CHAP, vii.] NAUNYN'S THEORY OF CHOLELITHIASIS. 387 



passages, by the migration into them of organisms existing in the 

 duodenum, of -which some exert a pathogenic action on the mucous 

 membrane, this migration being facilitated when the rate of flow of 

 the bile is diminished. 



As was formerly said, the normal bile is sterile, a fact first 

 demonstrated, in the case of the rabbit, by Netter in 1884 1 , and 

 confirmed in the case of man by Gilbert and Girode 2 in 1890. 



Netter and Martha, Brieger, Leyden and others had found in 

 purulent processes affecting the biliary passages of man, in addition 

 to other organisms (Staphylococci, Streptococci), a bacillus which sub- 

 sequent investigation has proved to be the Bacterium coli commune. 

 The same bacillus was afterwards found and cultivated by Levy in 

 a hepatic abscess, consecutive to gall-stones, occurring in Naunyn's 

 clinique. In five cases of cholelithiasis, in which an acute cholecystitis 

 had supervened, Naunyn, by puncturing the gall-bladder during the 

 life of the patient, discovered the same bacillus. 



The organism thus discovered is eminently pathogenic and 

 experiment has shewn that when introduced into the biliary passages 

 of dogs, after ligature of the common bile-duct, it induces acute 

 infection and rapidly kills the animal, whilst if a similar culture of 

 the bacillus is injected without ligaturing the duct, no bad con- 

 sequences follow and, when the animal is killed after an interval, no 

 abnormal appearance is observed, either in the biliary passages or 

 the hepatic substance. 



Naunyn's view is that the Bacterium coli commune migrating 

 from the intestine, under the necessary conditions of a retarded or 

 arrested bile-flow, induces an affection of the mucous membrane of the 

 gall-bladder, a ' calculus-forming ' catarrh (' steinbildende Katarrh '). 



When death suddenly occurs in individuals suffering from gall- 

 stones (but not suffering from cholecystitis), the epithelium cells 

 lining the gall-bladder are found to contain fat drops and, besides, 

 so-called myeline masses, with double outlines, which in some cases 

 fill the whole cell. From some of these myelin-laden cells, the 

 masses are seen to protrude and then to become detached, floating 

 away singly, or becoming aggregated into clumps of glassy, structure- 

 less, highly refractive, matter. Such glassy, structureless masses as 

 these are actually found floating in the bile in cases such as those we 

 are considering. On the addition of acetic acid, they may be observed, 

 under the microscope, to congeal into a mass of cholesterin crystals. 

 These clumps of cholesterin are, as Naunyn shews, the first rudiments 

 of gall-stones, and accompanying them are exactly similar but harder 

 masses, veritable little calculi. At first, these little calculi have a 



1 Netter, quoted by Naunyn, op. cit. p. 43. 



2 Gilbert et Girode, Comptes Rendus de la Societe de Biologic, 1890, No. 39 ; 1891, 

 No. 11. 



252 



