picture annexed to his Memoir, as big as middle-sized walnuts. Though the similarity of their composition with other gall-stones was proved by the analysis, it was questioned whether they had been formed in the gall-bladder or in the intestinal tube. Their dimension appeared indeed so much out of proportion with the usual diameter of biliary ducts, that the belief of their formation in the gall-bladder must partly rest upon the well-known and astonishing power of dilatation and contraction possessed by certain organs, whilst the explanation of their formation in the alimentary canal offers still greater pathologic difficulties. The excruciating pains which attended the evacuation of those enormous concretions and the cholestrin found in them, are sufficient proofs of their formation in the gall-bladder. Such is at least the opinion of the learned professor, Dr. Pleischl.
In a great number of cases, the violent pains in the vicinity of the biliary organs, the sudden cessation of those pains, a visible change in the complexion, and even the total disappearance of the jaundice, leave no doubts about the existence of gall-stones; but, if their passage through the alimentary tube is probable, they cannot always be detected. Most patients are careless about ascertaining the fact; many feel reluctant to trouble their physician with this loathsome investigation; in short, various circumstances render it more or less difficult, and, in order to be conclusive, the examination should take place every day. I attended last year a lady, whose
