lill.lMH rM.ci /.I 451 



eliolestorol in ^all-stoiu' roniiatioii was fi-oiii tin- (lc;:riK'ratiii^ and 

 desquamated epithelial cells of the jiall-hladdcr and l)ilr tracts. This 

 idea was supported by the larjie amount of cholesterol found in the 

 coutents of tiall-l)ladders shut off from the conunon duct, and by the 

 formation of (jall-stones in such isolated <iall-bladders. P^urther evi- 

 dence has since been brought forward in favor of this same view,^- 

 until it has been generally accepted as correct, although there are some 

 who, tinding no abundance of cholesterol in the wall of the gall 

 bladder, do not accej)t this origin."-' 



On the basis of this hypothesis the ordinarv steps in the formation 

 of a cholesterol concretion are as follows : Some injury to the mucous 

 membrane of the bile tracts is the starting-point ; this injury is 

 usually pi'oduced by infection, the colon and typhoid bacilli being 

 the most common organisms in this process. ''^ Through the degener- 

 ation of the epithelial cells an excess of cholesterol is formed, while at 

 the same time the desquamated cells and clumped bacteria offer 

 suitable nuclei upon Avhich the cholesterol begins to crystallize out. 

 Apparently after the calculi have reached a certain size they cause 

 sufficient mechanical injury to keep up the cell degeneration and 

 cholesterol formation, even after the infection has subsided. A cer- 

 tain amount of infection and inflammation is a favoring condition, 

 however, for Harley and Barratt ''"' found that fragments of chol- 

 esterol calculi introduced aseptically into the gall-bladders of dogs were 

 slowly dissolved and disappeared, but this was prevented by infecting 

 the gall-bladder with B. coli. According to Naunyn's investigations, 

 it is not an alteration in the composition of the bile, as formed in 

 the liver, which causes the precipitation of cholesterol, but rather the 

 presence of the nidus, and the production of large quantities of 

 cholesterol in immediate proximity to this nidus, that determines the 

 formation of a concretion. In case the bile stagnates in the gall- 

 bladder, the cholesterol that is being constantly formed by the normal 

 disintegration of surface epithelium accumulates, until, even without 

 infection, there forms a sediment of soft yellowish and brownish 



02 Thus ^Yakeman I quoted by Herter, Trans. Congress Amer. Pliysicians, 100.3 

 (6), 158: excellent resume) was able to cause an increase in tlie cliolesterol of 

 the bile in the gail-ijiadder of dogs by injecting into it HgCL, phenol, or ricin. 

 At first the cliolesterol seems to be contained largely in tlie degenerating des(|ua- 

 mated cells. Also the interesting case of a cholesterol calculus in a pvosalpinx, 

 described by Thies (Arb. Path. Inst. Tiibingen, 1908 ((i), 422), shows the pos- 

 sibility of an inflammatory origin for such concretions, and independent of bile. 



'■>3 Aschotr, Miinch. med.' Woch.. 1906 (53). 1847 and 1913 (00), 1753; Laroche 

 and Flandin, Compt. Rend. Soc. P.iol.. 1912 (721. (i60. 



04 See Cushing (Jt)hns Hopkins Hosp. Bull., 1899 (10). l()(i), who produced 

 gall-stones experimentally by injecting typhoid bacilli into the circulation after 

 injuring the gall-bladder. Literature (m the relation of bacteria to gall-stones 

 given by Fnnke, Proc. Path. Soc, Philadelphia. 1908 (11), 17: also see Uosenow 

 who finds that streptococci are often res!)onsible (Jour. Infect. Dis., 191fl (19), 

 527). 



«3Jour. of Physiol., 1903 (29), 341; see also Hansemann. Vircli. Arch., 1913 

 (212), 139. 



