Of 03,000 patients examined, stones were noted in only 133, making 0.14 per cent., while, on the other hand, at autop sies fully 10 per cent. of the bodies are found to possess them if a careful exam ination of the binary system is made. The great frequency with which gall stones are not diagnosed intro ritam is thus shown. The Roentgen rays may be looked upon as a valuable diagnos tic aid in the future, and already. a num ber of excellent photograms have been published. Best results will always be obtained with the strongly calcareous stones, while the rarer ones, consisting chiefly of cholestrin or bile-pigment, can hardly be expected to throw a shadow. H. Fiedler (Miinehener med. Wochen., Oct. 22, 1001).
Pending the study of other series of eases from various parts of the United States, one may draw the following conclusions:— Nationality: On the basis of the analysis of the 1655 autopsie:4 from the Johns Hopkins Pathological Depart ment, as compared with 1150 (?) eases as given by Schroder. of Strassburg. gall-stones are less frequent in the United States than in Germany, the United States showing a frequency of 6.94 per cent.; Germany, of 12 per cent.
Age: The frequency of gall-stones in a given number of cases will increase with the age of the patients examined. The American cases tend to confirm the statements of previous observers that gall-stones are rare before tbe thirtieth year and more frequent after that age.
Color: Gall-stones are more frequent in the white man than in the black, the American cases showing a frequency of 7.85 per cent. in the whites and 5.51 per cent. in the negro. I Sex: Women are more liable to have 1 gall-stones than are men, the American . eases showing the frequency in 61S WOIllell tO be 9.37 per cent., and in 1037 men to be 5.94 per cent. The American women ha.ve gall-stones only about half as frequently as the German women. In the United States only about 1 woman in every 10 has biliary calculi, while in Germany, according to Nattnyn, , gall-stones are found in 20.6 per cent., i or in about 1 woinan in every 5. C. D.
Mosher (Johns Hopkins Hosp. Bull., Aug., 1901).
In women the largest number of cases occur in the child-bearing period, and, according to Schroeder, 90 per cent. of the females were women who had borne children. The fact that cholelithiasis occurs in females in the proportion of 4 or 5 to 1 of males is established by all statistics. Tight-lacing has been given
a very prominent place in the causation , by some authors. In more than half of the female cases the liver has shown I signs of pressure of the ribs.
A pendulous abdomen is often found, which may favor the formation of cal cull directly in causing a partial ob struction of the bile by traction on the common bile-duct.
Langenbuch is of the opinion that the traction of a displaced right kidney 1 on the common duct is a predisposing cause of cholelithiasis to which suffi cient importance has not been given. The capsule is attached to the cystic ' duct, the hepatico-duodenal being con tinous with the hepatico-renal ligament.
As profession and social position as causative factors, Krauss gives tho fol lowing statistics of 472 cases in men which came under his observation:— Physicians, 45.
Officials, 74.
3Ianufacturers, 19.
Clergymen, 60.
Large landed proprietors, 24. Merchants and bankers, 40.
Small land-owners, 26.
Military officers, 40.
Professors and teachers, 103.
Tenants, 41.
Over 50 per cent. occurred in active brain-workers who at the same time lead sedentary lives. Krauss gives mental anxiety, chronic constipation, and fre quent pregnancies as probable causes.
He is also of the opinion that the de posit of fat in the abdomen prevents the active peristalsis of the intestines.
Heredity does not seem to play an important part. Naunyn claims that it would be difficult to estimate this factor in a disease so prevalent. In GO per cent. of Krauss's patients the disease could be traced in the families of the patient. He has often treated mothers and daughters for cholelithiasis at the same time.
Gout has been looked upon as a pre disposing cause. It may act in two ways: by producing a stagnation of bile in one who cannot take sufficient exercise, and by means of toxins which, when excreted by the liver, may bring about a catarrhal inflammation of the ducts.
The relation between diabetes and cholelithiasis has given rise to much dis cussion. Bouchard found gall-stones present in 165 cases of diabetes. Mayo Robson states that they are rarely found in case of diabetes when nitrogenous food is largely- taken.
Cardiac disease tends to the formation of calculi by rendering the patient in capable of much exercise, and by causing passive congestion of the liver. Brock bank found gall-stones in 27 out of 49 eases of heart disease.