386 NAUNYN'S VIEWS. [BOOK n. 



could not originate spontaneously, but presupposes the intervention 

 of some active agent, presumably of a pathogenic organism. 



As the bile has been shewn to be normally sterile, the mere 

 slowing of its current would be insufficient to induce the changes 

 which Frerichs assumed. But even were such an acid decomposition, 

 as he imagined, to occur, there is no evidence that it would lead to 

 a separation of the cholesterin of the bile, inasmuch as such a 

 separation does not occur when bile decomposes, through exposure 

 to atmospheric germs, and acquires an acid reaction. 



Naunyn's When discussing (p. 340) the probable origin of the 



theory of the cholesterin of the bile, we drew attention to the views 

 production of O f Naunyn, who has advanced the remarkable hypothesis 

 that it is not a product removed by the liver from the 

 blood, but that it takes its origin in the epithelial cells of the gall- 

 bladder and biliary passages. Whilst we advanced arguments which 

 appear to us to prove that such a view is inadmissible in the case of 

 the normal cholesterin of the bile, we would point out that these 

 arguments do not invalidate the possibility, nay the certainty, of 

 the local production of cholesterin, as a result of morbid processes 

 having their seat in the epithelial cells lining the mucous membrane 

 of the biliary passages. 



We have drawn attention to the observations of Frerichs which 

 merely confirmed and extended those made before him by Cru- 

 veilhier 1 , as to the local excretion of calcium salts by the mucous 

 membrane of the gall-bladder, when this becomes the seat of inflam- 

 matory action. Naunyn and his pupils have supplemented our 

 knowledge of this subject by shewing that the amount of calcium in 

 the bile is not affected by the amount taken into the body and 

 existing in the blood 23 . The only constituent of gall-stones, indeed, 

 which, according to Naunyn, is influenced by the food is bilirubin, 

 the amount of which seems to be larger when the diet is abundant 

 than when it is scanty. 



The most careful inquiries have revealed that neither hereditary 

 nor acquired diathesis, neither nationality nor dietetic habits, appear 

 to affect the incidence of cholelithiasis. Rich and poor, fat people 

 and spare, the gouty bon vivant and the abstemious peasant, all 

 suffer alike from gall-stones. Such being the case, must we not 

 seek for a local pathological process affecting in the first instance 

 the mucous membrane of the biliary passages, and leading secondarily 

 to the formation of gall-stones ? 



The essence of Naunyn's theory of cholelithiasis consists in 

 assuming that it is due to an infection of the gall-bladder and biliary 



1 Cruveilhier, Traite d'Anatomie pathologique, Vol. n. p. 190. 



2 Naunyn, Klinik d. Cholelithiasis, f Die Kalkausscheidung in der Galle, ' p. 14. 



3 Dr Ludwig Jankan, 'Ueber Cholesterin- und Kalkausscheidung mit der Galle' (Aus 

 d. med. Klinik d. Univ. Strassburg). Archiv f. exp. Path. u. Pharmak., Oct. 1891, pp. 

 237246. 



