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biliary passages was ascribed to the presence of an excess of this substance (which, together with an excess of pigment and other salts, characterised the "hereditary predisposition" of Bouisson). With the knowledge that cholesterine was an alcohol, not proved to have been present in excess, and deposited in consequence of the decomposition of its solvent-taurocholic acid-this imaginary connection ceased to be of the least weight, and the opinions of Durande and of L'Héritier (Traité de chim. pathol.', 1842), opposed as they already were by the investigations of Benkoe, lost all ground.

Sedentary Habits, Sleep, Rest, and Imprisonment, as alleged causes of Gall-stones.

That persons of sedentary habits, such as authors, or women following callings which entail little exercise of the body, are more liable to gall-stones than other persons of active habits, has been alleged, but not proved. So far as my own experience goes, active habits, on the one hand, do give no protection from gall-stones, if they are not joined with moderate habits of living; and sedentary habits, if not accompanied by excesses in eating and drinking, do not by any means predispose to gall-stones. Among the cases I have adduced I may here refer to that of an habitual sportsman, who was daily on horseback, a free liver, and who became afflicted with biliary calculi, all of which he passed, and recovered. A very active teacher of music, who, at the same time, was a most moderate liver, became the subject of the disease in question, and though it did not prevent him from reaching an age exceeding eighty years, nevertheless it embittered the last years of his life. A medical gentleman in a sea-coast town ascribed his gallstones to over-exertion during an epidemic of cholera. In

many cases neither want of exercise nor over-exertion can be accused of being at the bottom of the disease.

In the forty-five cases collated by Wolff sedentary habits could not be blamed for the disease, as most patients were of very active habits.

Imprisonment. Soemmering states that he found gallstones in the bodies of most females and males who died in the prisons of Mayence and Cassel. Bouisson also found them not rarely in the bodies of prisoners at Nismes and Montpellier, but not so often as had been stated by Soemmering. Besides these general statements, no data are in existence upon which to found any positive assertion, and, consequently, we are obliged to reject the hypothesis that imprisonment is favorable to the development of gall

stones.

Long-sleeping-Hoffmann, Van Swieten, and Haller have accused long-sleeping as causes of gall-stones. The hypothesis is not without a reasonable amount of support in one sense; calculous disease, putrefaction of bile, might exist without being due to long-sleeping, but this excessive rest might afford the opportunity for the settlement of any precipitate in the gall-bladder or ducts, which precipitate in an active condition of the body would have been carried out of the biliary passages altogether. On the other hand, a short sleep of six or seven hours seems to afford ample time for the deposition of any precipitate. Besides, the proposition is not countenanced by any expe

rience.

Coe attributes great influence to the compression of the intestines by a full meal. In so far as the meal is objected to as something that compresses mechanically, it seems to deserve but little attention; but the full meal itself, as an unmanageable and easily fermenting mass, is, no doubt, a breeding-ground for the ferment of which gall-stone disease

is the product. Coe, therefore, while appreciating the cause itself, seems not to have understood the manner of its action.

Complication of Gall-stone Disease with other Diseases. (a) Marasmus of Age.

Samuel Cooper drew attention to the frequent occurrence of gall-stones in bedridden persons. To some extent I can confirm this statement, but it lacks the confirmation of comparisons by figures. The dissecting-room, which receives the unclaimed dead of the workhouse infirmary, not rarely yields a crop of calculi in the gall-bladder. Thus, I found a number of small, dark-green calculi in the gall-bladder of an old man who had died of mollities ossium, many fractures and contortions of bones being found upon his body. An aged woman, emaciated to the last degree, had one brown, soft gall-stone in her gallbladder, besides a large hydatid cyst in the liver.

(b) Phthisis of the Lungs.

Calculi are frequently found in the gall-bladders of persons dead of consumption of the lungs. A connection between both diseases has been inquired after, but, besides hypotheses, no result has been obtained. It must be remembered that consumption is a very frequent cause of death, frequently inquired into anatomically, so that even if gall-stones were an accidental occurrence, and not a connected complication in consumption, they would frequently be met with by the anatomist. Nevertheless, I believe that in a proportion of cases of phthisis, particularly tubercular phthisis, gall-stone disease is a connected complication, and may precede, accompany, or supervene upon the development of the lung disease.

1. Gall-stone disease precedes phthisis.-In this place I

must allude to a case which exhibited a tendency to bilious attacks. Fever, coated tongue, yellow conjunctivæ, indigestion, and constipation, were the symptoms. Blue pill was largely used, contrary to my remonstrance, or before I was called into action. After purging and a period of weakness, the patient recovered, but was left much weaker than before. A coherent treatment had some effect. A return to business and some years of indifferent health ensued, until at last a certain pallor of the countenance and a clarionet-sound of the voice appeared as evil omens. One morning the patient was taken with hemoptysis, which brought him to the verge of the grave. During the last

years continued gall-stone pains leave no doubt of the formation of these concretions, which will probably remain in the seat of their formation until the natural solution of

the malady.

2. Gall-stone disease accompanies phthisis.-A case of this kind offers no particular symptoms; after death from phthisis one or many gall-stones are found. By a calculation of the probable duration of the disease in the biliary passages, a comparison with the known duration of the lung disease becomes possible, so that the biliary disease may be said to be of equal duration with the pulmonary.

In a man dead from phthisis I found a white, round cholesterine calculus, without any admixture of cholochrome.

Mr. Rogers Harrison brought a case before the Medical Society of London, in which, on dissection of the body of a young man who had died from consumption, the gallbladder was found filled with many hundreds of gall-stones of various sizes, white outside, from finely deposited cholesterine, not chalk, as had been believed from appearances, and containing a darker nucleus. Evidently bile had not entered the gall-bladder for a long time.

3. Gall-stone disease supervenes upon phthisis.-This may be the case in any stage, but is more commonly so in the hectic stage, or during a colliquation which becomes arrested and is followed by considerable improvement. In these cases, several hypotheses may be resorted to for an explanation. The disease of the intestinal canal, which many physicians assert is the consequence of the swallowing of the sputa, particularly of those which the patient during sleep fails to reject, may yield sufficient fermentative matter to kindle a diseased process in the liver. Or the blood may be poisoned by absorption of matter from the diseased parts of the lungs themselves, and may infect the liver, so as to dispose its secretion to an analogous decomposition. The liver is a favorite depository of pyæmic poison, and a breeding-place for its progeny. These speculations are, however, not capable of any very striking support by experiment or observation. They have, therefore, no greater value than that of suggestions for future inquiry.

Climate an alleged cause of Gall-stones.

Haller, based apparently upon the statistics of his dissecting-room, accused the climate of Göttingen of fostering gall-stone disease, but imparting, as a recompense for this infliction upon the inhabitants of this university town, a great immunity from urinary calculi. The century which has meanwhile elapsed has left the climate of Göttingen what it was in the time of Haller, but the proneness to gall-stones and the protection from urinary stones have both disappeared. Now-a-days the Göttingen people are not more subject to gall-stones than the people of other continental towns.

Brugmans has enlarged the statement of Haller, by expressing his belief that the people of the kingdom of

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