4. _Gall-stones may be lodged in the ductus communis choledochus._ This is one of the most common situations for these bodies, and they may reach the point, either from the gall-bladder, or from the ducts from the liver. While in this position, the calculus is likely to give rise to jaundice with paroxysms of severe pain, which will be repeated from time to time, until it passes into the intestines. _Effects._ As already intimated, gall-stones may remain for an indefinite period in the gall-bladder or ducts, without giving rise to any symptoms. In many instances, also, they may undoubtedly pass the ductus communis when small, and be discharged by the bowels, without the knowledge of the patient. More frequently, however, the passage of these bodies is accompanied with paroxysms of severe pain, the location and character of which will usually serve to indicate the true cause. Where, however, the body is too large to pass, its presence in the gall-bladder or any of the gall-ducts, may excite inflammation and ulceration in those parts, and thus lead to perforation and discharge of contents into the peritoneal cavity. CASE.—_Rupture of the Gall-bladder, with discharge of contents into the peritoneal cavity, followed by peritonitis and death._ Mr. De K. T——, of this city, aged about 60, had suffered from several attacks of severe pain in the region of the gall-bladder, which I had diagnosed as biliary colic, induced by the presence of a calculus. One morning in June, 1863, while working in his garden, he felt a sensation of something giving away in his side, which was immediately followed by an attack of severe pain. A chill and fever soon succeeded; and, in twenty-four hours, a violent peritonitis set in, resulting in death in four days. Autopsy, thirty-six hours after death. Upon opening the cavity of the abdomen, the peritoneal membrane was found intensely inflamed at all points, and containing nearly a quart of greenish sero-purulent fluid. Slight plastic adhesions were found at various points, uniting the intestines to the abdominal walls, while old, firm and extensive adhesions were found between the same and the liver and gall-bladder. There were evidences that the latter had been largely distended, yet, through a distinct opening, the contents had escaped into the peritoneal cavity, leaving behind a single calculus of a regular oval form, and one inch of its long diameter.[28] From the appearance of the part, it would seem that the calculus had excited inflammation and ulceration in the walls of the gall-bladder, destroying the latter so completely, that the fluid contents were kept from escaping into the abdominal cavity, only by the adhesions that had formed, and that these had been probably torn away by the exercise of digging with the spade.