GALL-STONES. 75 



terin and the brown pigment, and in others again we find only a 

 little cholesterin in the dark brown mass of pigment-lime. 



There is a third kind of concretion which is comparatively rare, 

 namely, the black or dark green variety ; this contains another 

 modification of the pigment, which however, in this case also is 

 combined with lime : this variety is usually free from, or at all 

 events very poor in cholesterin. 



Biliary concretions, in which carbonate and phosphate of lime 

 are the principal ingredients, are very rare. (Bailly and Henry, 

 Steinberg.) 



It is singular that uric acid has occasionally been found in 

 gall-stones. (Stockhard,* Marchand.f) 



All gall-stones absorb a little bile, which may be readily 

 abstracted from the pulverised concretion with water or cold alcohol. 



The forms of gall-stones are extremely varied ; while some are 

 very regular and symmetrical, others assume the most unaccount- 

 able shapes. 



BramsonJ has undoubtedly indicated an important point in 

 relation to the formation of the majority of gall-stones namely, 

 that it depends on the separation of a compound of pigment with 

 lime. 



Although Bramson's view has been much contested, we can 

 undoubtedly recognize the presence of a compound of pigment 

 with lime in the residue of the nuclei both of cholesterin concre- 

 tions and of the brown gall-stones after extraction with alcohol 

 and water, although we are, as yet, unable to establish a definite 

 proportion between the pigment and the base. Every residue 

 which is rich in pigment always contains a greater or lesser 

 quantity of earthy phosphates and a little mucus; these earthy 

 phosphates most probably originate from the mucus, which, how- 

 ever, like the protein-bodies in the formation of phlebolites, 

 gradually dissolves and disappears ; for the phosphates never stand 

 in a constant ratio to the mucus remaining in the concretion; the 

 mucus may also contain a little lime, which on incineration is 

 converted into carbonate and sulphate ; moreover, we sometimes 

 meet with oxalate of lime, although only in very small quantity ; I 

 have never found pre- formed carbonate of lime in the brown residue 

 of gall-stones (if present, it may be very readily detected by 

 observing, under the microscope, the effect produced by a little acid 



* De Cholelithis diss. inaug. med. Lips. 1832. 



f Journ. f. pr. Oh. Bd. 25, S. 39. 



$ Zeitschr. f. rat. Med. Bd. 4, S. 193-208. 



