Gall-stones and diseases of the bile-ducts . s. The severepain and constitutional disturbance which attendtheir passage along the ducts have attracted greatattention, and the deep interest aroused by the sur-gical treatment of cholelithiasis has added to theaccuracy of our knowledge concerning the localcomplications set up by gall-stones. These incon-veniences will be considered under three headings: (1) Gall-stones in the gall-bladder and cystic duct. (2) Gall-stones in the hepatic and common duct. (3) Concretions in the intrahepatic in the gall-bladder and cystic duct.— The
Gall-stones and diseases of the bile-ducts . s. The severepain and constitutional disturbance which attendtheir passage along the ducts have attracted greatattention, and the deep interest aroused by the sur-gical treatment of cholelithiasis has added to theaccuracy of our knowledge concerning the localcomplications set up by gall-stones. These incon-veniences will be considered under three headings: (1) Gall-stones in the gall-bladder and cystic duct. (2) Gall-stones in the hepatic and common duct. (3) Concretions in the intrahepatic in the gall-bladder and cystic duct.— The common place for gall-stones is the receptacle is admirably adapted for their pro-duction, especially as experimental inquiry has shownthat the two favouring conditions for their production CONSEQUENCES OF GALL-STONES 61 (stasis of the bile and the presence of micro-organisms)exist in it. Naunyn pointed ont that thoughcholesterin is found in many parts of the body inaddition to the bile-passages, the frequency of chole-. Fig. 21.—Gall-bladder dilated and filled; with mucus (hydropsvesicae fellese) secondary to the impaction of a gall-stone in thecystic duct. The triangular patch of liver kis sometimescalled Eiedels lobe. sterin stones in the gall-bladder is due to the presenceof a cementing substance admirably suited to thepurpose—namely bilirubin-calcium. Moreover, thegall-bladder is a place of refuge in which the newly- 62 DISEASES OF THE BILE-DUCTS formed concretions can undergo further developmentundisturbed, and their consolidation favoured by thecompression exerted by its muscular coat. The number and size of gall-stones in the gall-bladder vary greatly. A solitary calculus may belarge (see Fig. 17). In number they vary greatlyand it is not uncommon to find 100 calculi counted 5000 in a gall-bladder; and Otto7000. The conditions of calculi in the gall-bladder areworth comment. When the cystic duct is occludedby a calculus no bile en
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