Reflex Inhibition of the Human Gall Bladder.

Abstract

In a previous publication, one of the authors reported that merely drinking a glass of water resulted in a discharge of bile from the gall bladder. 1 In extending these observations to a large number of patients (10 in all) considerable variation was found, ranging from an individual with a discharge of 24 cc. of bladder bile after a glass of water (case G. B., Fig. 1) to one who reacted not by contraction but by dilation of the gall bladder (case B. B., Fig. 1).

In discussing these extreme types with Dr. W. H. Petersen, the latter suggested that we might be dealing with persons who were differently oriented in regard to the autonomic nervous system. And, indeed, when these individuals were subjected to the Goetsch test, it was found that one extreme (B. B.) was markedly vagotonic, registering a decided fall of systolic blood pressure and of pulse rate after subcutaneous injection of adrenalin, and that the other (G. B.) was markedly sympaticotonic. No generalizations could be made about the intermediate cases.

Up to the present writing we have not been able to secure a gall blader record ot another case showing so marked a fall in pulse rate. But Whether or not this reaction of the gall bladder proves to be characteristic of vagotonics, the present study is of value in that it has revealed a reversed type of response. In the individual in question (B. B., Fig. 1) we secured sudden dilation of the gall bladder, after giving the patient a glass of warm water, of cold water and of milk. That this is not merely a filling of the reservoir following abrupt closure of the sphincter but is due to relaxation of the gall blader musculature, is indicated by 2 observations: first, the rapidity with which the change takes place (see cholecystogranis, Fig. 2); and second, the contrast which it presents to case J. E. (Fig. 1) in which there is a slow filling of the gall bladder after each response to water, without marked relaxation of its muscular tonus—case which is probably characterized by so hypertonic a sphincter that even the contraction of the gall bladder after milk is relatively ineffective.