My attention was recently called to the views apparently held concerning cholecystitis and gall-stones by the rank and file of the profession, by a remark of my chief of clinic, " that the general profession at present seems to occupy the same position towards biliary surgery that it did ten years ago towards appendicitis." I am satisfied that this is largely true, and that the real importance of certain biliary condi¬ tions and the impossibility of successfully dealing with them otherwise than by the knife, is not widely enough recog¬ nized. The idea is certainly too prevalent in the profession that to warrant a diagnosis of cholecystitis some jaundice should be present, and that a painful, tender tumor in the region of the gall-bladder should be demonstrable with pos¬ sibly chill, but certainly marked fever, while the failure to detect jaundice seems to many, unavowedly, to unsettle their tentative diagnosis as to the possibility of cholecystitis. If asked, point blank, whether uncomplicated inflammation of the gall-bladder could produce jaundice, the majority would answer correctly, no, but practically the absence of this symp¬ tom staggers them.My first postulate is that cholecystitis is an infective process which precedes the' formation of calculi, and that either with or without stone formation this disease of the gall-bladder implies certain potential dangers. It is true that the most common form of cholecystitis is produced by germs * Read before the Rochester Academy of Medicine,
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