^do 



PHILOSOPHICAL TRANSACTIONS. 



[anno 1738. 



the cystis, or grand bag, through which the great collection of bile in this 

 saccus had afterwards made its way ; and it was observed, that the strong coali- 

 tion of this bag to the peritoneum, round that part where the pus had been 

 collected, had shut up all communication with the cavity of the belly, and so 

 prevented any extravasation into the abdomen 



Now the bag or cystis being separated from the peritoneum, and this and the 

 liver spread on a board, it was observed that the matter had been collected in 

 the gall-bladder, without affecting the liver itself. The vesica fellis was become 

 a very large bladder, and extended so as then to appear capable of containing 3 

 pints, or more ; it was nearly as broad as long : it arose very broad from the 

 surface of the right lobe of the liver, which it occupied about 10 inches in cir- 

 cumference, or more: its bulk had removed the stomach and pylorus from their 

 natural situations, and pressed them far under the left hypochondrium, and that 

 part of the colon placed naturally on the right kidney, forwards on the spine : 

 its surfaces were rugged and unequal, as that of a potatoe, and its coats thick 

 and horny, forming several tumours, elongations or expansions, of different 

 sizes and figures ; one of which, as large as a hen's egg, was full of a cretaceous 

 matter, intermixed with hard white stones. This cretaceous bag was made in 

 the duplicature of the vesica fellis, but had no communication with nor open- 

 ing into it, which several other tumours, appearing of the same kind had ; 

 whence it was presumed that some very small pieces of creta, found in the great 

 bag, might have dropped from them into it ; but it is more likely they had 

 dropped them there, because nothing like them had been discharged through 

 the wound. The outer opening in this bag answered in the cavity of the 

 abscess, where incision had been made, as this latter was formed between it 

 and the peritoneum. In the bag were found about 2 oz, of the same bilious 

 matter which had all along been discharged ; which being computed, must be 

 equal to, if not exceed, the quantity of 18 or 20 quarts, during the 25 days 

 the patient lived, from and after the opening of the tumour. 



It has been observed, that the liver was in a natural state, and that the matter 

 collected in the vesica fellis, had not in the least wounded or affected the liver 

 itself; so that the great quantity of bile and lymph daily discharged through 

 the incision, must have proceeded from the internal surface of the distended 

 gall-bladder. This put them on inquiring for the radices cysticae and hepatico- 

 cyslic ducts ; i. e. for those very ducts which Giovanni Caldesi so carefully 

 traced in several animals, and delineated in his Observ. Anatomiche al illustr. 

 Sig. Francisco Redi 1687, and which Verheyen discovered in the bullock 

 kind, but could not trace in man ; these ducts, by which so great a quantity of 

 gall had been deposited in the vesica fellis^ for as much that the cystic duct was 



