A REVIEW OF ABDOMINAL SURGERY

GALLBLADDER  Moynihan¹ found that infection began in the outer coats of the gallbladder in 63 of 81 cases of cholecystitis. In 18, the inner coats were primarily involved. Infection may reach the outer coats by direct extension from the liver, by means of the lymphatics communicating directly between the liver and gallbladder or by involvement of the peritoneal surface as a consequence of disease in an adjacent organ. In cases of infection from within, the ascending route is followed more frequently than is realized. Cholecystitis as a rule is only a part of an infection which has its origin elsewhere. Hepatitis is commonly, if not always, present, and is almost certainly of earlier origin than the inflammation of the gallbladder. Moynihan stated that sufficient regard has not been paid to the spleen as an infective agent. In some cases with recurrent stones and with marked infection in the common