Licence: In copyright
Credit: Diseases of the liver, gall-bladder and bile-ducts. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![is any underlying cholecystitis or cholelithiasis, treatment should be directed to those conditions. In seven cases where the morbid condi- tion of the gall-bladder was treated the tongue-like lobe disappeared (Terrier and Auvray*). An ill-fitting corset or one which presses on the liver should be replaced by a straight-fronted corset, and tight lacing or constriction of the waist by a belt should be prevented. It is not often that radical treatment, such as stitching the lobe to the abdominal parietes or its complete removal, is necessary. In three cases the tongue-like lobe has been stitched to the abdominal parietes with success (Billroth,! Tscheming.J Langenbuch^. Removal of the lobe has been carried out by Bastianelli, Martin, and Lockwood. j] Efifect of Tight Lacing on the Gall-bladder.—^The gall-bladder is frequently dilated. Hertz ** found it so in 24 out of 41 cases. The downward displacement of the duodenum brings tension to bear on the cystic duct, which even under normal conditions requires a spiral valve to keep it open (Keith ft), and thus leads to obstruction. The resulting retention of bile and mucus in the gall-bladder may tend to elongation of the right lobe, and so give rise to, or accentuate, the tongue-Uke lobe seen in many corset Uvers. Retention of bile in the gall-bladder disposes to cholecystitis and cholelithiasis, and the predominance of female suf- ferers from gall-stones is no doubt in part due to the bad effects of the corset. When calculi are present in the gall-bladder, the pressure exerted by the corset may, as suggested by Fiitterer,tt increase the friction between the gall-stones and the mucous membrane of the gall-bladder, and thus help to explain the greater frequency of primary carcinoma of the gall- bladder in women. In this connexion it is noteworthy that the larger bile-ducts, which are not affected in the same way by corsets or belts, are more often the site of primary carcinoma in man. * Terrier et Auvray: Rev. de Chirurg., 1897. t Bilh-oth: Wiener med. Wochen., 1886, No. 14. t Tscherning: Centralblatt f. Chirurg., 1888, p. 426. § Langenbuch: Deutsche med. Wochen., 1888. il Lockwood, C. B.: Lancet, 1903, vol. ii, p. 223. ** Hertz: Abnormitaten in der Lage und Form der Bauchorgane, 1894. tt Keith, A.: Lancet, 1903, vol. i, p 639. tt Fiitterer, G.: Chicago Medical Society, April 1, 1897](https://iiif.wellcomecollection.org/image/b2398417x_0035.jp2/full/800%2C/0/default.jpg)
