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picture annexed to his Memoir , as big as middle- 

 sized walnuts. Though the similarity of their com- 

 position with other gall-stones was proved by the 

 analysis , it was questioned whether they had been 

 formed in the gall-bladder or in the intestinal tube. 

 Their dimension appeared indeed so much out of pro- 

 portion with the usual diameter of biliary ducts, that 

 the belief of their formation in the gall-bladder must 

 partly rest upon the well-known and astonishing 

 power of dilatation and contraction possessed by cer- 

 tain organs, whilst the explanation of their formation 

 in the alimentary canal offers still greater pathologic 

 difficulties. The excruciating pains which attended 

 the evacuation of those enormous concretions and the 

 cholestrin found in them , are sufficient proofs of 

 their formation in the gall-bladder. Such is at least 

 the opinion of the learned professor, Dr. Pleischl. 



In a great number of cases , the violent pains in 

 the vicinity of the biliary organs, the sudden cessa- 

 tion of those pains , a visible change in the comple- 

 xion, and even the total disappearance of the jaundice, 

 leave no doubts about the existence of gall-stones; 

 but, if their passage through the alimentary tube is 

 probable, they cannot always be detected. Most pa- 

 tients are careless about ascertaining the fact; many 

 feel reluctant to trouble their physician with this 

 loathsome investigation; in short, various circum- 

 stances render it more or less difficult, and, in order 

 to be conclusive, the examination should take place 

 every day. I attended last year a lady, whose 



