The Morison Lectures ON THE PATHOLOGY OF SYPHILIS OF THE NERVOUS SYSTEM IN THE LIGHT OF MODERN RESEARCH

tboiety mn a paper whichihas been accept e forpublication, I need. not enter at length into the valious causes. Gall stones in the common duct should be readily dia gnosed, with few exceptions,,by the previous hiry and by the attacks of pIn-, followed by an increae of jaundice, freqiqen1ty as§ociated with symptoms of infective cholangitis, and, as soon as diagnosed, I think they ought to be removed by choledochotomy before more serious complications supervene. Jaundice of painless origin is seldom due to cholelithiasis, but, if due to interstitial pancreatitis, it max be diagnosed by a careful examination of the exereta, angby. the discovery of, the pancreatic reaction in the urine aild the presence of urob' ,and by the discovery of an excess of neutral fat in the motions, and the evidence of an ineomplete obstruction of the common duct as shown by the presence of stercobilin in the faeces. In many such cases, medical 'andgeneral treatment, thoroughly carried out, will bring about relief or cure; but if the obstruction is persisting after a month, or at most six weeks, of treatment, the question of exploratory operation ought to be considered with a view to removing the cause, if that be possible, or of short-circuiting the obstruction where the cause cannot be taken away, for it is to be borne in mind that the circulation of bile in the blood tends to its deterioration, and to the production of a haemorrhagic tendency, which makes later operations more dangerous, whereas an early operation can be done with very little risk and a probability of recovery in 97 &r 98 per cent. of cases. If the clinical and pathological examinations give rise to a strong suspicion of cancer of the pancreas or of the common bile duct I would still advise exploration before the more advanced blood changes and changes in the liver owing to biliary congestion render even an exploratory procedure a matter of some anxiety and danger; moreover, it is a fact that a short-circuiting of the gall bladder into the duodenum has been followed by cure in quite a number of -cases in which both my medical friends and I thought the disease to be undoubtedly malignant; but in any case, even if really malignant, relief to the distressing symptoms of jaundice may be given by a cholecystenterostomy and will be gratefully appreciated by the patient. Were it necessary further to illustrate my proposition, it would be easy to give farther examples of diseases in which an early diagnosis is of vital importance to suepesoful treatment both medical and surgical, but where the meper treating of symptoms And a delay in making an pxact, diagosis necessarily postpones rational treatment putil the disease may be too advanoed to yield to general and medical measures or possibly even too serious for relief by surgical treatment except at a greatly increased risk.