. Annals of surgery . quadrant which often radiate to the right shoulder-blade. Thereis (iften a history of vomiting and sour eructations. The attacks, however, arenot as severe as those of colic due to the cystic obstruction. Physical examination reveals as a rule a definite area df tenderness in thereginn of the gall-bladder. The leukocyte count is usually normal. If, atoperation, the wall is definitely thickened and there are numerous adhesions 608 CHRONIC CHOLECYSTITIS WITHOUT STONE about the gall-bladder, one feels justified in performing a , however, the gall-bl
. Annals of surgery . quadrant which often radiate to the right shoulder-blade. Thereis (iften a history of vomiting and sour eructations. The attacks, however, arenot as severe as those of colic due to the cystic obstruction. Physical examination reveals as a rule a definite area df tenderness in thereginn of the gall-bladder. The leukocyte count is usually normal. If, atoperation, the wall is definitely thickened and there are numerous adhesions 608 CHRONIC CHOLECYSTITIS WITHOUT STONE about the gall-bladder, one feels justified in performing a , however, the gall-bladder is found free from adhesions. It emptieson pressure rather slowly, and the wall feels slightly thicker than may be areas of subperitoneal fat deposit as described b\- Deaver andWilly Meyer. If one opens the gall-bladder, it means that either a cholecys-tectomv or a cholecystostomy has to be performed. Is one justified, then, inopening the gall-bladder for inspection? Upon opening it. one frequently. FiC, 2.—Chronic chulccystiti». ^»:ven >; liurattun. Gall-bladder adherent toduodenum. Contained black bile on aspiration. Granular fat seen on cystic duct. Numer-otis round cells in muscularis and submucosa. Cholecystectcmy. Patient well. finds the picture of a strawberry gall-bladder: small, raised, pale elevationson a red background. In other cases, the mucous membrane appears relativelynormal. What procedure should one adopt in the latter type of case ? The writer feels that perhaps a careful study of a series of 38 consecutivecases may aid in the sohing of this problem. Cases which have been analyzedfrom a study of their histories, a study of the ])athol()gical sections removed,and an analysis of late results. Conceptions of the pathogenesis of infections of the gall-bladder are basedon four assumed possibilities : 3 r,09 FREDERIC \V. BANCROFT First: A descending infection fruni the li\er hy bacteria carried down inthe bile. Second: An ascendint
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
