A treatise on cholelithiasis / by B. Naunyn ; translated by Archibald E. Garrod.

  • Naunyn, Bernhard, 1839-1925.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on cholelithiasis / by B. Naunyn ; translated by Archibald E. Garrod. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    NAUNYN ON CHOLELITHIASIS. they shrink considerably, and often break up into small particles during the process. Those of the second type are harder, but still, as a rule, are only of small size, from that of a grain of sand to that of a pea : they have very various forms, and often exhibit processes. The surface of the larger and even of the slightly distorted specimens is smooth. Their colour is steel grey or black, with a pronounced metallic lustre, which is especially conspicuous in the crumbled or pounded material. They are firm, hard, brittle, but I have never found the larger specimens homogeneous; but they consist of a spongy structure, in the meshes of which lie small granules with a metallic lustre, such as are also met with loose in the neighbourhood of such larger concretions. These tiny calculi, whichever form they assume, consist almost exclusively of the calcium compounds of bilirubin and its higher oxidation products, free bilirubin and free biliverdin being only present in traces. Bilirubin-calcium is, as a rule, the chief constituent, but there are always present, and often in quantity, biliverdin-calcium and bulifuscin. Bilicyanin is rarely present, bilihumin, on the other hand, practically always. The last-named substance often forms a chief constituent, and in one case, in which it was in part combined with lime, it constituted more than 60 per cent, of the entire mass of a calculus. These stones contain only quite minute quantities of cholesterin, and sometimes mere traces, which are difficult of detection. 6. Rarer forms. (a,) Amorphous and incompletely crystalline cholesterin gravel. —Small calculi varying from the size of a grain of sand to that of a large pea, which are often exactly like pearls, from their subdued lustre both on the surface and in section. In their centre there is always a nucleus of different structure, and I have often found within them small black stones of bilirubin- calcium, whilst in some there is only an admixture of bilirubin- calcium which imparts a brown colour to the central portion. They seldom show lamination. To the naked eye they never exhibit a definitely crystalline structure, and under the microscope they appear vitreous or exhibit incipient crystal- lization of cholesterin from the centre outwards. With the