The most common conceptions of the pathogenesis of infections of the gallbladder and bile tracts are based on four assumed possibilities: (1) descending infection from the liver by bacteria carried down in the bile, (2) ascending infections from the duodenum up the common bile duct, (3) hematogenous infections of the gallbladder and ducts, and (4) a spreading infection through the wall of the gallbladder from an inflamed contiguous organ. Of these possibilities, it is only the last two which take into serious consideration the actual infection of the deeper layers of the wall of the gallbladder, despite the fact that microscopic examinations of gallbladders removed at operation, at least those which we have studied, demonstrate that there are inflammatory changes not merely in the mucosa but also in the deeper layers and that usually these changes are more pronounced in the deeper layers. The other two possibilities are concerned only
GRAHAM EA, PETERMAN MG. FURTHER OBSERVATIONS ON THE LYMPHATIC ORIGIN OF CHOLECYSTITIS, CHOLEDOCHITIS AND THE ASSOCIATED PANCREATITIS. Arch Surg. 1922;4(1):23–50. doi:10.1001/archsurg.1922.01110100032002
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