Addresses on surgical subjects / by Sir Berkeley Moynihan.

  • Berkeley Moynihan
Date:
1928
Catalogue details

Licence: In copyright

Credit: Addresses on surgical subjects / by Sir Berkeley Moynihan. Source: Wellcome Collection.

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    present in cases of cholecystitis, and I have already ad¬ duced evidence indicating that the hepatitis plays a causative role in its production. The possibility, also, suggests itself that a disordered function of the liver resulting from its inflamed condition is responsible for the formation of an excess of cholesterol. If this is true, then all the morbid changes met with in the gall-bladder, both anatomical and chemical, find their origin in hepatitis. This suggestion is not an extravagant one in view of the facts observed. It is not at present susceptible of proof, but is worth bearing in mind in any future re¬ search conducted on the histology of the liver and the chemical composition of the hepatic bile. The most striking piece of evidence which has been cited in view of a primary gall-bladder dysfunction is that the raised blood cholesterol returns dramatically to normal after cholecystectomy. The whole question of the cholesterol content of the blood in infections may assume a different importance in view of these considerations. The question is at once raised as to whether in such conditions the liver cells and the gall-bladder are implicated, and if so, what sig¬ nificance is to be attached thereto. The importance of all these considerations both to the physician and to the surgeon is obviously consider¬ able. If, on the one hand, infections of the gall-bladder begin from within, then medical treatment in the early stages by the methods suggested by Lyon, and ad¬ vanced by Hurst, may not only bring immediate relief, but may interrupt an impending and otherwise inevitable series of changes leading at last to irremediable condi¬ tions in which the aid of the surgeon would be necessary. It is, in my judgment, not the least of the functions of
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