VOL. XL.] PHILOSOPHICAL TRANSACTIONS. 233 



have been impossible for the sides of the cystis to have yielded to such a sudden 

 dilatation, no more than the womb in the first week, of gestation, can be dilated 

 to the pitch it is brought to in the Qth month, without a rupture : so that the 

 dilatation here must have been very slow and gradual, and therefore the ob- 

 struction must have been at first, and probably for many years, only partial ; 

 and the gall-bladder thus slowly distended, gradually yielded and gave way, only 

 for the reception of the excess of the secretion beyond the excretion, and so 

 prevented the jaundice, or regurgitation of the bile into the blood. 



This partial obstruction of the cystic duct may probably have been occasioned 

 by one of those small soft incysted tumours, lodged between the membranes of 

 the cystis fellea, near the origin of its excretory duct, containing a soft white 

 pultaceous matter, with calculi, or chalky concretions, in its centre. If this 

 was the case, it is conceivable that while the contents of this small incysted 

 tumour were fluid or soft, they might not be capable to obstruct totally the current 

 of the bile through the excretory duct : but as the matter of it grew thicker, 

 and its bulk, increased, by pressing gradually more and more on the duct, the 

 obstruction must increase ; and the formation of calculi, by their pressure, 

 must at last make the obstruction total. But as the cystic duct was, at opening 

 of the body, entirely coalesced and obliterated, its vicinity and situation, with 

 respect to these small incysted pultaceous and cretaceous tumours, cannot be 

 precisely determined ; and therefore this is offered only as a probable con- 

 jecture. 



The bulk, contents, and adherences of the gall-bladder to the right side, 

 were doubtless to him a very sensible, and to us a visible cause of his first 

 symptom, the increasing weight he had felt in the region of the liver, for 14 

 years before his death. 



The current of moving humours in the animal body, is always determined 

 most strongly to the place of least resistance : therefore, by the partial ob- 

 struction of the cystic duct, a greater quantity of bile than usual will be forced 

 on the biliary ducts, leading directly from the liver into the great hepatic duct, 

 to discharge itself by the choledochus communis into the duodenum, suflicient 

 for the moderate uses of the animal economy ; though not so perfectly suflicient, 

 but that the peristaltic motion, in this case, felt the want of the cystic bile, or 

 at least the defect of it so far, as to become weak and imperfect, too weak to 

 propel the excrements, or keep the elastic air within due bounds; and therefore 

 the patient must be subject to flatulent distentions, and some degree of costivc- 

 ness, only to be relieved by supplying the want of a suflicient natural stimulus 

 of the gall, by the artificial stimulus of purgatives and clysters, to assist from 



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