SITUATION OF GALL-STONES. 203 



found in any part of the liver where bile is secreted ; 

 they are consequently erratic in their movements, in 

 their endeavour, so to speak, to take their departure 

 from the body. 



1. Gall-stones may form in the radicles of the 

 hepatic duct, in the interior of the liver ; they are here 

 very small and numerous, and constitute what has been 

 generally called " biliary gravel." Chopart met with a 

 case where the liver contained so many concretions, 

 that it could not be cut with a scalpel. These con- 

 cretions sometimes cause ulceration of the ducts : a 

 series of small abscesses, obliteration, and dilatation of 

 the bile-ducts. 



2. Gall-stones may become arrested in the hepatic 

 duct. When this takes place, the immediate conse- 

 quence is an obstruction to the flow of bile, extending 

 over the whole of the ducts within the liver, followed 

 by enlargement of the liver, jaundice, vomiting, colic 

 and other symptoms indicative of obstruction of the 

 common duct. Wolf records a case of this kind, which 

 gave rise to violent colic and rupture of the hepatic 

 duct, terminating in death. 



3. Gall-stones are found most frequently, of a larger 

 size, and in greater numbers in the gall-bladder, than 

 in any othur portion of the biliary passages. This organ 

 seems to be the central depot for the manufacture of 

 these concretions, from whence the various derangements 

 they give rise to usually proceed. Gall-stones may exist 

 in the bladder for a considerable length of time without 

 giving rise to any marked symptoms. I once found over 

 thirty stones (some of them as large as small marbles) in 

 the gall-bladder of a young man who died of consumption, 



