502 



Mr. A. W. Mayo Robson. On the [Apr. 24, 



Flow of Bile. 



The Tables appended show the dates and hours of collection lasting 

 over a period of eight months ; the nature and quantity of the diet ; 

 and the amount of bile excreted. The Charts also show the dates of 

 administering certain medicines, and their effect or absence of effect 

 on the biliary secretion. 



In the drawing up of the charts and tables I have been greatly 

 assisted by my friend Mr. C. W. Biden. 



Daily Quantity of Bile Flow. — In Case I, the quantity of bile col- 

 lected in twenty-four hours on various dates in October, November, 

 and December of 1888, and January, February, March, and April 

 of 1889, varied from 39'53 oz. to 25'86 oz., and averaged 29*98 or 

 nearly 30 oz. In Case II the gall-bladder fluid measured 2*53 oz. in 

 twenty-four hours. 



Subtracting this amount from the twenty-four hours' discharge in 

 Case I, we get the average daily flow of bile as 27^ oz. 



Diurnal Variation in Flow. — The Tables and Charts show distinctly 

 that more bile is invariably excreted during the day than at night ; 

 the difference at times being as much as 5 oz., at others not more 

 than 3 dr. 



In the tables and charts which show an hourly collection for over 

 twenty-four hours, it is clearly seen that the excretion of bile is con- 

 tinuous night and day. These measurements were carefully and 

 regularly made by the sisters in charge of the ward, under the super- 

 vision of the resident surgical officer, Mr. H. Littlewood, F.R.C.S., 

 and my house surgeons, Mr. B. Moynihan, M.B., F.R.C.S., and Mr. 

 F. Hudson, M.R.C.S., to whom I am much indebted for the great 

 pains they took over so long a period. 



The daily quantity does not correspond with the observations of 

 von Wittich and Westphalen, who reported a collection of one pint 

 in the twenty-four hours, with but small variations during ten days. 



More solids are contained in the bile by night than by day, as is 

 shown by the analysis of the specimens which were examined by 

 Mr. Fairley (see appended Tables). 



The quantity of bile discharged is apparently not much influenced 

 by the ingestion of food. The reception of food into the stomach is 

 generally contemporaneous with a marked decline in the flow of bile, 

 lasting for about two hours. The colour of the fresh bile was always 

 green. The violet odour of turpentine was perceived in the bile soon 

 after its administration. 



The Effect of Drugs on the Bile Flow. 



The observations made on the effect or non-effect of certain 

 drugs on the biliary secretion show results which are at variance 



