734 DISEASES OF THE GALL-DUCTS. 



small concrements are often found in the gall-bladder, which apparent 

 ly had no effect on the health of the patient during life. We may 

 even say that it is exceptional for calculi in the gall-bladder to cause 

 trouble, or betray themselves by any definite symptoms. Calculi of 

 small size may even pass through the ductus cysticus or choledochus 

 without exciting pain or any other symptom. The experiences at 

 bathing-places, such as Karlsbad, where the stools are carefully ex- 

 amined for gall-stones, afford numerous examples of this. 



Among the morbid processes which gall-stones induce, as above 

 stated, we have already described suppurative hepatitis and obstruc- 

 tion of the excretory bile-ducts, so that we may here limit ourselves 

 to describing the symptoms that arise during the passage of large gall- 

 stones through the excretory passages, and, during their impaction 

 there, the so-called gall-stone colic, as well as the symptoms of inflam- 

 mation and ulceration of the gall-bladder and excretory ducts, which 

 are excited by gall-stones in some few cases. 



Gall-stone colic begins unexpectedly and suddenly at the moment 

 a concrement passes from the gall-bladder to the ductus cysticus and 

 becomes impacted there. The patient is seized with a piercing or 

 griping, insupportable pain, which starts from the right hypochondrium 

 and spreads over the whole abdomen, often also to the right side of 

 the thorax, and even to the right shoulder. The abdominal muscles 

 are cramped and very sensitive to pressure ; the patients sigh and 

 moan, double up, and roll about on the bed or floor. During all this 

 there is no fever, but there are a number of other symptoms. The 

 pulse becomes small, the skin cool, the face pale and distorted ; occa- 

 sionally the patient actually faints. In some cases the patients are 

 affected with spasmodic trembling or chills ; in other cases there arc 

 convulsions either general or limited to the right half of the body 

 There is most frequently obstinate sympathetic vomiting. After a 

 few hours, or in severe cases not till next day, the sufferings of the 

 patient are usually moderated, and the general disturbance quieted. 

 This remission, during which, however, the patient still suffers severe- 

 ly, and still has a small pulse, and pale, cool skin, appears to corre 

 spond to the passage of the concrement from the cystic duct into the 

 ductus choledochus, which, except the portio intestinalis, is a somewhat 

 wider canal. The symptoms do not change very much till the concre- 

 ment has passed the ductus choledochus and entered the duodenum. 

 Then the patient is entirely free from pain and uneasiness ; the pulse 

 rises, the warmth of the skin returns, and the distortion of the counte- 

 nance disappears. This passage, from great agony to complete ease, 

 often occurs in a very short time, and then the contrast is very strik- 

 ing. In other cases the pain does not cease suddenly but subsides 



