ACTION OF THE BILE IN DIGESTION. 281 



be, undoubtedly depends chiefly upon the biliary salts, and perhaps to some extent upon 

 its saponaceous constituents. 



Experiments with regard to the action of the bile upon different alimentary substances 

 out of the body have not led to any definite results. It is only in connection with the other 

 digestive fluids that the bile seems to be efficient ; and the only observations which have 

 thrown any light upon the subject are those made upon digestion in the living organism. 

 Simple ligation of the bile-duct has taught us very little regarding the effects of shutting off 

 the bile from the intestine ; for the immediate effects of the operation generally interfered 

 with the process of digestion, and subsequently the experiment was necessarily disturbed 

 by the effects of the retention of bile in the excretory passages. As would naturally be 

 expected, these observations have been quite contradictory. The most satisfactory ex- 

 periments upon the digestive function of the bile have followed the establishment of a 

 fistulous opening into the gall-bladder, the flow of bile at the same time being completely 

 shut off from the intestine. In all experiments of this kind in which fatal inflammation 

 did not follow the operation, death has taken place from inanition, notwithstanding an 

 increase in the quantity of food taken. This result is not due simply to the loss of the 

 solid matter discharged in the bile, which is small in proportion to the total daily loss of 

 weight ; but it undoubtedly proceeds from disordered nutrition, which has its starting- 

 point in disordered digestion. 



Observations on a Dog with a Biliary Fistula. We have now to study the modifica- 

 tions in digestion and nutrition which are the result of simply diverting the bile from the 

 intestine. With that view, we followed carefully these changes in an animal with a 

 biliary fistula that was under our own observation. This experiment confirmed, in all 

 important particulars, those of Schwann and of Bidder and Schmidt. It is given here 

 somewhat in detail, for, inasmuch as no inflammation followed the operation and nothing 

 occurred to complicate the effects of the diversion of the bile from the intestine, we re- 

 garded the experiment as remarkably successful. 



November 15, 1861, a biliary fistula was established in a young cur-dog weighing 

 twelve pounds. The abdominal organs were very little exposed, and the experiment, 

 from the first, promised to be very satisfactory. The bile-duct was first ligated next the 

 intestine and at its junction with the cystic duct, and the intermediate portion was ex- 

 sected. The incision in the abdomen was in the median line just below the ensiform 

 cartilage, and was about three inches long. The fundus of the gall-bladder was then 

 drawn to the upper portion of the wound, and the bile was evacuated by a small opening, 

 the edges of which were attached to the abdominal parietes. The wound in the abdo- 

 men was then closed, except the opening into the gall-bladder, into which a few shreds 

 of lamp-wicking were introduced. 



The animal appeared to do perfectly well after the operation and ate the usual quan- 

 tity the next day. He was kept in a warm room, although the weather was mild ; and 

 a careful record was made of his condition every day. The fistula occasionally showed a 

 tendency to close, but it was kept open by the occasional introduction of a glass rod. 

 From time to time, while the animal was under observation, he licked the bile as it 

 flowed from the fistula. This was afterward prevented by a long wire-muzzle, the sides 

 of which were covered with oil-silk. 



The abdomen was somewhat tumid, with some rumbling in the bowels, for five days 

 after the operation. The first alvine discharge took place on the evening of the second 

 day. The faeces seemed in all regards normal. After that time, they became very infre- 

 quent, although the animal ate well every day. The fasces that were passed after the 

 third day were of a grayish color and moderately soft. They had an exceedingly offensive 

 and penetrating odor. At about the fifteenth day, the fasces became more frequent, and, 

 from that time, were passed three or four times a day. Generally, they were clay-col- 

 ored ; but on one or two occasions they were quite dark. They always had a peculiarly 

 offensive odor. 



