. Diseases of the gall-bladder and bile-ducts, including gall-stones . , the following notes of cases may be useful: Case 1 (No. 127).—-The patient, a woman of fifty-four,gave the history of having had an enlarged gall-bladder fortwelve years, which had given no trouble until three yearsbefore, from which time she had had gall-stone four months she had been failing in health, and whenseen, the gall-bladder reached the right groin, and the rightlobe of the liver the level of the umbilicus. TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 129 She was operated on on November 23, 1895, and o
. Diseases of the gall-bladder and bile-ducts, including gall-stones . , the following notes of cases may be useful: Case 1 (No. 127).—-The patient, a woman of fifty-four,gave the history of having had an enlarged gall-bladder fortwelve years, which had given no trouble until three yearsbefore, from which time she had had gall-stone four months she had been failing in health, and whenseen, the gall-bladder reached the right groin, and the rightlobe of the liver the level of the umbilicus. TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 129 She was operated on on November 23, 1895, and on open-ing the gall-bladder the walls were found infiltrated withgrowth, and the contents putty-like in consistence. Theentrance to the cystic duct was occluded by a growth thesize of a walnut, and beyond this a gall-stone could be feltin the cystic duct. As there was a nodule of growth on theunder surface of the liver close to the one in the neck of thegall-bladder, the whole mass was pulled forward, and en-circled with an elastic ligature, which was passed below. Fig. 36.—Excision of a Portion of Liver for Tumour (Mayo Robson)(reduced one-third). , Outer surface of gall-bladder; near x the growth is infiltrating thewall, shown in shaded portion ; B. W., thickened and infiltrated wall of gall-bladder, laid open; L, liver; LS, liver laid open to show—N, secondarymalignant nodule in liver; D, cystic duct. (Trans. Roy. Med. and Chir. Soc,vol. lxxix.) the gall-stone so as to get well beyond the growths, retrac-tion being prevented by two knitting-needles pushed throughthe projecting liver. The projecting portion was then cut away; it includedliver, gall-bladder, and part of the cystic duct, and weighedhalf a pound. Recovery was uninterrupted, and the tempe-rature never reached ioo°. The growth, on examination byMr. J. W. Haigh, was reported to be epithelioma. The caseis fully reported in the seventy-ninth volume of the Med. and Chir. Soc. (Figs. 36 an
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