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

ORIGINAI, COMMUNICATIONS 367
diagnosis of gall bladder disease, but we iiig, Sept. IStli. and discovered a tumor in
now know that we can have a grreat deal of region of gall bladder extending downward
trouble in the gall bladder and biliary pass- as far as umbilicus. Patient continued to
ages wilhout having jaundice as a symp- have pain in right side with nausea and
torn, and the surgeon who waits to see the vomiting, with slight elevation of temperayellow
flag and other grave symptoms, such ture, until admitted to the hospital on Tuesas
clay colored stools, enlarged liver, etc., day, Sept. 21st.
makes a great mistake and will miss the at any time.
Patient had no jaundice
opportunity of curing the majority of peo- Diagnosis at time of admission was tumor
pie who suffer from gall bladder disease. of gall bladder with the probability of stone
Tumor as a symptom of gall bladder dis- in cystic duct. She was immediately preease,
without jaundice, would point to either pared for operation, which was done Wedan
infection of the gall bladder cystic duct, nesday, Sept. 22nd. Patient was placed on
with plugging of cystic duct by thickened table with head raised six or eight inches
or insipisated bile and mucous or stone in above her feet. At the same time a sand
cystic duct, while tumor
would suggest malignancy.
with jaundice bag was placed under back at or a little
In some cases above level of liver. An incision beginning
of gall bladder disease ih^ symptoms are so at costal margin and extending downward
vague and misleading that despite our best 5 inches along outer border of right rectus
efforts it will be impossible to make a diag- muscle was made. The gall bladder was
nosis wiihout an exi)loratory section, but I found and brought into wound without any
believe with the proper interpretation of a trouble. Palpation of gall bladder showed
thorough and carefully taken history that it to be moderately full of fluid. Examinthe
majority of the