The Preliminary Work With Neoarsphenamine

placed aseptically in the gallbladder. The sand was intended to represent biliary sediment. It was opaque to roentgen rays ; thus, its rate of disappearance from the gallbladder could be studied.Sixty dogs were used: Group 1. Fifteen of the animals served as controls. They were fed a mixed meal four times daily (every six hours). The sand disappeared from the gallbladder in an average of eighteen days ; range, ten to thirty-one days. Group 2.Fifteen animals were treated like the controls, except that they were given 0.5 Gm. of ketocholanates with each meal. This dose of ketocholanates is known to cause a hydrocholeresis. The sand disappeared from the gallbladder in an average of seventeen days ; range, eight to thirty-three days. Group 3. Fifteen animals were given 125 cc. of half and half egg yolks and cream four times daily. The sand disappeared in an average of ten days; range, six to fifteen days. Group 4. Fifteen animals received the egg yolks and cream plus 0.5 Gm. of ketocholanates. The sand disappeared in an average of eight days ; range, four to fourteen days.The results of these experiments, conducted by Drs. H. Wigodsky and B. P. Phibbs in my laboratory, show that choleresis per se does not have a significant flush¬ ing action of the gallbladder. However, they show definitely that the frequent administration of egg yolks and cream augments the rate of passage of sand from the gallbladder. Thus, in the presence of normal formation of bile, frequent evacuation of the gallbladder facilitates the removal of sediment from the viscus. If bile had not been adequately formed, then bile salts probably would have been of benefit. In these experi¬ ments on normal animals the administration of bile salts was superfluous. SUMMARY 1. Protein promotes the formation of bile and cholic acid in the dog, a fact that is worthy of consideration in the management of cholecystectomized patients.2. Bile salt output is maintained at a relatively constant level because the rate of production is bal¬ anced by the rate of "destruction." The rate of pro¬ duction depends primarily on the amount of protein metabolized and the rate of destruction on the rate of enterohepatic circulation of a particular quantity of cholic acid. About 10 per cent of a quantity of cholic acid is lost during each enterohepatic circuit. Excessive bile salt causes catharsis, which increases the loss ("sluice mechanism"). Given a high protein diet and otherwise normal conditions, a cholecystectomized subject probably should pass a larger volume of bile through the common duct than a subject with a normal gallbladder.3. Oxidized cholic acid (dehydrocholic or triketocholanic acid) is a hydrocholeretic agent. The bile formed is less viscous and contains less total solids per cubic centimeter than the bile formed in response to glycocholic and taurocholic acid. 4. Sodium dehydrocholate quite consistently increases the rate of blood flow through the hepatic artery. This is not true of sodium cholate, glycocholate and taurocholate.5. Evidence showing that the dai...

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The Preliminary Work With Neoarsphenamine

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