232 PHILOSOPHICAL TRANSACTIONS. [aNNO 1738. 



actually removed soon after a vent was made for the purulent matter, which 

 had occasioned this inflammation. 



Some Observations on the foregoing Case of Mr. Le Grange. By Alexander 

 Stuart, M. D. F. R. S. &c. N° 449, p. 325. 



Dr. Stuart points out what appears to be the mechanical and necessary con- 

 nexion between these apparent causes and their effects, in this uncommon 

 case. 



], As to the original or prime cause of all the symptoms, viz. the distention 

 of the gall bladder, now become a morbid cystis of an enormous extent. 



If we consider the size and figure of the liver, and the situation of the gall- 

 bladder, with the course or direction of the biliary vessels, from various places 

 of the liver, towards that narrow space where the pori biliarii open into the 

 cystis, it will appear, that in almost every position of the body, at least in an 

 erect, supine and lateral position, some of these biliary ducts terminating in the 

 gall-bladder, are perpendicular, or nearly perpendicular, to the Horizon and to 

 the cystis : therefore, as far as gravity takes place in the animal economy, the 

 bile descending by these ducts, will press on the contents of the full cystis and 

 its sides, as a cylinder of that fluid, of the length of the secretory ducts or 

 pipes, and of the diameter of the cystis. 



Besides this, the extremity of every one of these small ducts, conveys its 

 fluid into the full cystis, as a wedge acted on by the repeated strokes, impulses, 

 or pressures of the circulating blood of the vena porta, where it supplies the 

 gland at the origin of each secretory duct. Therefore, by the known laws of 

 hydrostatics and mechanics, it is apparent, that the force of this secretion of 

 the bile, into the gall-bladder, is very great, and the quantity copious; suffici- 

 ent at least to distend the cystis to an enormous pitch, where the discharge by 

 the ductus cysticus, is not equal to the secretion by the pori biliarii and the 

 ductus hepatico- cysticus. 



These powers sufficiently account for the distention of the abdomen in an 

 ascites, of the womb in gestation, of the bladder in a morbid or voluntary 

 retention of urine ; also of morbid imposthumes or tumours, and of the gall- 

 bladder in the case before us. 



But this distention could never have happened, without a total or partial ob- 

 struction of the excretory duct, the ductus cysticus. Had this obstruction been 

 at once total, as when a calculus is thrown suddenly out of the cystis into the 

 duct, and stops it totally, he must have had the jaundice immediately, or very 

 soon after : for, notwithstanding the strong powers abovementioned, it would 



