Cholecystotomy for the removal of gall-stones in dropsy of the gall-bladder / by J. Marion Sims.

  • J. Marion Sims
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Cholecystotomy for the removal of gall-stones in dropsy of the gall-bladder / by J. Marion Sims. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    existence outside of the portion near the neck is very uncertain (Kolliker). The alteration which has taken place in the gall-bladder manifests itself on the mucous lining, and is purely of an inflammatory character. It is transformed into a granular tissue similar to that of fungus-granulations, composed of embryonic elements permeated with vessels of a new formation, whose walls are also in an embryonic condi- tion. These lesions are identical with those we find in cases of ob- literation of the canal of the gall-bladder (calculous cholecystitis). 2. The liquid contained in the dilated gall-bladder offers an ex- ample, not of colourless bile, but of dropsy of the gall-bladder, from which we are able to draw two conclusions. a. Sometimes the gall-bladder contains a colourless liquid, still having the bitter characteristic of the bile, and in which, by the reac- tion of Pettenkofer, we are able to recognise the existence of biliary acids. b. Sometimes, on the contrary, the liquid contained in the gall- bladder, also colourless and viscous, is deprived of the bitter principle of the bile, and a chemical reaction shows not only the absence of the colouring matter, but also of biliary salts. Cases of this kind are not rare. We find them mentioned by Cruveilhier (Atlas d'Anatomie Palhologique), who gave them the name of dropsy of the gall-bladder (Frerichs, Traite des Maladies du Foie; Moxon, Pathological Society's Transactions, 1870, vol. xxiv). They occur in many cases of occlusion of the bile-ducts, whatever may be the cause. In the case related by Frerichs, the liquid which dilated the gall- bladder and biliary canals was transparent, slightly mucous, and a little alkaline. The reaction of Pettenkofer could not be obtained. Under the microscope, a large number of mucus-corpuscles were found, and, by the addition of acetic acid, a precipitate characteristic of mucin was formed. It is generally admitted, in order to explain the substitution of this liquid (different from the bile) for the bile, that the bile, for a long time retained and submitted to a considerable and increasing pressure, is absorbed, and a sero-mucous liquid, secreted by the mucous glands and the epithelial covering, takes its place. This is also the opinion of Professor Charcot [Leqons stir les Maladies du Foie, 1876). If we now ask ourselves what is the nature of the liquid under con- sideration, and which so distended the gall-bladder, notwithstanding the absence of a chemical examination, we will find an answer to our question by the preservation of the red corpuscles in the liquid. Every
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