CHAP. IV.] QUANTITY OF BILE SECRETED BY MAN. 273 



Nevertheless we may be certain for reasons to be subsequently stated 

 (p. 278 et seq.) that the quantity. of bile obtained from a permanent 

 biliary fistula is less than that which would be secreted under normal 

 conditions. 



Ranke's ob- In the year 1871 J. Ranke published the observa- 

 servations. tions which he had made on a patient in whom, 

 through the rupture of a multilocular hydatid cyst of the liver into 

 the lung, bile was expectorated by the bronchi. At the time of 

 Ranke's researches, the fistula had existed for a considerable time. 

 At intervals, the bile appeared to be wholly expectorated, as judged 

 from the fact that the faeces then contained no bile-colouring matter 

 and became very rich in fat ; at other times, no trace of bile was 

 expectorated, although a catarrhal bronchial expectoration persisted, 

 and then the faeces became normal. The catarrhal bronchial ex- 

 jctoration was estimated at 135 c.c. per diem. The total quantity 

 bile and bronchial secretion was collected and analysed on five 

 jparate occasions, the whole secretion of 24 hours being obtained. 

 Deducting the average quantity of bronchial secretion from the 

 >tal quantity of mixed fluid collected, Ranke obtained as a mean of 

 iese five sets of observations, 636 c.c. as the daily amount of bile 

 icreted by his patient. The mean of the total solids excreted 

 imounted to 20'62 grms. Ranke's patient secreted at the rate of 

 13'52 c.c. of bile and 0'44 grm. of bile-solids per kilo of his body- 

 weight per diem 1 . 



von Wit- In 1872 v. Wittich investigated the amount of bile 



tich's case. in a woman who, as a result of cholelithiasis, had a 

 biliary fistula. On one occasion, during a period of four hours, 

 88 c.c., and on another occasion during 16 hours 224 c.c. of bile 

 were collected. The mean of these two observations gives 542*8 as 

 the amount of bile secreted by this woman in 24 hours 2 . 



observa- I n the year 1883 Professor Yeo and Mr E. F. 



MIS of Yeo u erroun published an interesting set of observations 

 Herroun * n a case ^ biliary fistula in man. The patient (a 



man aet. 48) had been admitted into King's College 

 Hospital, under the care of Dr George Johnson, F.R.S. (in a 

 condition of extreme emaciation, weighing 112 Ibs.), suffering from 

 jaundice of six months' duration. 'On the 27th of February his 

 tensely-filled gall-bladder was opened with aseptic precautions by 

 Sir Joseph Lister, F.R.S., in the hope of removing the obstruction, 

 which, however, was found to depend upon occlusion by a carcino- 

 matous growth of the common bile-duct, and could not be made 



pervious There was no trace of bile in the faeces 



at any time during his stay in the hospital. The secretion was 

 collected in sacks of black caoutchouc, which were kept aseptic by 



1 Job. Ranke, ' Directe Bestimmung der in 24 Stunden vom ruhenden Menschen 

 producirten Gallenmenge,' Chapter vui. of Eanke's work, Die Blutver the Hung und 

 der Thdtigkeitswechsel der Organe, Leipzig, 1871. 



2 v. Wittich, ' Zur Physiologic der menschlichen Galle,' Pniiger's Archiv, Vol. vr. 

 (1872), p. 181. 



G. 18 



