Gall-stones and diseases of the bile-ducts . Fig. 9.—A group of common facetted gall-stones. are laminated, and within the nucleus there is fre-quently a cavity filled with yellow alkaline calculi do not exhibit any distinct crystallinestructure to the naked eye. (4) Mixed bilirubin-calcium calculi.—These stonesare usually as large as a cherry or larger. A solitarystone is common, but groups of three or four may befound in the gall-bladder or large bile-ducts. Whenmultiple they are facetted. These stones contain25 per cent, of cholesterin, the remainder being 46 DISEASES OF THE BILE
Gall-stones and diseases of the bile-ducts . Fig. 9.—A group of common facetted gall-stones. are laminated, and within the nucleus there is fre-quently a cavity filled with yellow alkaline calculi do not exhibit any distinct crystallinestructure to the naked eye. (4) Mixed bilirubin-calcium calculi.—These stonesare usually as large as a cherry or larger. A solitarystone is common, but groups of three or four may befound in the gall-bladder or large bile-ducts. Whenmultiple they are facetted. These stones contain25 per cent, of cholesterin, the remainder being 46 DISEASES OF THE BILE-DUCTS bilirubin-calcium. The nucleus is cholesterin, coveredby thick layers of dark brown material which easilyflakes off. (5) Pure bilirubin-calcium calculi.—These stones. Fig. 10.—A large cholesterin calculus in section. vary in size from a grain of sand to a pea; theyoccur in two forms : (a) As solid, brownish-black concretions aboutthe size of a pins head with rough, irregularsurfaces. They are waxy, and show a tendencyto weld together. (b) These are, as a rule, small, steel-grey orblack, with a pronounced metallic lustre. They arehard and brittle, and have a spongy texture, and in GALL-STONES 47 the midst of the meshes there are small granuleswith a metallic lustre. Bilirubin-calcium is the chief constituent of thesecalculi, but there are always present, and often in
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