Emptying of Human Gall Bladder After Saline Cathartics.

Abstract

In a recent number of the Proceedings 1 it was shown that magnesium sulphate, when injected directly into the duodenum, produced relatively as great an expulsion of bile from the gall bladder as usually resulted from the first phase of contraction following a meal of egg-yolk. Secondly, the striking change in shape of the cholecystograms made it certain that not merely emptying but also contraction of the gall bladder was induced by the injection of this salt.

Since then, a large number of other salts have been tried, employing the same quantitative method of measuring the response that has been used in our other investigations, namely, computation of successive gall bladder volumes and the plotting of a contraction curve. Up to the present time, this work has revealed the existence of 2 other salts which in strong solutions are as effective as magnesium sulphate, viz., magnesium chloride and sodium sulphate. Furthermore, each of the 2 sulphates when diluted and given by mouth, induce nearly as pronounced an emptying as when given by Rehfuss tube. But magnesium sulphate, when given to cats, either by mouth or by duodenal tube, does not induce emptying of the gall bladder. Similar negative findings in dogs have been recorded by Gantt and Volborth. 2 One of the alternative explanations they suggest is therefore probably correct—that there is a species difference in the reaction of the gall bladder. Yet in both animals and man, magnesium sulphate induces active peristalsis of the intestine. This confirms our previous observations (made upon animals in which the common duct had been severed from the intestine) that peristalsis of the duodenum is not a significant factor in the evacuation of the gall bladder. 3

Further evidence in this direction is supplied by our experience with such other well known hydragogue cathartics as sodium phosphate and citrate, magnesium citrate and Rochelle salts (tartrates of sodium and potassium) all of which induce peristalsis but none of which cause any pronounced emptying of the gall bladder. Indeed, some of these, as well as hypertonic solutions of sodium chloride and sodium bicarbonate, may close the outlet of the common duct and induce sudden relaxation and filling of the gall bladder. It would seem, therefore, that the action of the 3 effective salts mentioned in the preceding paragraph is best explained on the ground of stimulation of sensory nerve endings by certain specific ions—a hypothesis which is being subjected to further experimentation.