Gall-stones and diseases of the bile-ducts . so dilated as to resemble theappearance seen in a hydronephrotic kidney. Papillomata.—A papillomatous condition of themucous membrane of the gall-bladder has beenobserved in association with gall-stones and withoutthem. No special consequences have been connectedwith the presence of papillomata of this organ. The most luxuriant growth of papillomata thathas been observed in a gall-bladder is figured byYirchow, and its subject was a cow. Clinical characters.—Primary cancer of the gall-bladder is three times more common in women thanin men : the perio

Gall-stones and diseases of the bile-ducts . so dilated as to resemble theappearance seen in a hydronephrotic kidney. Papillomata.—A papillomatous condition of themucous membrane of the gall-bladder has beenobserved in association with gall-stones and withoutthem. No special consequences have been connectedwith the presence of papillomata of this organ. The most luxuriant growth of papillomata thathas been observed in a gall-bladder is figured byYirchow, and its subject was a cow. Clinical characters.—Primary cancer of the gall-bladder is three times more common in women thanin men : the perio

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Gall-stones and diseases of the bile-ducts . so dilated as to resemble theappearance seen in a hydronephrotic kidney. Papillomata.—A papillomatous condition of themucous membrane of the gall-bladder has beenobserved in association with gall-stones and withoutthem. No special consequences have been connectedwith the presence of papillomata of this organ. The most luxuriant growth of papillomata thathas been observed in a gall-bladder is figured byYirchow, and its subject was a cow. Clinical characters.—Primary cancer of the gall-bladder is three times more common in women thanin men : the period of greatest liability is betweenthe fiftieth and sixtieth years. The beginning of the disease is very insidious, andit is remarkable that, notwithstanding the presence CANCER OF THE CALL-BLADDER 125 of gall-stones, the familiar signs and symptoms ofcholelithiasis are usually in abeyance. As a rule,the patients seek advice either on account of a locallump which they have detected, or, on account of amarked depreciation of their health.. if^£*u CALCULUS Fig. 41.—A gall-bladder with primary cancer of its neckextending into the cystic duct; a gall-stone is imbedded inthe growth. From a man aged seventy years (Museum,Charing Cross Hospital). In my experience there are two distinct conditionswhich present themselves in this disease. In one amore or less movable painful pyriform swelling existsin the right hypochondrium associated with a slighttinge of jaundice; this swelling resembles in all 126 DISEASES OF THE BILE-DUCTS particulars an enlarged gall-bladder, but the localsigns are not so acute as in cholecystitis, yet thereis usually such an obvious impairment of the generalhealth as to make one suspect the lump to be malig-nant in nature. In the late stages of the diseaseascites is present. In the other class the patients come under ob-servation with signs indicating serious disease whichresemble in part those peculiar to the gall-bladder,and those indicating cancer of the