392 THE LIVER. 



is not an accurate measure of the quantity of sugar formed, and as we, 

 as yet, do not know the quantity of oxygen necessary to form sugar 

 from protein, HAMMARSTEN believes that it is just as impossible to 

 conclude from the respiratory quotient that sugar is formed from the 

 fats as from the proteins. 



We have no complete proofs of a sugar formation from fat or from 

 protein alone, nevertheless we have proofs of the possibility of a formation 

 from both of these. There is really no objection to the assumption that 

 the body has the power of producing sugar from protein as well as from 

 fat. The observations on the formation of sugar or on the carbohydrate 

 metabolism in diabetes do not give any positive explanations as to the 

 question whether proteins are direct glycogen-formers or not. 



The Bile and its Formation. 



By the establishment of a biliary fistula, an operation which was first 

 performed by SCHWANN in 1844 and which has been improved lately by 

 DASTRE and PAWLOW 1 , it is possible to study the secretion of the bile. 

 This secretion is continuous, but with varying intensity. It takes 

 place under a very low pressure; therefore an apparently unimportant 

 hindrance in the outflow of the bile, namely, a stoppage of mucus in the 

 exit, or the secretion of large quantities of viscous bile, may cause stagna- 

 tion and absorption of the bile by means of the lymphatic vessels (absorp- 

 tion icterus). 



The quantity of bile secreted in the twenty-four hours in dogs can be 

 exactly determined. The quantity secreted by different animals varies, 

 and the limits are 2.9-36.4 grams of bile per kilo of weight in the twenty- 

 four hours. 2 



The reports as to the extent of bile secretion in man are few and 

 not to be depended on. RANKE found (using a method which is not free 

 from criticism) a secretion of 14 grams of bile with 0.44 gram of solids 

 per kilo in twenty-four hours. NOEL-PAYTON, MAYO-ROBSON, HAM- 

 MARSTEN, PFAFF and BALCH, and BRAND 3 found a variation between 

 514 and 1083 cc. per twenty-four hours. Such determinations are of 

 doubtful value, because in most cases it follows from the composition 



'Schwann, Arch. f. (Anat. u.) Physiol., 1844; Dastre, Arch, de Physiol. (5), 2; 

 Pawlow, Ergebnisse der Physiol., 1, Abt. 1. 



2 In regard to the quantity of bile secreted in animals see Heidenhain, Die Gallenab- 

 sonderung, in Hermann's Handbuch der Physiol., 5, and Stadelmann, Der Icterus und 

 seine verschiedenen Formen (Stuttgart, 1891). 



3 Ranke, Die Blutvertheilung und der Thatigkeitswechsel der Organe (Leipzig, 

 1871); Noel-Paton, Rep. Lab. Roy. Coll. Edinburgh, 3; Mayo-Robson, Proc. Roy. Soc. r 

 47; Hammarsten, Nova Act. Reg. Soc. Scient. Upsala (3), 16; Pfaff and Balch, Journ. 

 of Exp. Med., 1897; Brand, Pfliiger's Arch., 90. 



