CHAP. VI.] 



' HYDROPS CYSTIDIS FELLED.' 



369 



THE SECRETION OF THE GALL-BLADDER IN SO-CALLED HYDROPS 

 CYSTIDIS FELLED. 



In the records of cholecystotomy a large number of cases occur 

 in which the gall-bladder having been opened, in order if possible to 

 remove a calculus obstructing the neck of the bladder or the biliary 

 passages, it was found full of a colourless, generally highly viscous, 

 liquid, of alkaline reaction. The calculus is, in these cases, very fre- 

 quently impacted in the cystic duct and acts as a valve, permitting the 

 expulsion of bile from the gall-bladder but preventing its entrance. 

 The colourless liquid found in these cases is not a decolourised bile, 

 but the secretion of the mucous membrane of gall-bladder. When 

 complete occlusion of the gall-bladder exists, it may become enor- 

 mously distended with this fluid, and there is then established the con- 

 dition known as dropsy of the gall-bladder, or hy drops cystidis fellece. 

 It would be a great mistake to suppose that the mucous secretion 

 which fills the gall-bladder in these cases represents, either qualita- 

 tively or quantitatively, its normal secretion. Frerichs, Naunyn, 

 and others have found indeed that in such cases the epithelium of 

 the gall-bladder has changed in character. Referring to them, 

 Naunyn says, "das Epithelium verliert den Character des Cylinderepi- 

 thels. Ich fand in mehreren Fallen, statt seiner, einen aus viel 

 grosseren kubischen Zellen bestehenden, Epithelbelag. Das Gleiche 

 fanden Pittres u. A. vor mir 1 ." 



Glisson 2 and de Graaf 3 were the first to examine the fluid under 

 discussion, though the first chemical analysis of it was published by 

 Frerichs 4 , who, in one case, found it to contain, in 1000 parts, 9827 

 parts of water and 17'3 parts of solid matters. The organic matters 

 (mucin, &c.) amounted to 16'0, the alkalies to 0*6 and the earths to 

 0'7 parts for 1000. In some cases of this kind, if the gall-bladder be 

 opened and a fistula established, the secretion of liquid continues. 

 Two such cases have been observed by Mr Mayo Robson of Leeds. 

 The fluid was, in the first instance, examined by Birch and Spong 5 . 

 One of these cases was afterwards much more satisfactorily investi- 

 gated by Mr Mayo Robson himself 6 . 



The case was that of a woman, aged 32 (weighing 48'6 kilos.), 

 who was operated on in January, 1884, for distended gall-bladder due 

 to gall-stones. A fistula having been established, a constant flow of 

 somewhat viscid liquid was set up ; this was assumed to be the un- 

 mixed secretion of the gall-bladder, as complete occlusion of the 

 cystic duct existed and as no trace of bile could be detected in the 



1 B. Naunyn, Klinik der Cholelithiasis p. 106. Compare also Frerichs' remarks 

 (Klinik d. Leberkrankheiten, Bd. n. p. 449). 



2 Glisson, Anatom. Hepatis, Cap. 39. 



3 de Graaf, Tractatus de succo pancreatico, Cap. 8. 



4 Frerichs, Klinik d. Leberkrankheiten, Bd. n. p. 449. 



5 Birch and Spong, Journal of Physiology, Vol. vm. p. 378. 



6 Mayo Robson, Proceedings of the Royal Society, Vol. ZLVII. (1890), pp. 499 et seq. 



G. 



24 



