GALLSTONES IN THE COMMON DUCT.

Whether the formation of galistones is due to chemical or to bacterial causes, it seems fairly certain that the stones are first formed in the gall bladder and are usually associated with recurring attacks of cholecystitis, usually of a subacute character. Whether the inflammation of a gall bladder stands in the relation of cause or effect, it is apparently a clinical fact that, while we may occasionally see a primary cholecystitis without stones, we do not find a secondary attack occurring after any appreciable length of time without finding stones present either in the gall bladder or in the ducts. I suppose it is possible for a patient to pass all of his stones through the common duct, and so cure himself, but my experience leads me to believe that such a result is almost impossible. In fact, the passage into the intestine of a single stone is rare, and in the only case in which I have ever been able to prove such a passage and recover the small stone, there were many