76 BILE. 



on the substance previously moistened with water and freed from 

 all air-bubbles). Sulphate of lime does not exist pre-formed^ or at 

 all events it is only present in very small quantity. 



The ratio of the ash to the organic substance in the insoluble 

 portion of gall-stones is altogether variable; in the insoluble part 

 of six different concretions, there were 8*5, 12% 16'6, 30*4, 46*3, 

 5OG. and even 54*7-- of ash; in the analyses of these six ashes 

 there was comparatively much carbonate and little phosphate of 

 lime according to the smallness of the ash ; that is to say, in pro- 

 portion as organic substance preponderated in the insoluble 

 residue of a concretion, so much the more was the phosphate of 

 lime encroached upon by the carbonate. In the ash which amounted 

 to 8*5, there were 7*994 parts of carbonate of lime, and only 0*492 

 of earthy phosphates; while in the ash which amounted to 54'7, 

 there were only 12*135 parts of carbonate of lime, a portion of 

 which originated from oxalate of lime, which was recognised in the 

 fresh object. Bramson has pointed out that dilute acetic acid 

 extracts lime from the insoluble residue of biliary concretions ; 

 as this lime cannot be combined with sulphuric or oxalic acid, and 

 as only an extremely minute quantity can be associated with 

 phosphoric acid, it must be obtained from a combination with an 

 organic substance : and as there is too little mucus present for us 

 to ascribe it to that cause, it must necessarily have existed in 

 combination with the pigment. 



Further, if the bile-pigment were not in combination with some 

 substance, it would be soluble in alcohol ; for it is by no means a 

 modified pigment which has become insoluble through some mole- 

 cular change, but actual cholepyrrhin, in combination however 

 with lime ; and if we remove the lime by the application of a dilute 

 acid, we obtain the cholepyrrhin, which is then soluble in alcohol, 

 and possesses all the properties which we formerly enumerated. 



An enormous deal has been written on the formation of the 

 different varieties of biliary calculi, as well as regarding the 

 proximate cause of the deposition of solid particles, and especially 

 of the cholesterin ; but any analyses of the various hypotheses that 

 have been brought forward in relation to these points, would be 

 here altogether out of place. The following is all that is actually 

 known regarding the mode of formation of the concretions. Mucus 

 and epithelium generally yield the points or foci around which a 

 deposition of solid particles occurs; we always find pigment-lime 

 with a little mucus in the centre of the concretion, and hence we 

 may fairly conclude that it plays a part in their formation ; but the 



