 above the ileo-csecal valve is a large gall-stone impacted inthe ileum. Nos. 2,261 and 2,262 in St. Bartholomews Museum show-gall-bladder duodenal Fig. 24.—A Portion of Liver with Gall-bladder, and a Piece ofthe Transverse Colon. The gall-bladder is much elongated and narrowed ; its fundus is adherent to thetransverse colon, and communicates with it by a circular orifice. (No. 1,589,Middlesex Museum.) No. 1,676 in Kings College Museum shows a gall-bladderduodenal fistula. Death occurred from peritonitis, thoughthe gall-stone had passed per annm. 88 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS No. 1,595 in the Middlesex Museum shows a gall-bladderduodenal fistula, through which gall-stones passed. Deathoccurred from intestinal obstruction. Gall-bladder colic fistulse are less common in the museums,probably because they do not often cause death. There are,however, a sufficient number of examples to show that eventhis method of discharging gall-stones is not altogether No. 2/809A in the Royal College of SurgeonsMuseum is an example of gall-bladder colic fistula caused bycarcinoma (Fig. 16, p. 65). No. 1,589 in the Mi
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