Vol. 60, 1909 - University of North Carolina at Chapel Hill

-,^^
THE CHARLOTTE MEDICAL JOURNAL.
carbohydrates independently, or as Cohn present "a^^ >
heim believes, is necessary to render act ve t.cular^
'^f^^L blood vessels within the
a proferment wh:ch,smanufactnied,n the P.-^^^^S.^;';;^ constUnents needed in the
muscle cells.
formation of bile, and thus, by a descend-
BTiOLOGY OF GfKUi. STONES. i„g infection, enters the gall bladder. These
The vast amount of attention that has organisms are capable of producing an inbeJn
devoted to the subject of gall sto.ies flammation nf the bihary passages, mild or
durhiethl past decade has resulted in the severe, of an acute or chronic na ure, and
flue dat on of manv problems regarding the the acute cholecystitis, m particular, is be-
So-^enesis as well as the treatment of i„g recognized as a by no means infrequent
?hSaS It s generally admitted that complication of typhoid fever. According
sevS factors are concernedly^ forma- to Naunyn, the bacteria multiply m the
tfon of *all s'ones The most important of stagnant bile and cause an inflammation of
these afeLmmerated bv Fitz: Thev are the mucous membrane, the cellular product
suTnatL oHhebile, infection of the bile from which contains the cholesterin and
Dassatesand unknown disturbances of lime of which the calcuh are composed m
metabolism ncluded under the term pre- addition to the pigment derived from the
TisposSr No one of these factors seems bile. The milder the inflammatory process
sXe t but the combination of at least and the longer its continuance, te larger
^ passages by
two is essential. The importance of the or more numerous are the calculi likely to ,
fiTst twoT i-enerallv accepted, while the become, but for the formation of the cal-
Siiificance of the third is doubtful, the cuius a preceding inflammation of the bile ,
'
Smpredsposition being perhaps more a passages is necessary. Gall stones th-
form of speech than a demonstrated process, may arise m the bile
P^f^^f^^ henat^J
The importance of stagnant bile is to be without the hver.m the ^o"^° P^^^, •
"^
Jf
reco-nized from the fact that infection with- or cystic duct, but especially withm the
out "stagnation is less likely to be a fore- gall bladder.
runner of gall stones than when combined Experiments on anima s ^^o"" ^^^^ ^^^
^^th stagnation. Gall stones are more culi may be produced m the gall bladder by ,
Ike y o be found in those in whom the flow obstructing the flow of bile and nitroducing
of Me is r^ore likely to be impeded. Sev- bacteria into it, while the admission of bace«ty-si4
per cent, of the Mayos' cases are teria without an associated obstruction to
wometin whom the stagnation is attribut- the flow of bile 1^-, "° -'^'^^^JfbilSy'
able to the habit of lacing, and to repeated bacteria may be admitted to the bUiary
p?e' nancies which lead after parturition to tract through the ^^'^'^'^'}^''',\f^'^^^fl^,
Sion of the cystic duct from prolapse of by inoculating the
^f-'^tlvViUo the Ra^l
the liver and during pregnancy to pressure they may be injected directly into the gall,
d^^tlv^pontSegJ^^ladder. In the obese bladder or bile duct, '^^-e experimented
and in those of sedentary habits of either are of interest also as s^Sge^^^^^jlie rapid ,
Jexs agnation is more likely to occur for ity with which gall stones may be formed
;
obviouf reasons. In the aged, because of Concretions as large as a frain of whe^^^^
the exposure throughout a longer life to bave thus been produced wihiix weeks ,
variousinfectiveprocesses, and also because others, of the size of a pea withm tour,
of the g eral muscular enfeeblement from months. Our definite knowledge hovveve,
degeneration and disuse, the flow of the bile of the rapidity of the ».o"
fo'^^^f
"f .^^
fsSardedinthebile passages. Most im- stones in the 1--^" .^^
f^, , "„tm "nsj
oortant of all however, is infection of the from the operations of Kehr and oHomansj
bUe carrying apparatus. Naunyn first di- who found at a subsequent operation upor.
rected special attention to this factor. the patient that gall stones had formeCj
Infectious organisms, especially the colon
^^^^^^^ ^^^ ligature in the gallbladder
bacillus, the typhoid and paratyphoid
^^^^ .^^ ^.^^^ months in Kehr'si
^:^:^^!i::::rLTt^'^::i ....... Lmans emptied the gallblad^!
with greater or less frequency in the gall of stones in April, 189... bymptoms of ga
bladder. Although human bile is usually gtones returned in December, 1896; the galj
sterile under normal conditions, it is claimed
j^jg^jj^ej- ^as re-opened in Jauuar^^ 1897!
that if a sufficient quantity be examined the
^^^^^^ were found to hav!
colon bacillus may constantly be found.
ana sev
It g
'
n^ature
is an excellent culture medium, and if the formed around the ligature.
.