730 DISEASES OF THE GALL-DUCTS. 



In croupow inflammation, we find the mucous membrane of the gall- 

 bladder covered with a more or less firm false membrane, and in the 

 ducts we find tubular coagulations, enclosing inspissated bile, and caus- 

 ing biliary obstruction. In diphtheritic inflammation, the tissue of the 

 mucous membrane is infiltrated at certain places with a fibrinous exuda- 

 tion, which causes sloughing of the mucous membrane, and from sepa- 

 ration of the slough deep losses of substance occur. These processes 

 cannot be recognized during life. Even an intense icterus occurring 

 during typhus, septicaemia, cholera, etc., cannot be referred to a 

 croupous or diphtheritic inflammation of the bile-ducts, as it far more 

 frequently occurs without any perceptible change in them. 



CHAPTER III. 



OBSTRUCTION AND CLOSURE OF THE EXCRETORY GALL-DUCT AND CON- 

 SECUTIVE DILATATION OF THE BILE-DUCTS. 



ETIOLOGY The excretory gall-ducts are most frequently con- 

 tracted and closed by catarrhal swelling of their mucous membrane 

 and by collection of mucus. Among the further causes of this contrao 

 tion and closure, and of consecutive dilatation of the bile-ducts above 

 the contraction, are : 1. Tumors pressing on the excretory ducts, or 

 growing into them. Sometimes they are caused by carcinoma of the 

 liver, pancreas, stomach, or duodenum ; sometimes by caseous or other 

 degeneration of the lymphatic glands ; sometimes by abscesses ; rarely 

 by hydatid cysts, aneurisms, or collections of hard faeces in the colon ; 

 and lastly, in a few cases, by multilocular echinococci, that have wan- 

 dered into the gall-ducts or broken through into them, and have thence 

 reached the ductus hepaticus. 2. Occasionally there is a more or less 

 complete closure of the ductus choledochus, hepaticus, or cysticus, from 

 cicatricial contractions, which remain in the excretory bile-ducts, or in 

 the duodenum after ulcers have healed, or the thickening and consecu- 

 tive atrophy of the peritonaeum after peritonitis, particularly when the 

 excretory bile-ducts are at the same time distorted or bent. 3. Lastly, 

 foreign bodies, particularly stony concretions, obstruct or close the 

 excretory bile-ducts. 



When the ductus hepaticus is constricted or closed, the consecutive 

 dilatation of the gall-passages is limited to the bile-ducts of the liver. 

 But if the ductus choledochus becomes impervious, the ductus hepati 

 cus, cysticus, and the gall-bladder, are all dilated. Finally, if the duc- 

 tus cysticus alone be closed, no bile can enter the gall-bladder, it is 

 true, but its mucous membrane continues to secrete mucus, and the 



