CHAP. VII.] CONSTITUENTS OF BILIARY CALCULI. 



381 



"The pure bilirubin-calcium stones are found not only in the 

 gall-bladder, .but also in the intra-hepatic ducts. The habitual 

 tenants of the gall-bladder 'are the common mixed cholesterin- 

 calculi " (Naunyn). It is to be noted, however, that small concretions 

 of pure cholesterin may, and do, originate in the intra-hepatic bile- 

 ducts. 



SECT. 2. ENUMERATION OF THE CONSTITUENTS AS YET FOUND IN 

 GALL-STONES. THE PIGMENTS WHICH ARE ONLY FOUND IN 

 GALL-STONES (BILIFUSCIN AND BILIHUMIN). 



We have already referred to the fact that cholesterin and the 

 calcium compound of bilirubin constitute the most important con- 

 stituents of biliary concretions, though the latter is often mixed with 

 considerable quantities of calcium carbonate. 



In addition to bilirubin in combination with calcium, calculi 

 which contain this compound may contain biliverdin, bilicyanin, 

 choletelin and imperfectly known bodies, described as bilifuscin and 

 bilihumin, which are also for the most part combined with lime. 

 The bilirubin-calcium calculi nearly always contain copper (which 

 Naunyn thinks probably exists as a bilirubin-copper compound), 

 besides iron. Frerichs 1 examined and described calculi of bilinibin- 

 calcium which contained globules of metallic mercury, and his 

 observations on this point have been confirmed by several observers 

 (Beigel 2 , Lacarterie 3 , Naunyn 4 ). 



It is to be noted that neither free bilirubin nor the salts of the 

 bile-acids occur in gall-stones ; the traces of these substances which 

 are discoverable are derived from the bile with which the gall-stones 

 are permeated. 



In rare cases, biliary calculi have made their way into the urinary 

 passages and uric acid has then been found as a constituent 5 . 



Similarly, when gall-stones have sojourned for some time in the 

 intestines they may be coated with phosphate of calcium and mag- 

 nesium, as well as with calcium carbonate 6 . 



acknowledge his great indebtedness to this able, interesting, and admirably illustrated 

 work, the appearance of which has marked a new era in our knowledge of chole- 

 lithiasis. 



1 Frerichs, Klinik d. Leberkrankheiten, Vol. n. pp. 474 and 475. 



2 Beigel, Wiener med. Wochenschr. 1856, No. 15. 



3 Lacarterie, Gazette med. de Paris, 1827, quoted by Charcot, op. cit. p. 131. 



4 Naunyn, ' So beschrieb Frerichs Gallenconcremente (die ich iibrigens selbst unter- 

 suchen konnte) welche aus Gallenfarbstoffkalk bestanden und Kiigelchen metallischen 

 Quecksilbers enthielten,' loc. cit. p. 7. 



5 Giiterbock, Berlin, klin. Wochenschr. 1871, Nos. 49 and 51, and Virchow's Archiv, 

 Vol. LXVI. (1876), p. 273. The reader is referred to an account of the literature of 

 cases of this kind in the learned work by Professor Courvoisier of Basel, entitled 

 Casuistisch-statistische Beitrage zur Pathologic und Chirurgie der Gallenwege, Leipzig, 

 1890. The cases yet recorded will be found at page 362, under the heading, ' Ulcerative 

 Perforationen der Gallenwege in die Harnwege.' 



6 Charcot, op. cit. p. 133. 



