Gall-stones and diseases of the bile-ducts . Fig. 17.—A solitary gall-stone successfully removed from aninflamed gall-bladder. Nat. size. (Museum of the MiddlesexHospital.) is the largest specimen I have removed: it measures13 cm. round the base and 19 cm. round the majoraxis. The patient, a woman aged fifty years, hada gall-bladder so large that this big calculus couldfloat about in the bile it contained. When the gall-stones are multiple, and especially 56 DISEASES OF THE BILE-DUCTS when gregarious, facets are usually present; theseare produced by pressure when the calculi are soft,Fig.
Gall-stones and diseases of the bile-ducts . Fig. 17.—A solitary gall-stone successfully removed from aninflamed gall-bladder. Nat. size. (Museum of the MiddlesexHospital.) is the largest specimen I have removed: it measures13 cm. round the base and 19 cm. round the majoraxis. The patient, a woman aged fifty years, hada gall-bladder so large that this big calculus couldfloat about in the bile it contained. When the gall-stones are multiple, and especially 56 DISEASES OF THE BILE-DUCTS when gregarious, facets are usually present; theseare produced by pressure when the calculi are soft,Fig. Fig 18.—A gall-bladder elongated like the finger of a glove, tightly compressing a row of gall-stones. Fig. 19.—Gall-bladder with a drum-shaped calculus. and not by abrasion. The effect of pressure inproducing facets is shown in Fig. 18 ; here, in an GALL-STONES 57 elongated gall-bladder and imbedded in thickmucus this string of calculi was firmly kept in lineand facets only appear on their opposed surfaces. The facets on calculi in such circumstances re-semble those seen in large gall-stones tightly im-pacted in the cystic duct. The presence of facets on gall-stones is of someimportance to the surgeon because in the course ofan operation it affords him valuable evidence con-cerning the existence of other calculi in the gall-bladder or ducts. The fact that gall-stones in the early stages oftheir formation are soft explains their curious shapewhen occupying the intra-hepatic ducts (see p. 91). The formation of gall-stones is more complexthan would appear at first sight. For example
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