1890.] Secretion of Bile in a Case of Biliary Fistula. 501 



he found Mr. Fairley's analysis of the secretion for twenty-four 

 hours. 



The alleged Diastatic Action of bile may possibly be due to the admix- 

 ture of the secretion from the gall-bladder, or from the mucous glands 

 in the large bile ducts. In the gall-bladder fluid from Case II, Pro- 

 fessor Birch found a diastatic ferment, concerning which he reported : — 

 " The secretion cannot be regarded as having any important part to 

 play in digestion, the small diastatic action it possesses on starch 

 being shared by many fluids in the economy upon which it does 

 not confer any special digestive value." (' Journal of Physiology/ 

 vol. 8, No. 6.) 



Antiseptic Action. — In Case I, the value of bile as an antiseptic in the 

 intestine could be tested only by the character of the fasces, which, over 

 a period of fifteen months during which no bile entered the bowel, did 

 not by odour or aspect indicate any irregular fermentative process. In 

 Case II, the constant clean appearance of the edge of the fistula sug- 

 gested to me the idea that it might be due to the antiseptic quality 

 of the gall-bladder fluid ; and the observation, that when collecting 

 the fluid for experimental purposes I could leave the flasks exposed 

 to the air for several days without any apparent change, suggested 

 the same conclusion. Professor Birch, from numerous cultivation 

 experiments, came to the conclusion that its antiseptic properties 

 were slight, the want of change being rather due to the poverty of 

 the fluid in nourishing materials. (* Journal of Physiology,' vol. 8.) 



Aperient Action. — In Case I, the bile did not seem to be at all 

 necessary as an intestinal stimulant, for the bowels were quite regular 

 during the whole of the time that no bile was entering the intestines. 



Alleged Action of Bile in Promoting Absorption. — In Case I, 

 fat could apparently be digested in quantities sufficient not 

 only to maintain normal nutrition and good health, but to lead 

 to an increase in weight. If taken too freely it seemed to create 

 disturbances of digestion, and to be passed in rather larger quantities 

 than usual in the fasces, as ascertained by careful observation and by 

 separation by means of ether. 



Diet. — Details of the daily diet are given in the tables, and may be 

 grouped as follows : — 



I. Oct. 24th — 27th. Light diet. Broth, bread, egg, tea, milk, 

 pudding. 



II. Oct. 29th— Nov. 4th. Chicken diet. Ditto with 



chicken. 



III. Nov. 5th— 8th. Potato diet. Ditto with 



potato. 



IY. Nov. 12th. Meat diet. Meat, bread, milk, tea. 



