GALL BLADDER DISEASE IN A SEVEN-AND-ONE-HALF-YEAR-OLD CHILD

GALL BLADDER disease is generally admitted to be very uncommon in childhood. As in adults, the cause is obscure. The commonest cause of cholelithiasis in childhood, according to Ladd and Gross,¹ is related to the excessive excretion of pigments during a hemolytic anemia. Typhoid is considered a likely cause, and respiratory infections, scarlet fever, and measles in childhood have also been implicated, at least as the forerunners of an attack of cholecystitis. Considering the frequency of respiratory infections in childhood and the rarity of gall bladder disease in this age group, it seems unlikely that respiratory infection plays the sole causative role without some other factors operating. One of these may be agglutinins in the bile. According to the experiments of Sterling,² agglutinins appear in the bile of dogs in response to a specific infection, and through their ability to cause agglutination or precipitation, a nidus for stone