Gall-stones and diseases of the bile-ducts . Calcium carbonate ranksnext. Pure bilirubin-calcium stones are found inthe gall-bladder, sometimes in its mucous membraneand in the intrahepatic ducts. The true denizensof the gall-bladder are the common mixed chole-sterin stones. It is a noteworthy fact that stones ofthis kind removed from any one gall-bladder arealways alike in appearance and constitution. A solitary calculus closely embraced by themucous membrane of the gall-bladder has a roughsurface, due to small tubercles, and if these becarefully examined they will be found to correspond GALL
Gall-stones and diseases of the bile-ducts . Calcium carbonate ranksnext. Pure bilirubin-calcium stones are found inthe gall-bladder, sometimes in its mucous membraneand in the intrahepatic ducts. The true denizensof the gall-bladder are the common mixed chole-sterin stones. It is a noteworthy fact that stones ofthis kind removed from any one gall-bladder arealways alike in appearance and constitution. A solitary calculus closely embraced by themucous membrane of the gall-bladder has a roughsurface, due to small tubercles, and if these becarefully examined they will be found to correspond GALL-STONES 49 to the pitlike depressions (foveolae) which beset themucous membrane of the gall-bladder. There is a condition of the mucous membrane ofthe gall-bladder occasionally seen in which thesefoveolse are occupied by small dots of bilirubin-calcium; these are the beginnings of calculi, andmore rarely its inner surface is sprinkled withcholesterin crystals, which are adherent to the epi-thelium. The museum of the Medical School attached. Fig. 13.—A solitary tuberculated gall-stone. to Charing Cross Hospital contains some carefullyprepared specimens of this, and in two of the pre-parations the spangles of cholesterin on the mucousmembrane sparkle like the tinsel on the coat of aharlequin. The mode of origin of gall-stones.—Our knowledgeof this matter we owe to Naunyn, who showed thatthe cholesterin of which they are so largely com-posed is not derived from the bile, but from theepithelium of the gall-bladder, especially wheninflamed; little masses of cholesterin, mixed with 4 50 DISEASES OF THE BILE-DUCT bilirubin-calcium form the nuclei of the stones, andthese two substances may collect about shed epi-thelium and clumps of bacilli which may happen tobe in the gall-bladder. Micro-organisms, especiallythe Bacillus typhosus, coli communis, streptococcus,and pneumococcus, are often present in the gall-bladder, and thus act in a twofold capacity, for theyset up a catarrhal co
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