274 QUANTITY OF BILE SECRETED BY MAN. [BOOK II. 



the dressings. The exclusion of atmospheric germs had the advan- 

 tage of preventing cystitis and decomposition of the bile, and the 

 attending complications 1 / 



The patient lived two months after the operation, and on eight 

 separate days (intervening between March 26 and April 5, 1883) 

 (with the exception of quite insignificant losses) the whole of the 

 bile was collected. The average quantity was found to amount to 

 13*2 ozs. or 374*5 c.c. in 24 hours. The average percentage of solid 

 matters in the bile was 1*3468, so that the bile-solids eliminated per 

 diem amounted to 5*04 grms. Both the quantity of bile secreted and 

 the solid matters which it contained were, as it will be at once seen 

 on comparison, decidedly less than the amounts estimated by Kanke 

 and v. Wittich. The condition of the patient was, however, so far 

 removed from the normal as to forbid any conclusion as to the 

 average amount of bile secreted by healthy human subjects being 

 drawn from them. 



Observations J n 1889, Copeman and Winston 2 had the oppor- 

 tunit y of investigating a case of biliary fistula in a 

 woman set. 26 (weighing 42*7 44*7 kilo.) under the 

 care of Dr Bristowe in St Thomas's Hospital. In this case complete 

 occlusion of the common bile-duct existed, which was due, as was 

 discovered on post-mortem examination, to a calculus firmly 

 impacted in the duct just at its junction with the intestine. On 

 the admission of the patient, the gall-bladder had been found 

 distended with bile. Mr Sidney Jones cut down on the gall-bladder, 

 stitched it to the edges of the wound and laid it open, when about 

 six or seven ounces of a glairy, semi-transparent fluid was evacu- 

 ated, which was quite free from biliary colouring matter. A fistula 

 resulted, through which the whole of the bile secreted was discharged, 

 as evidenced by the facts that the jaundice which had existed, little 

 by little, disappeared and the urine gave no bile reaction, whilst the 

 stools remained of a greyish colour and contained no trace of bile. 

 As soon as the fistula had become established a glass cannula wa& 

 accurately fitted into it, and by means of an indiarubber tube the 

 bile was led into a bottle placed on the floor beneath the bed. 

 There was no loss of bile into the dressings and no trace of bile in 

 either the urine or fasces, proving that the whole amount of the 

 secretion was collected. For more than a month the total quantity 

 secreted during the previous 24 hours was carefully measured daily at 

 10 p.m.; during the whole period the patient was in excellent health 

 and her subsequent death may be looked upon as entirely accidental, 

 having been caused by haemorrhage, resulting from an unfortunate 

 attempt to re-establish forcibly the continuity of the common bile-duct. 

 From the observations of Copeman and Winston it results that 

 the mean secretion of bile per 24 hours was 779*6 c.c. and of bile 



1 'A note on the Composition of Human Bile obtained from a Fistula.' By 

 Gerald F. Yeo, M.D. and E. F. Herroun, Journal of Physiology, Vol. v. p. 116 et seq. 



2 Copeman, S. Monckton, and Winston, W. B. ' Observations on Human Bile ob- 

 tained from a case of Biliary Fistula,' Jo urnal of Physiology, Vol. x. (1889), pp. 213231. 



