. Diseases of the gall-bladder and bile-ducts, including gall-stones . e for operation. When seen she was so ill that it was not considered safeto employ a general anaesthetic, especially as it was almostcertain she was now the subject of malignant disease as wellas gall-stones. The operation was done on July 20, cocaine being theonly anaesthetic used. The gall-bladder was aspirated, in-cised, and stitched to the parietes in the usual way, noattempt being made, on account of the weak condition ofthe patient, to exactly localize the obstruction. TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 147 No
. Diseases of the gall-bladder and bile-ducts, including gall-stones . e for operation. When seen she was so ill that it was not considered safeto employ a general anaesthetic, especially as it was almostcertain she was now the subject of malignant disease as wellas gall-stones. The operation was done on July 20, cocaine being theonly anaesthetic used. The gall-bladder was aspirated, in-cised, and stitched to the parietes in the usual way, noattempt being made, on account of the weak condition ofthe patient, to exactly localize the obstruction. TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 147 Notwithstanding the apparent simplicity of the operation,and the absence of visceral exposure, there followed a con-siderable amount of shock. There were hsematemesis and some little haemorrhage fromthe wound on the 21st and 22nd, and notwithstandingstimulation and other general treatment the patient graduallysank, dying from exhaustion on the 24th. At the autopsy, besides extensive heart disease and granularkidneys, there were found two large stones, one in the gall-. Fig. 41.—Tumour occupying the Junction of Hepatic, Cystic, andCommon Ducts, and completely occluding them. (From drawingby Dr. Roberts.) The hepatic ducts have been cut, and are turned forward. bladder, the other impacted in the cystic duct. Situated atthe junction of the cystic, hepatic, and common bile-ducts,was a growth about the size of a filbert, which was found,when the ducts were opened, to completely occlude them(see Fig. 41). There were no adhesions in the neighbourhood, nor werethere any secondary growths to be found. The stomachshowed no evidences of ulceration, but there were slightsigns of cirrhosis of the liver. There was no peritonitis. Cancer of the ampulla of Vater was probably first described 10—2 148 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS by McNeal in 1835 in the North American Arch., Baltimore,and was later drawn attention to by Stokes in 1846.* Morerecently the subject has been fully d
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