. Diseases of the gall-bladder and bile-ducts, including gall-stones . seum,specimen No. 2,809 shows a mela-notic sarcoma of the gall-bladder. Simple growths in the gall-bladderare not of great clinical importance,except as precursors of malignantdisease. The following specimenshave been found in the museums : No. 2,812, Royal College of Sur-geons, shows villi and papillae onthe mucous surface of the gall-bladder associated with 1,404, Guys Museum, showspapillomata in the gall-bladder froma woman of fifty-nine, who died ofphthisis. They are sessile towards thefundus, and pedunc
. Diseases of the gall-bladder and bile-ducts, including gall-stones . seum,specimen No. 2,809 shows a mela-notic sarcoma of the gall-bladder. Simple growths in the gall-bladderare not of great clinical importance,except as precursors of malignantdisease. The following specimenshave been found in the museums : No. 2,812, Royal College of Sur-geons, shows villi and papillae onthe mucous surface of the gall-bladder associated with 1,404, Guys Museum, showspapillomata in the gall-bladder froma woman of fifty-nine, who died ofphthisis. They are sessile towards thefundus, and pedunculated towardsthe neck of the bladder (Fig. 38).In the Museum of the Western Infirmary, Glasgow, is abeautiful specimen of adenoma of the fundus of the gall-bladder, which has been described and figured by Dr. L. R. Sutherland, t No. 1,405, Guys Museum, shows a gall-bladder in whichthe mucous membrane is covered with warty growths. * Boston Medical and Surgical Journal, December 15, 1889. f Clinical Journal, April 7, 1897. % Glasgow Medical Journal, September, Fig. 38.—Papillomata ofthe Gall-bladder. (No. 1,404, Guys Museum.) TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 137 II. TUMOURS OF THE BILE-DUCTS. Cystic Tumours.—Tumours of the bile-ducts, per se, onlyoccasionally form a projection so large as to be distinguishedthrough the abdominal walls. Tumour, however, in suchcases is, as a rule, present sooner or later on account of theobstruction in the ducts and secondary distension of the gall-bladder. The common duct has been found dilated to sucha size as to form a cystic tumour, presenting all the charac-teristics of a distended gall-bladder, the gall-bladder itselfbeing atrophied. Terrier describes four cases in which an external fistulousopening wTas established in the common bile-duct. In threeof these the duct was much distended, and formed a distinctabdominal tumour. The first case was one in which medianlaparotomy was performed for the removal of a swellingdiag
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