Diseases of the intestines and peritoneum / by Hermann Nothnagel ; edited, with additions by Humphrey D. Rolleston ; authorized translation from the German, under the editorial supervision of Alfred Stengel.
- Hermann Nothnagel
- Date:
- 1904
Licence: Public Domain Mark
Credit: Diseases of the intestines and peritoneum / by Hermann Nothnagel ; edited, with additions by Humphrey D. Rolleston ; authorized translation from the German, under the editorial supervision of Alfred Stengel. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![excretory, for through this channel many of the useless products of jiietaholisni are eliminated. Here, however, it is only necessary to give a brief description of the secretion of bile and its chemic composition. Bile obtained from biliary fistulas can be analyzed, and results are more easily and satisfactorily obtained than in the case of the pancreatic jnice. The contents of the gall-bladder are unsuitable for analysis, inas- nuich as the bile in the gall-bladder is much more concentrated than the bile that flows through the ducts into the intestine. The bile is a clear, tenacious, mucoid fluid with an alkaline reaction, due to the presence of alkaline carbonates and phosphates. The color varies from a golden yellow to an olive brown, and is never green or greenish (Hammarsten). The ingestion of food increases the secretion of bile, water apparently exercising the greatest influence in this respect (C. Voit). According to Bidder and Schmidt, Wolf, and von Voit, the curve of biliary secretion varies according to the character of the food ingested. The highest point is always reached during the first hour after a meal (Arnold, Voit). Proteids increase the amount of bile excreted; fats reduce it; ^vhile carbohydrates are without any appreciable influence (Voit). During fasting only one-half to one-third as much bile is excreted as on a normal diet. [Bruno and Kladnizki, pupils of Pawlow, by means of an ingenious fistula which allowed the bile to be collected from the biliary papillae, showed that during fasting no bile enters the duodenum. Investigation of the effect of food showed that the admin- istration of water, acids, raw egg-albumen, and boiled starch was not followed by the passage of bile into the bowel, but that fats, ex- tracts of meat, and the products of the digestion of egg-albumen set up a free flow of bile into the duodenum.—Ed.] The total quantity of bile excreted in twenty-four hours, according to Eanke, Wittich, and others, amounts to about from 500 to 600 c.c. Hammarsten has indorsed these figures as a result of observations on the bile in 7 cases of biliary fistula in human subjects. In his cases the percentage of solids in the bile was found to be as high as 2 or even 3 per cent., and was consequently greater than is usually assumed. The most important and most characteristic constituents of the bile are the bile acid salts (glycocholic and taurocholic acid salts) and the pigments (bilirubin and biliverdin). In addition there is a peculiar, mucin-like substance wiiich has been carefully analyzed by Paijkull, who, working with ox bile, came to the conclusion that it was nucleo-albumin. In Hammarsten's cases a considerable quantity of mucus containing mucin was constantly found; nucleo-albumin alone was found in only 1 case. It is probable that this mucoid substance is an addition to the bile and is poured out by the glands in the walls of bile-ducts and the gall- bladder. In addition, small quantities of cholesterin, lecithin, soaps, fats, and salts are found. The amount of iron found in fresh bile was 0.003 to 0.0044 per cent. A diastatic ferment has also occasionally been found in the bile. According to Neumeister, this is not a specific constituent of the bile, and has no more significance than the diastatic ferment of the urine.](https://iiif.wellcomecollection.org/image/b21170010_0030.jp2/full/800%2C/0/default.jpg)
