Cholecystitis or abscess gives rise to a painful, tender swelling near the cartilage of the ninth rib of the right side. If allowed to take its course, adhesions may form around it and it may burst into the intestine or on to the surface of the abdomen, a biliary fistula remaining. Either condition being suspected, an incision should be made, and, its covering having been stitched to the abdominal wall, the gall-bladder should be opened and drained, or, which is still more preferable, the gall-bladder shoilld be removed unopened.
Stones in the gall-bladder should be removed by operation, as, if left, there is a great risk of their trying to escape with the bile into the intestine and thus causing a blockage of the common bile duct, and perhaps a fatal leakage of bile into the peritoneum through a perforating ulcer of the duct. Whether the gall-bladder should be removed along with the calculi depends upon circum stances. Other treatment than surgery is useless if not positively harmful. "Biliary colic" is the name given to the distressing symptoms associated with the passage of a stone through the nar row bile-duct. The individual is doubled up with acute pains, which, starting from the hepatic region, spread through the abdomen and radiate to the right shoulder-blade. Inasmuch as
the stone is blocking the duct it gives rise to jaundice, which becomes obvious a day or two after the colic has occurred. The distress is due to spasmodic muscular contraction and comes on at intervals, each attack increasing the patient's misery. He breaks out into profuse sweats and may vomit. If the stone happily finds its way into the intestine the distress suddenly ceases. In the meanwhile, relief may be afforded by fomentations, and by morphia or chloroform, but if no prospect of the stone escaping into the intestine appears likely it must be removed surgically.