Volume 1

A dictionary of practical surgery / [Samuel Cooper].

Samuel Cooper

Date:: 1825

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

21/1282 page 9

$in the ductus hepaticus, or its’main branches, in the gall-bladder, the ductus ‘cysticus, or the duc- tus choledocus. When their size is not dis- proportionate to the diameterof the ducts, they pass with facility; but, when their dimensions are larger than those ducts can naturally admit, the latter become’ stretched and dilated, whence arise the sharp pains and colic which attend the dis- order, analogous to the sufferings produced by the descent of large calculi from the kidneys to the bladder. ‘ile reality of these dilatations of the hepatic ducts is proved by dissection. Heister found the orifice of the ductus choledocus, which is usually very small, so much enlarged that it could’ receive a finger ; and Vicq d’Azyr saw this duct enlarged through its whole extent inva similar degree. (fist. de la Société Royale de Médecine, an. 17.79, p. 220.) Galeazzis in dis- secting a body, found the ductus choledocus so dilated, that it resembled a kind of bay, in which several calculi were included. Mr. Thomas has likewise seen two cases, in which the point of the forefinger readily passed from the duo- denum into the gall bladder. (See Med. Chir. Trans. Vol. 6. p. 105.) \Morgagni saw this duct in one instance Jarge enough to hold a couple of fingers, and he quotes many similar instances from Bezold, Trew, Verney, and others. We may conceive how dilated this tube must have been in a case recorded by Richter, where, though it was ‘not completely obstructed, a calculus weighing three ounces and a half was lodged within it. (Rwbini, op. cit. p. 7—10.) With regard to those concretions which are distinguished by the epithet gustric, or intestinal, some are formed in the cavity of the stomach; the rest in one or other of the intestines. ‘They remain for a greater or lesser period in the place of their formation, according as they happen to be lighter, or heavier, smoother, or rougher, more or less adherent, or as Jocal, or general circum- stances are more or less favourable to their re- tention or expulsion. Sometimes, they continue undischarged, ‘until they have attained a very considerable size. In particular instances, in- stead of remaining constantly in one place, they successively pass through the whole intestinal tube, lodging at different points for a greater or lesser time. In the works. of Haller and Con- radi may be seen representations of the points of the intestinal canal, where these concretions have been found. The alvine concretion, of which Maréschal has given an account, was some years in traversing all the convolutions of the bowels, These gastric, or alvine concretions, which are very common in animals, are less fre. quent in the human subject, as is proved by the observations of Fourcroy and Vauquelin, inserted in their valuable essay on this subject in the An= nales du Museum Nationale d’ Histoire Natu- relle de Paris. In the horse, they are sometimes of an enormous size, as we may learn from an instance on record, in which the concretion weighed thirteen pounds, (Voigt, Magazin fur das Neueste der Naturkunde, 3 B. p. 578.) As for the third species, which Rubini names mixed, or hepatico-gustric, they have their begin- ning in the hepatic organs, and augment in the intestinal tube. Here if the extraneous body be detained, and the contents of the bowels have a round it, as a nucleus, it may be rendered larger by additional strata of matter, and would increase sine Jine, if a stop were not put to the augmentation by the narrowness of the canal, or an effort made for the expulsion of the concretion. Morgagni cites two instances of this sori of concretion: one, from Gemma ; the other from Bezold; and he gives his opinion that another alvine calculus spoken of by Vater must have been of the same nature. Dr. Coe describes another interesting specimen; and others are referred to by Vander- monde, Moreali, Portal, &c. Perhaps, says Ru- bini, the instances of this kind would have been more numerous, if all the concretions discharged from the bowels had been noted with greater at- tention, and the hepatico-gastric substances not confounded with the hepatic.’ The lodgment of these concretions in the intestinal canal is of un- certain duration, and depends upon a variety of circumstances: Vandermonde gives the history of a calculus, which, as far as could be judged of by the pain in the ri¢ht hypochondrium, and the change of symptoms, must have passed into the duodenum in the month of January, and then continued in the bowels until August, when it was discharged from the rectum. The crystallized appearance of alvine con- cretions is generally so conspicuous that it has not escaped the attention of several of the old writers, as we may convince ourselves of by re- ferring to the works of Corn, Gemma, Greisel, Baglivi, Scultetus, &c. It was noticed by Haller in his Elementa Physiologiz, vol. 6, and by Morgagni in his Epist. 37, de Sedibus et Causis, &e. If, says Rubini, these erystalliza- tions are not always plainly visible, distinct, and regular, this depends either upon their imper- fection; the heterogeneous nature of the ac- cumulated matter; or particular unfavourable circumstances, which would equally affect the process of crystallization out of the body. Now, as all erystallizations depend upon the fluids, in which they form, and from which they receive their crystallizing elements, it must’ be evident that, inasmuch as the fluids of the hepatic organs differ in their constituent principles from the fluids contained in the intestinal canal, the concretions, produced in the first system, must differ from those originating in the second; whilst the hepatico-gastric calculi will combine the na- ture and properties of both together. ? The fluid from which hepatic concretions are formed is unquestionably the bile, either some or all its ingredients entering into their composition. Indeed, previously to the new chemical doctrines, hepatic calculi were generally considered as being simply condensed indurated bile. From ‘investigations made, in more modern times, however, when the art ‘of analysis has attained a precision, of which the old chemistry was not susceptible, it appears, that, although hu- man biliary calculi yield the same products as the bile, there is contained in them more or less of a peculiar substance, which was named by the celebrated Fourcroy, adipocere. (Mém. de T° Acad. des Sciences, 1789, p. 323.) The presence of this substance in the concretion is of such im= portance, that, when it is abundant and in large proportion, the caleulus is regular and the cry- stallization well finished; and, when it is in small$

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