Gall-stones and diseases of the bile-ducts . Fig, 39.—A cancerous gall-bladder in section (Museumof the Middlesex Hospital). bladder are thick and tough, and firmly contractedon a set of gall-stones which completely fill it; yetthe organ is free from adhesions and mobile. Onthe other hand, it may be tightly contracted on a CANCER OF THE GALL-BLADDER 123 solitary gall-stone, and the growth so infiltrate the liverthat there is no obvious indication of the limit betweenthe gall-bladder and the hepatic tissue (Fig. 40).. Fig. 40.—A cancerous and calculous gall-bladder in section,showing the manner
Gall-stones and diseases of the bile-ducts . Fig, 39.—A cancerous gall-bladder in section (Museumof the Middlesex Hospital). bladder are thick and tough, and firmly contractedon a set of gall-stones which completely fill it; yetthe organ is free from adhesions and mobile. Onthe other hand, it may be tightly contracted on a CANCER OF THE GALL-BLADDER 123 solitary gall-stone, and the growth so infiltrate the liverthat there is no obvious indication of the limit betweenthe gall-bladder and the hepatic tissue (Fig. 40).. Fig. 40.—A cancerous and calculous gall-bladder in section,showing the manner in which the liver is infiltrated (Museumof St. Bartholomews Hospital). Cancer usually begins, as far as we know, nearthe fundus of the gall-bladder, but it may begin inany part of it or the cystic duct. The specimen 124 DISEASES OF THE BILE-DUCTS represented in Fig. 41 is instructive in this respect,for the neck of the gall-bladder and the cystic ductare infiltrated with cancer, which is occupied by asolitary calculus. The new growth forms a ledgeor collar of cancer around it. The gall-bladder wasfilled with pus. The patient died nine months afterthe beginning of the symptoms. The extension of cancer into the cystic ducthas a clinical interest, for in a woman, aged sixty-six years, who died under the care of Furth (seeWeber) with deep jaundice and extreme emaciation,the gall-bladder was filled with calculi and surroundedwith malignant growth; all the bile-ducts, intra- andextra-hepatic, were so dilated as
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