CHAPTER VII. 



THE FORM, STRUCTURE AND CHEMICAL COMPOSITION 

 OF BILIARY CALCULI. CHOLELITHIASIS AND THE 

 THEORIES ADVANCED TO EXPLAIN IT. 



SECT. 1. THE FREQUENCY OF OCCURRENCE, THE FORM, THE 

 CLASSIFICATION AND STRUCTURE OF GALL-STONES*. 



IN a preceding Chapter of this Book we have already referred 

 incidentally (see p. 316) to biliary calculi and have pointed out that 

 one, though much the less frequent, variety contains considerable 

 quantities of the compound of bilirubin and calcium, nearly always 

 mixed, however, with more or less cholesterin, and containing small 

 quantities of little investigated derivatives of bilirubin. A second 

 variety is composed almost entirely of cholesterin. 



Though biliary calculi may be found in the intra-hepatic biliary 

 ducts, much the larger number occur in the gall-bladder, and where 

 calculi are found in the cystic or common bile-duct they have 

 almost invariably migrated from their seat of formation in the gall- 

 bladder. 



Frequency of The frequency of the occurrence of biliary concre- 



gaii-stones. tions led the t Drench pathologist Cruveilhier to 



Number found. , , 6 , . . . . 



remark, La production des calcines biliaires est une 



des lesions les plus communes de Tespece humaine 2 '. Charcot 

 illustrates the accuracy of Qruveilhier's statement by telling us that, 

 in his experience, in about one-fourth of the autopsies of the aged 



1 Early history of Gall-stones. Gall-stones were first noticed in the year 1565 by 

 J. Kentmann, of Dresden, who communicated his observations to Conrad Gessner, who 

 published them in his work entitled De omnium rerum fossilium genere, Tigur. 1565. 

 Amongst the earlier accurate observers of gall-stones were Vesalius, Fallopius, Glisson, 

 Sydenham, Boerhave and van Swieten, Sauvages. The first chemical examination of 

 gall-stones was made by Galeatti (Comment. Acad. Sclent. Bonon. 1748, t. i. p. 354). 

 Fourcroy and Thenard, after discovering cholesterin, made the first really scientific 

 examination of biliary concretions. The fact that the colouring matters of bile in 

 biliary calculi are combined with calcium was discovered by Bramson. For references, 

 and other information, on the subject of the history of gall-stones the reader is referred 

 to Frerichs, Klinik d. Leberkrankheiten, Vol. n. pp. 466 and 467. 



~ Cruveilhier, Traite d'anatomie pathologique, t. n. p. 167. 



