CHAP. IV.] QUANTITY OF BILE SECRETED BY MAN. 275 



solids 10'8 grms. The specific gravity varied between 1*0085 and 

 1-015 1 . 



Observations I n 1888 and 1889 Mr Mayo Robson 2 performed 

 Mayo Rob- a ser i es O f very important observations on a patient in 

 whom he had established a biliary fistula. The ob- 

 servations extended over a period of many months, during which the 

 patient continuously enjoyed remarkably good health. Her weight 

 during this period was 53 kgms. (8 stone 4J Ibs.). Many very 

 elaborate analyses of the bile collected in this case were made by 

 Mr Fairley. The average quantity of bile secreted, deduced from 

 observations extending over 8 months, was 30 ozs. or very nearly 

 850 c.c. during 24 hours. Its specific gravity varied between 

 /0085 and 1'0090, and the solid matter amounted on the average to 

 L'81 per cent., the total solids excreted being 15 '3 grms. Mr Mayo 

 )bson was subsequently able to establish a communication between 

 ie gall-bladder and the small intestine (by the operation of chole- 

 systenterostomy), so that the bile resumed its normal course, the 

 iternal fistulous aperture being closed. The weight of the patient 

 ibsequently increased to 60 kgms. (9 st. 6^ Ibs.). 

 Observations ^ ne ^ as ^ se ^ ^ observations on the amount of bile 



Noel Paton secreted by the human subject have been carried out 

 j. M. Bai- on a patient in whom Mr John Duncan, P.R.C.S.E., 

 had established a biliary fistula, the case being one of 

 cholelithiasis in which the common bile-duct had become occluded. 

 ?be patient was a woman aet. 51 years and weighing 70'7 kilos. 



This patient differed from those investigated by Drs Copeman 

 ind Winston and by Mr Mayo Robson in so far that her condition 

 at the time when Noel Paton and Balfour were conducting their 

 elaborate investigations was in no sense a normal one, as proved 

 by the abnormal variations in temperature, in the quantity of 

 food ingested and of nitrogen excreted. The total quantity of 

 bile excreted in 24 hours was found to amount (in the average) to 

 638 c.c. ; the specific gravity varied between 1005'5 and 1008*2: the 

 solids in 100 parts amounted to 1*31 and the average total weight of 

 the bile-solids excreted in 24 hours was 8'378 grms. 



In this case Dr Noel Patoii 4 had the opportunity to renew his 

 observations after an interval of one year. In the meantime the 

 patient had returned to her home and her health had been perfectly 



1 The authors give the specific gravity as varying between 1-0085 and 1-105; in the 

 latter figure it is obvious that a in the first decimal place has been omitted. 



2 A. W. Mayo Robson, F.E.C.S., Hon. Surg. Leeds Gen. Inf., 'Observations on 

 the Secretion of Bile in a case of Biliary Fistula,' Proceedings of Royal Soc. Vol. XLVII. 

 (1890), pp. 499 524. The information as to the weight of the patient was inadvertently 

 omitted in this paper, but has been privately communicated to the Author by Mr Mayo 

 Robson. 



3 I). Noel Paton, M.D., F.R.C.P.Ed., and John M. Balfour, M.B., C.M. 'On the 

 Composition, Flow, and Physiological Action of the Bile in Man.' Reprinted from 

 Vol. in. of Laboratory Reports issued by the Royal College of Physicians, Edinburgh, 

 1891, pp. 191240. 



4 D. Noel Paton, 'Further Observations on the Composition and Flow of the Bile 

 in Man ' (1892). Reprinted from Vol. iv. of Laboratory Reports issued by the Royal 

 College of Physicians, Edinburgh. 



182 



