Genesis of Gall Stones 



317 



may again appear in the bile and crystalline deposition again 

 takes place upon them. We have observed such a sequence of 

 events after poisoning with chlorform or toluylenediamine, after 

 biliary obstruction of some days' duration, and following intra- 

 venous injection of a concentrated solution of calcium chloride. 

 The majority of the stones forming upon the canula and col- 

 lecting tube within the animal have such granules as their nuclei. 



Whence come these granules ? They suggest in size and shape 

 the "bile thrombi" observed under pathological conditions within 

 liver tissue. By digesting the tissue with trypsin such "thrombi" 

 can be obtained separately, and their characters compared with 

 those of the granules, — from which they are then found to differ 

 in many respects, notably in being isotropic. Yet our observa- 

 tions leave no doubt that "thrombi" identical with those in the 

 liver do sometimes appear in the bile. Whether they have any 

 relation to gall stones has not been determined. 



The dogs studied were losing all of their bile. May this not 

 have been a factor in the cholelithiasis? That it was not a pri- 

 mary factor was shown by interpolating small glass tubes into 

 duct systems left with intestinal connection undisturbed. In 

 some of the animals thus treated, stones of the characteristic 

 sort formed upon the glass. This being true, why were they 

 never found in the ducts, or, more especially, in the gall bladder 

 of healthy animals? Foreign bodies left in the latter viscus under 

 aseptic conditions fail to bring about the development of stones. 2 

 The ducts, elaborating, as they do, a secretion of their own, 3 and 

 provided with a musculature, may well be able to rid themselves 

 of particulate matter. But the shortcomings in this connection of 

 the gall bladder are strikingly proven by the frequent occurrence 

 in it of a shreddy, cellular debris which, if present in a glass- 

 rubber system, would almost infallibly lead to a formation of 

 calculi. The cause for the absence of stones from the gall blad- 

 der is to be found in the change in the reaction of the bile which 

 this organ effects. It acts to render the secretion acid, even acid 

 to litmus, as others have noted before us. 4 The P H of hepatic 

 duct bile, as determined electrometrically, ranges between 7.5 and 



2 Mignot, R., Arch. gen. de Med,, 1898, I, VIII Ser., T. X., 129. 



3 Rous, Peyton and McMaster, P. D., Jour. Exper. Med., 1921, xxxiv, 75. 



4 0kada, S., Jour. Phys., 1915-16, I, 114; Neilson, N. M., and Meyer, K. F., 

 Jour. Infect. Dis., 1921, xxviii, 130. 



