Royal Medical Benevolent Fund Society of Ireland

draw ouit aitlir-SiZC(l 1w(lliCe I(Ii tllcI'lSCI\ ts', all(l vet ar1,c hOt 'O CIflorl that approacli to the pe(licle is iml)ossible. I'rior to closing the abdomleni, the gall-bladder---small, firmii, thick-wallc(l, and conitracted-was exanmined, andl founcd to conltainl up near the cystic duct three calculi, each the size of a smiiall pea. Cholecystectomy was pcrfomed, which was not easv throughI the left-sided ilcisionll, particularly as the gall-bladdler was smiiall and fibrosed. The liver was normal in appearance. (iall-stones are niot inifreqtuenlt with aclholutr-ic jauindice, although miiost commlllon N-ith the adult oracquired type, in whom thley are sai(d to be as fre(quent as forty per cent. WIith the congenital variety thley are said to occuri less frequently, and the percenita(re is not mentIlioned. Thllis intturallv is (lilfthlt to a,scertain, as the (cases arce aill operated upon at (liferent agesc. T1hsesCt uC'.are usuially regar(dc(l as a (lC)osil of inspissated bile, but in this particullar case2 a radiogIramill olf the gall-I ladder whecni removed showed th-iat the calctli WeCre rich ill calclium, and the fact that the -all-bladder was thick clan( fibrosed sig-gested a cholecystitis of somlCe sort, and furlther-, tile examination of the calculi thciselves showed tlwiat thev were of thle mixed varietv , w itlh cllclcili, chiolestcrl, elnad 1)1 IC Ioigilncils Dr)r. A.. I'isher). Wliat is the corrIect trcaticiiiet i1 suIci a casc irIm oval or (dlrinaag,e' hill1s catse w-ith tllilckene( wall, reioVal was justificd(l, but wi tlh normal trallsparclnt wall -Would drainage or cholecystotomvy with clostu-e be correctt 1v som01e it iS a(lvised to cruslh the stonies \witll the fing-ers throug-h the gall-bladder wvall, whicl sounIds verv unconvincillg. The case is interesting in a chlild of thlis age-C. The cchild( hias sinice lost lheijaundice and is free fromn atll symptonis. 1 wish to thanik Dr. Rovland Hill, tinider whose car-e in the Belfast Hospital for Sick Children the child has been.