. Diseases of the gall-bladder and bile-ducts, including gall-stones . sexplaining the remission of jaundice in many cases, whereit might have been supposed that the jaundice would bepersistent. In the greater number of the cases of floatingstone tabulated below, the concretions were, though easilymoved by the fingers, too fixed to be called floating. Fenger explains the contracted condition of the gall-bladder, which is almost universally found in cholelithiasis,by this floating of gall-stones in the ducts ; but, as thesame condition occurs where the gall-stones are fixed, thisexplanation mus
. Diseases of the gall-bladder and bile-ducts, including gall-stones . sexplaining the remission of jaundice in many cases, whereit might have been supposed that the jaundice would bepersistent. In the greater number of the cases of floatingstone tabulated below, the concretions were, though easilymoved by the fingers, too fixed to be called floating. Fenger explains the contracted condition of the gall-bladder, which is almost universally found in cholelithiasis,by this floating of gall-stones in the ducts ; but, as thesame condition occurs where the gall-stones are fixed, thisexplanation must be only a partial one. In a paper before the Clinical Society in 188S, and again GALL-STONES, OR CHOLELITHIASIS 247 in On Gall-stones and their Treatment,* published in 1892,attention was drawn to this contraction of the gall-bladderas an important diagnostic point, and this has been borne outby other observers independently. It was then pointed outthat jaundice with distended gall-bladder was presumptiveevidence in favour of malignant disease, but that jaundice ,. Fig. 46.—Hepatic and Common Ducts distended with Calculi—One in Cystic Duct, None in Gall-bladder. (No. 2,825, Royal College of Surgeons Museum.) without distended gall-bladder favoured the diagnosis ofcholelithiasis. Of thirty-five operations for obstruction in the commonduct, Courvoisier found that eighteen were due to causesunconnected with gall-stones, such as cancer, stricture ortumour; out of these, the gall-bladder was dilated in sixteen, * On Gall-stones and their Treatment, Mayo Robson. Casselland Co. 1/ 248 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS whereas only seventeen were dependent on gall-stones, andout of these seventeen, the gall-bladder was atrophied inthirteen. Whilst Fengers explanation is not all-sufficient to accountfor this contraction of the gall-bladder, neither does thatgiven by Courvoisier fully explain it; he says the contractionis due to chronic inflammation of the walls of the ga
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