. Diseases of the gall-bladder and bile-ducts, including gall-stones . the gall-bladder, depen-dent on gall-stones. No. 2,263A, St. Bartholomews, shows many small ulcers,with one larger, that has perforated, and caused deathfrom peritonitis. The walls of the gall-bladder are greatlythickened, and there is a cholesterine coating, but thereare no gall-stones. The patient was a man of sixty-seven. No. 1,675, Kings College Museum, shows numerous ulcersdue to gall-stones. The specimen from Case 8 of Mr. Warners JacksonianEssay, now in the College of Surgeons Museum, showsnumerous small ulcers with
. Diseases of the gall-bladder and bile-ducts, including gall-stones . the gall-bladder, depen-dent on gall-stones. No. 2,263A, St. Bartholomews, shows many small ulcers,with one larger, that has perforated, and caused deathfrom peritonitis. The walls of the gall-bladder are greatlythickened, and there is a cholesterine coating, but thereare no gall-stones. The patient was a man of sixty-seven. No. 1,675, Kings College Museum, shows numerous ulcersdue to gall-stones. The specimen from Case 8 of Mr. Warners JacksonianEssay, now in the College of Surgeons Museum, showsnumerous small ulcers with biliary gravel, but no gall-stone. * Clinical Soc. Trans., 1895, p. 160. 64 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS One small ulcer, the size of a pea, had perforated, and puswas found outside the gall-bladder. The patient had beenill for two weeks. No. i,594A, Middlesex Museum, affords a beautiful exampleof deep ulcers due to typhoid fever (Fig. 14). No. 1,021, St. Marys Museum, shows an epithelioma ofthe gall-bladder, with a perforating ulcer, occurring in an. Fig. 14.—Typhoid Ulceration of Fig. 15.—Perforating Epithelio- Gall-bladder. matous Ulcer of Gall-bladder. (No. i,594A, Middlesex Museum.) (No. 1,021, St. Marys Museum.) old lady, and leading to death from peritonitis (Fig. 15) ;and No. 2,8ogA, from the Hunterian Museum, shows theulceration of a malignant stricture, causing a fistula betweenthe gall-bladder and colon (Fig. 16). Stricture of the Gall-bladder and Bile-ducts. Stricture of the bile-ducts is one of the rarer sequelae ofulceration, by which it is probably always preceded, except INFLAMMATORY AFFECTIONS 65 in those cases dependent on malignant disease, which areconsidered under another heading. Though there is no reason why stricture should not be asequence of typhoid ulceration, such has yet to be proved,
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