

CHAP. VII.] MODE OF FORMATION OF GALL-STOXES. 385 



origin and separation of cholesterin and the calcium compound of 

 bilirubin. 



As has previously been stated (p. 339), cholesterin is chiefly held 

 in solution in the bile by the alkaline salts of the bile acids, though 

 the neutral fats and the alkaline salts of the fatty acids also possess 

 the power of dissolving considerable quantities. 



From the experiments of Happel 1 , recorded by Nauuyn, sodium glyko- 

 cholate or taurocholate, when existing in solutions containing from 0'2 to 

 2-5 per cent, of these bodies, are able, at temperatures of 37 38 C., 

 to dissolve about one-tenth of their weight of cholesterin. Soap in dilute 

 solutions is able to dissolve about half its own weight and olein dissolves 

 5 p.c. of its weight of cholesteriii. 



Bilirubin and calcium both exist in the bile. The former appears 

 to be held in solution by the alkaline salts of the bile acids which, in 

 addition, possess the power of hindering its precipitation by calcium 

 salts, unless these are added in great excess (Naunyn 2 ). The 

 addition of albumin to a solution of sodium glykocholate, holding 

 bilirubin and calcium salts in solution, causes, however, a separation 

 of the insoluble calcium and bilirubin compound (Naunyn 3 ). 



Frerichs' Frerichs assumed that a stagnation of bile in the 



theory of the gall-bladder was the first condition for the formation of 

 f gall-stones. Under the influence of mucus secreted by 

 the gall-bladder, he believed that the salts of the bile 

 acids then underwent decomposition 5 and the reaction of the bile 

 became acid : consequently, the cholesterin, and the bilirubin which 

 had been held in solution by the bile salts, separated, the former in a 

 crystalline condition, the latter partly in a crystalline condition, but 

 chiefly as the insoluble calcium compound (Bramson). He drew 

 attention to the important part played in this process by lime salts, 

 which, he shewed, are secreted by the mucous membrane of the 

 gall-bladder ; this he repeatedly had found incrusted with numberless 

 crystals of calcium carbonate. Frerichs believed that, in order to 

 lead to the formation of biliary concretions, the precipitated bodies 

 must needs remain some time in the gall-bladder and require the 

 co-operation of the elements resulting from catarrh of its lining 

 membrane (mucus, epithelium ?), though he gives no details as to the 

 process. 



In criticising Frerichs' theory from the present stand-point of 

 science it is at once obvious that such an acid fermentation as he 

 assumed, leading to a decomposition of the salts of the bile acids 



1 Happel's experiments appear to have been performed at Naunyn's instigation and 

 are recorded in his Klinik d. Cholelithiasis, p. 16. 



2 Naunyn, op. cit. p. 18. 



3 Ibid. p. 19. 



4 Frerichs, Klinik der Leberkrankheiten, Braunschweig, 1861. ' Die Entstehung 

 der Gallenconcremente,' Vol. n. pp. 484 487. 



5 ' Stockung und Zersetzung der Galle ist also die erste Ursache der Concrement- 

 bildung,' Frerichs, op. cit. p. 485. 



G. 25 



