272 



QUANTITY OF BILE SECRETED BY MAN. [BOOK II. 



TABLE EXHIBITING THE KELATION BETWEEN THE WEIGHT OF THE 

 BODY AND OF THE LIVEE, ON THE ONE HAND, AND THAT OF 

 THE BILE AND BILE-SOLIDS SECKETED PEE HOUE, ON THE 

 OTHEE 1 . 



Quantity of It is obvious that our knowledge of the amount of 

 bile secreted bile secreted by man can only be derived from observa- 

 by man. tions in the very rare cases in which a biliary fistula 



results from some morbid process which, at the same time, hinders 

 the flow of bile into the intestine. The fact that in the rare cases 

 which have chanced to be observed by highly-skilled investigators 

 and which have been elaborately investigated, the person observed 

 has necessarily been in a more or less diseased condition detracts 

 somewhat from their value. In three sets of observations, however, 

 which will be referred to below (observations of Copeman and 

 Winston, Mayo Robson, and Noel Paton) the general condition 

 of the patient so nearly approached that of perfect health as to 

 leave no doubt upon our mind that they furnish us with a more 

 reliable estimate of the amount of bile secreted by the human liver 

 than could be arrived at if we depended merely on calculations based 

 on the widely discordant observations made on the lower animals 2 . 



1 Heidenhain in Hermann's Handbuch, Vol. v. i. p. 253. 



2 In addition to the observations mentioned in the text the following may be 

 mentioned: 



1st. A case recorded by Dr George Harley (Med. Ghirurg. Transac. 1866, p. 89) of 

 ecchinococcus of the liver in which for a week or so during the progress of the malady 

 bile was absent from the stools and was discharged from a fistulous opening, to the 

 amount of between 16 and 20 ozs. per diem (quoted, at second-hand, from Noel 

 Paton's and Balfour's paper). 



2nd. A case of Dr Murchison's (Diseases of the Liver, 3rd ed., p. 576), in which a 

 biliary fistula, with occlusion of the common bile duct, existed. The quantity of bile 

 secreted by the liver in 24 hours was roughly estimated as not much under two pints 

 (1128 c.c.), though the patient was taking very little food. 



3rd. A case of Westphalen's (Deutsche Archiv f. klin. Med., Vol. xi. p. 588), in 

 which right-sided empyema had existed and in which through a thoracic fistula the 

 whole of the bile was excreted. The bile in this case was elaborately investigated by 

 0. Jacobson, to whose results attention will afterwards be directed. The conditions 

 of Westphalen's case appear to the Author to have been too abnormal to permit of any 

 conclusions as to the normal bile secretion in man being drawn from it. 



