. Diseases of the gall-bladder and bile-ducts, including gall-stones . e been found dilated. Congenital Malformations.—There is apparently no part ofthe biliary apparatus, except the liver, which may not beabsent; while this is not to be wondered at in the case of thegall-bladder and cystic duct (as in specimen No. 1,390 inGuys Museum, in one specimen in St. Thomass, and in twoat Middlesex), since they are normally wanting in certainanimals, and are frequently obliterated by disease in thehuman subject; it affords serious food for thought, to findthat life has been possible for six months, whe
. Diseases of the gall-bladder and bile-ducts, including gall-stones . e been found dilated. Congenital Malformations.—There is apparently no part ofthe biliary apparatus, except the liver, which may not beabsent; while this is not to be wondered at in the case of thegall-bladder and cystic duct (as in specimen No. 1,390 inGuys Museum, in one specimen in St. Thomass, and in twoat Middlesex), since they are normally wanting in certainanimals, and are frequently obliterated by disease in thehuman subject; it affords serious food for thought, to findthat life has been possible for six months, where even the ANATOMICAL CONSIDERATIONS 15 hepatic and common ducts are represented by mere fibrouscords, as in specimen No. 973 in St. Marys, and No. 1,017in Kings College Museums. Though but little attention has been paid to the matter,hour-glass-shaped gall-bladder is probably not one has to operate on cases in which the distalpart of the gall-bladder contains calculi, and communicatesby a narrow neck with the cyst proper. In some instances,. Fig. 1.(No. 1,390, Guys Museum. no doubt, this condition arises from contraction of an oldulcer, but in others, as in Case 55, the mucous membranebeing smooth and showing no evidence of cicatrization, thedeformity appears to be congenital. Dr. Pilcher has describeda case belonging to the latter category, and another hasrecently been published by Dr. H. C. Donald, of Paisley, inwhich the gall-bladder was found to be thickened and con-tracted, being firmly adherent to, and tucked up to, theunder surface of the liver. It was distinctly hour-glass in 16 DISEASES OE THE GALL-BLADDER AND BILE-DUCTS character, and contained a thick, clear, and glairy calculi were removed from the proximal part of thegall-bladder, which was separated from the distal by a narrowdiseasesofgallbl1900robs
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