A. Inflammation

We often observe catarrhal inflammation occurring in the biliary passages, with various terminations and results. Like catarrhs of other mucous membranes, it not unfrequently is a primary affection, and becomes chronic, or it as often is propagated from the intestine to the gall-ducts; but it often evidently has its origin in the irritation caused by an accumulation or an alteration in the composition of the bile, and especially by biliary calculi. At the bedside the affection is undoubtedly often mistaken for irritation and inflammation of the hepatic parenchyma.

Owing to the paralytic state induced in the contractile and irritable layer of their coats, and to the accumulation of bile, the gall-ducts become distended, their mucous membrane relaxed and tumid, and the muscular coat hypertrophied; within the liver saccular dilatations are formed; the catarrhal disease induces a stagnation of bile, which gives rise to calculous concretions, and occasionally suppuration and perforation of the gall-ducts follow. In the range of the biliary capillaries it most probably causes, in the manner just described, the formation of peculiar accumulations (abscesses), which are remarkable for the blennorrhoic pus and the bile they contain, and are thus distinguished from the products of parenchymatous inflammation of the liver.

Inflammation originating in irritation, caused by biliary calculi, deserves a special consideration, on account of its terminations and its consequences; it occurs chiefly in the gall-bladder. Occasionally and particularly when brought on by an accumulation of bile from obturation of the neck of the bladder or of the ductus cysticus, it runs a very rapid course, attacking the submucous tissue of the gall-bladder, and terminating in rupture and effusion of its contents into the peritoneal cavity. At other times it proceeds more slowly, and after repeated relapses, induces suppuration and ulcerative perforation of the gall-bladder. The latter is most liable to occur at the dependent portion, which is chiefly exposed to irritation, viz. the fundus of the bladder;' and as previous peritoneal exudation will have agglutinated it to adjoining viscera, the suppuration extends to them, giving rise to abscesses in the liver itself above the gallbladder, or in the lesser omentum; or establishing fistulous passages through the abdominal parietes, or communications between the gallbladder and the pylorus, the duodenum and the transverse colon. Lastly, in favorable cases, the coats of the gall-bladder may be converted into a fibrous, callous tissue; its contents are discharged by the normal or by the above-described anomalous passages, and the organ represents a thick-coated hollow capsule, with or without cicatrices on its inner surface, and containing, according to the condition of the mucous membrane, a mucous or serous fluid, and not unfrequently one or more calculi. This is the so-called obliteration or atrophy of the gall-bladder. The calculous inflammations of the biliary passages are followed, though less frequently, by similar results, viz. rupture, suppuration, gangrenous perforation, callous induration, and obliteration.

B. Croupy Inflammation Is Of Very Rare Occurrence

We have observed it in the mucous membrane of the gall-ducts in the liver, accompanying cholera-typhus and ileo-typhus. It gives rise to tubular exudations, in which the bile forms branched concretions which block up the passages, and thus cause dilatation of the capillary gall-ducts.

We have already noticed the occurrence of the secondary and gangrenous typhous process on the mucous membrane of the gall-bladder.

C. Edema Of The Coats Of The Gall-Bladder

Serous infiltration of the coats of the gall-bladder occurs in general dropsy, and especially in ascites, and also in the shape of subserous infiltration in inflammation of the peritoneum.

D. Adipose Deposits In The Coats Of The Gall-Bladder

An excessive deposit of fat under the peritoneal investment of the gall-bladder only occurs as an accompaniment of general adipose accumulation, or at least of accumulation of fat in the abdomen. Its occurrence is of some interest, inasmuch as, like the fatty deposit in the heart, it is likely to induce fatty degeneration of the muscular layer.