460 CHEMISTRY OF THE DIGESTIVE PROCESSES. 



and estimated the amount of fatty material in the stomach and intestine. The 

 amount so found was usually slightly in excess of that given in the food, the 

 surplus being probably due to intestinal secretion or excretion. Lewiii, 1 as a 

 result of microscopic examination of sections of the intestine, concludes that fat 

 absorption does not take place in a normal manner if bile or pancreatic juice, or 

 both, are kept from entering the intestine. He also found under such circum- 

 stances that the lacteals did not present the usual milky appearance which 

 accompanies fat absorption. 



The effect of a biliary fistula on fat absorption seems to be identical 

 with that of a pancreatic fistula ; exactly the same kinds of results have 

 been recorded in the two cases. All observers are agreed that so much 

 fat cannot be absorbed in presence of a biliary fistula as when bile has 

 access to the intestine, but, while some find fat absorption practically 

 arrested, others have observed that a considerable, nearly normal, amount 

 of fat can still be disposed of. As in the case of absence of the pan- 

 creatic secretion, most of the unabsorbed fat is found in the freces as 

 fatty acid. 2 



Rohmann 3 also found that sodium soaps were not absorbed, but were 

 converted into free fatty acids, and appeared as such in the faeces. Bidder 

 and Schmidt 4 state that normal dogs can digest as much as seven times the 

 quantity of fat which can be disposed of by dogs with fistula of the gall bladder, 

 and that, while during fat absorption in a normal dog the lacteals are filled with 

 milky chyle, they are, under similar conditions in a dog with a biliary fistula, 

 filled with a yellow or slightly opalescent fluid. 



C. Voit 5 estimates the average loss of fat at 22 "2 to 34'7 per cent.; Munk, 6 

 at 33-1 per cent. ; Rohmann, 7 at 48'5 to 58'4 per cent. ; Xoiil Paton, 8 at 34-58 

 per cent. ; Dastre, 9 at 57 '65 per cent. Munk 10 found that the absorption of fats 

 of high melting point (mutton) suffered more than that of fats of low melting 

 point (hog's lard) ; of the former but 35 '5 per cent, was utilised, of the latter 

 67 per cent. He also found that the free fatty acids in the absence of bile were 

 absorbed equally well, in fact slightly better, than the corresponding neutral 

 fats. Dastre n ligatured the ductus choledochus, and made a fistula between 

 the gall bladder and small intestine much lower down (60-150 cm.) ; he 

 observed, after a meal of fat, that the lacteals were only injected with milky 

 chyle below the artificial point of entry of the bile. ' As Dastre himself 

 remarks, the result is more elegant than decisive. It is only qualitative in 

 character, and does not show quantitatively the share taken by pancreatic 

 juice and bile in fat absorption. Hedon and Yille 12 established first a biliary 

 fistula, and afterwards removed nearly all the pancreas, leaving just enough of 

 the tail to preserve the animal alive, and destroying all communication with 

 the intestine. In this manner both bile and pancreatic juice were kept out of the 

 intestine, and under such conditions the digestion and absorption of fat was 



1 Arch.f. d. ges. Physiol., Bonn, 1896, Bd. Ixiii. S. 171. Lewin removed the influence of 

 both secretions by making a Thiry-Vella fistula of that part of the duodenum into which 

 the ducts open. 



2 Rohmann, Arch. f. d. ges. PhysioL, Bonn, 1882. Bd. xxix. S. 509 ; I. Munk, VirchovSs 

 Archiv, 1890, Bd. cxxii. S. 313 ; Hedon and Ville, Compt. rend. Soc. de UoL, Paris, 1892, 

 tome xliv. p. 309. See, however, Dastre, Arch, de physiol. norm, et path., Paris, 1891, 

 tome xxiii. p. 186. 



3 Loc. cit., S. 532. 4 < : Die Verdainmgssafte, " etc. 

 "Beitr. z. Biologic," Julildumsschriftf. v. Bischoff, Stuttgart, 1882. 



6 Virchow's Archiv, 1890, Bd. cxxii. S. 302. 7 LOG. cit. 



8 Rep. Lab. Roy. Coll. Phys., Edin., 1891, vol. iii. p. 214. The case was one of a com- 

 plete biliary fistula in a woman. 



9 Loc. cit. 10 Loc. cit., S. 324, 325. n LOG, cit. 12 LOG. cit. 



