PRODUCTS, ADVENTITIOUS. 



posed of a nucleus of indurated faeces, and a 

 cortex of saline matter arranged in layers. 

 Oleaginous matters sometimes accumulate in 

 the intestine in the form and of the consistence 

 almost of calculi. A mass of this kind, voided 

 by a young tuberculous female, and examined 

 by M. Lassaigne, was found to consist of 



f Stearin 

 4 Elain 



74 



Acid fatty matter 

 composed of j iar 



Substance analogous to fibrin 21 



Phosphate of lime 4 



Chloride of sodium 1 



100 



These oleaginous formations will be presently 

 further considered. 



The oriental bezoard, a resinous intestinal 

 calculus, chiefly met with in certain species of 

 goats and deer, appears (like ambergris in the 

 whale) to be the result of morbid secretion 

 from the bowels of the animal, and not to be 

 composed (as was imagined by Vauquelin) of 

 materials derived from its food. A very doubt- 

 ful case of calculus occurring in the human 

 intestine, with close resemblance to ambergris 

 in its characters, has been published by Dr. 

 Kennedy.* 



We have lately examined some masses 

 composed solely of fibrin, (Univ. Coll. Mus. 

 presented by Dr. Rayner,) passed from the 

 rectum after prolonged sufferings, simulating 

 those of cancerous disease. 



(.) Biliary. (Gall stones, Choleliths). 

 Biliary calculi are found in every part of the 

 system where the bile circulates, and even make 

 their way occasionally into localities in which 

 that fluid is not naturally found. Most com- 

 mon in the gall-bladder, they are frequent in 

 the larger ducts ; far less rare than has been 

 affirmed by some writers in the radicles of the 

 hepatic duct, not uncommonly encountered in 

 their transit through the different parts of the 

 intestine (where it is possible they may be 

 sometimes actually formed), they 'are very 

 rarely seen in the stomach. 



Biliary calculi vary in number from one to 

 several hundreds and even thousands : 3,646 

 are said to have been shown by Fuschius from 

 the gall-bladder of a certain gladiarius -j- ; and 

 Dr. Parry J gives a case in which 2,654 were 

 found in the same part. It is not uncommon 

 to find one only, or two, three, or four; but 

 observations are wanting as to the relative fre- 

 quency of small and large collections. Their 

 size varies as their numbers. When single or 

 few in number, they are comparatively large, 

 have been known to reach the bulk of a hen's 

 egg , but rarely, even when single, exceed a 

 walnut in dimensions ; when very numerous, 

 they are sometimes scarcely larger than pins' 

 heads, and some, of these small dimensions, 



* London Med. Chir. Journal, vol. iv. 

 t Morgagni de Sed. &c. Ep. 37, 19. 

 j On Angina Pectoris, p. 240. 

 Saye, Journ. des Savans, Sept. 1697. Baillie, 

 Morbid. Anat. 



85 



may be associated with others of far creater 

 bulk. 



Their form likewise varies to a certain extent 

 with their number. When single, the spherical, 

 oval, or elongated shape predominates ; when 

 numerous, they press upon and mould each 

 other into cubic, pentagonal, or polygonal 

 figures, with obtuse and rounded angles. 



Their most common colour is greenish yel- 

 low ; but various shades of brown, green, dark 

 or canary yellow, and even black or white, are 

 observed. Their colour frequently varies in 

 different parts of the mass ; and the differences 

 of hue may either correspond to the lamellae of 

 the calculus, or to the matters acting as the 

 nucleus and the cortex respectively (the most 

 common case), or be irregularly observable 

 over the surface so as to produce a mottled 

 appearance. Biliary calculi have a smooth 

 surface and slightly unctuous feel. 



When a biliary calculus is broken across, a 

 distinction of nucleus and cortex is very com- 

 monly seen. Complete homogeneousness, with- 

 out any lamellar or other obvious arrange- 

 ment, is extremely rare. The cortical portion 

 generally consists of dull-looking lamellae ar- 

 ranged concentrically, but also striated trans- 

 versely. A tendency to the alternating charac- 

 ter of urinary calculi is sometimes visible : thus 

 in the central point may appear a dark coloured 

 and homogeneous matter in 

 Fig. 87. small quantity (bile pigment), 



and from this shining strata 

 (cholosterin) radiate towards 

 a cortex such as that above 

 described (fig. 87.) The 

 thickness of the cortex va- 

 ries in different parts; though 

 Fractured surface generally greatest at the 

 of a biliary cal- angles of polygonal calculi 

 culus. (fig' 87), this is not always 



the case. In a few instances on record a 

 foreign body (e.g. a piece of needle) has been 

 found forming the nucleus of a biliary calculus; 

 such cases are of singular rarity, however^ and 

 for obvious reasons. 



The constituents of biliary calculi are cho- 

 lesterin (the chief one) with other kinds of fat 

 in small proportion, choleate of soda, bilifel- 

 linic acid or biliary resin mixed with bile pig- 

 ment, epithelium, and mucus. In some cases 

 the mass is almost wholly composed of colour- 

 ing matter * ; in others of biliary resin and 

 modified colouring matter, with mere traces of* 

 cholesterin.-{- Berzelius describes a gall-stone 

 composed principally of carbon. Von BibraJ 

 discovered 1.5 percent, of alumina with iron, 

 and 1.4 per cent, of carbonate of lime in a 

 biliary calculus ; the latter salt was also de- 

 tected by Witting in considerable amount. A 

 calculus analyzed by Bally and Henry J con- 

 sisted of carbonate of lime with traces of car- 

 bonate of magnesia 72.70, phosphate of lime 

 13.51, mucus with a little peroxide of iron and 



* Archiv. der Pharmacie, Bd. xli. S. 291. 

 Simon, loc. cit. p. 47 0-. 

 Eod. loc. 



G 3 



