Cardiac Failure and Sudden Death

With regard to the cholecystectomy, I found it a much simpler operation than I had expected, and as the patient seems to do quite well without her gall-bladder, I should not hesitate to perform it again in any case in which the bladder was much damaged, or in which it was impossible to properly suture it into the external wound. Looking to the tedious convalescence in the cases in which the gall-bladder is sewn into the parietal wound, and to the possibility of re-formation of stones, I think the question of cholecystectomy versus cholecystotomy as a rule of practice will have to be seriously considered. Watching these various cases, and the nature of the fluids contained in the distended bladder and discharged during healing, I cannot help having doubts as to whether physiologists are right in regarding the gall-bladder as a storeroom for bile; it seems to me that it is very likely intended to secrete a mucous fluid to mix with the bile, and render its passage through the duct more easy; the fact that bile finds its way into it and through it when it is cut open does not militate against this suggestion, because any slight obstruction or closure of the outlet of the common duct would naturally cause the bile to flow back along the cystic duct and in the direction of least resistance when the bladder is open, and when it is closed it must act somewhat like one of the little rubber bottles with which we are all familiar, and squirt out fluid whenever its muscular coat contracts, and suck it in when it relaxes. Whatever its function, it is to many a source of infinite pain, and trouble, and danger, and if it is found that they get on as well without it, so much the better for their future peace. I do not wish it to be thought that I am advocating the performance of cholecystectomy, and leaving the stones, as a rule of practice; I merely did in this particular case what seemed to me at the time to be best, and the sequel proved that I did right. The only remark I have to make about the fifth case, the simple cholecystotomy, is that the breaking down of the wound from the passage of the bile ov-er it, and the slow closure and great discomfort suffered by the patient from the large quantity of discharge soaking through everything, made me often think whether it would not have been better for her if I had removed her gallbladder. However, she has got her gall-bladder, and the wound has healed, and she is as well as her companion in misfortune who is without her gall-bladder. Since this was written she has been to see me, complaining of a good deal of pain about the site of the suture of the gall-bladder to the parietes, but I can detect nothing -wrong, and think it must arise from the drag on the gall-bladder.