. Diseases of the gall-bladder and bile-ducts, including gall-stones . side by side in Guys Museum are specimensNos. 1,456, 1,457, 1,458, and 1,459, showing by no meanslarge calculi—one, in fact, only weighing 55 grains—all ofwhich, nevertheless, caused fatal obstruction, and specimensNos. 1,449, I»45°5 and ij45i> showing large stones safelypassed per avium, though in one case the stone was 3! inchesin circumference, and in another 3 inches long and \\ inchesin diameter. In a case of Dr. J. Blackburns the stone, 3§ inches longby 11 inches broad, actually produced no symptoms exceptwhen at t
. Diseases of the gall-bladder and bile-ducts, including gall-stones . side by side in Guys Museum are specimensNos. 1,456, 1,457, 1,458, and 1,459, showing by no meanslarge calculi—one, in fact, only weighing 55 grains—all ofwhich, nevertheless, caused fatal obstruction, and specimensNos. 1,449, I»45°5 and ij45i> showing large stones safelypassed per avium, though in one case the stone was 3! inchesin circumference, and in another 3 inches long and \\ inchesin diameter. In a case of Dr. J. Blackburns the stone, 3§ inches longby 11 inches broad, actually produced no symptoms exceptwhen at the anus. The gall-stone is in the HunterianMuseum, No. 143A. In the Hunterian Museum, No. 2,436, is shown a beautifulspecimen of a gall-stone weighing 400 grains, and measuring 102 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS 2 inches by i^ inches, taken from a woman of fifty-two. Thefistula; between the gall-bladder and duodenum throughwhich it had passed into the bowel is also shown. In the Middlesex Museum are two of the most perfect * :#Si; f m 1 *® f | .. Fig. 27.—Large Gall-stones pro-ducing Acute Intestinal Ob-struction, PASSED PER ANUM,with Recovery of Patient. (No. 317A, Leeds Museum.) Fig. 28.—Large Gall-stoneimpacted in Ileum, andproducing Fatal Obstruc-tion. (No. 1,493, Middlesex Museum.) specimens of the kind to be found (Nos. 1,493 and 1,595).No. 1,493 shows a portion of the middle of the ileum(Fig. 28). Impacted in it is a large, almost spherical gall-stone, nearly 4 inches in circumference. It has been sawn INTESTINAL OBSTRUCTION 103 in half, and the upper fragment removed. The mucousmembrane of the intestine corresponding to this has beendestroyed by ulceration. The intestine above the obstruc-tion is dilated. Its peritoneal surface is partly covered withlymph. The gall-stone had passed into the duodenum,through an ulcerated opening between it and the gall-bladder. The patient was a woman aged forty-six, who died in thehospital, January 31, 1856. Twe
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