204 SITUATION OF GALL-STON 



which gave him no inconvenience during life. While 

 stationary in the bladder they give rise t<> no marked 

 symptoms unless they are so large and numei 

 distend the viscus, when they give rise to a sense of 

 lit, uneasiness, tension, or a dni.L'^iii^ pain in the 

 region of the gall-bladder, which extends through to the 

 right shoulder blade, and even to the right arm. The pain 

 is usually worse after meals, violent muscular exertion, 

 riding or driving over rough roads. Gall-stones, when 

 located in the bladder for some time, give 

 to considerable irritation of the mucous membrane, 

 followed by uleeration which may terminate in perfo- 

 ration. Moreover diphtheritic purulent 

 fluid, hypertrophy, adhesions between the Madder and 

 pylorus, duodenum, colon and abdominal walls some- 

 times result from concretions in the gall-bladder. 

 When the -all-bladder is occupied by asolita: 

 it is usually large, nd smooth, the mucous 

 membrane is lik> <>oth, and not ul< 



4. Gal'. in the neck of 

 cystic duct, ami in the ductus communis choledochus. 

 When a stone passes from the gall-bladder into the ne< -k 

 of the cystic duct, it usually gj to vomiting, and 

 colic, and as long as it does not beyond that 

 there is no jam. ^onu-times tl, will roll 

 back into the bladder, when all unpkv i painful 

 Symptoms disappear ; at other times it becomes firmly 

 fixed iii the duct, where it sets up inflammation and 

 suppuration, foilo\u-d by te of the coats of the 

 gall-bladder, with an escape, of bile into the abdominal 



1 Y- 



5. Gall-stones may become arrested in the common 



