Abstract
We have been unable to find any previous report of a chemical test by which bile drawn from the gall-bladder or bile ducts of patients suffering from cholelithiasis may be distinguished from normal human bile. For the past 3 years we have been observing a phenomenon, as yet unexplained, which is characteristic of the bile drawn by needle and syringe from human gall bladders or bile ducts containing calculi, but which is absent in normal human bile and in dog's bile. Through the courtesy of Dr. Harry Koster of Brooklyn, N. Y., and of Dr. Ralph Bettman of Chicago, Illinois, we have now observed this reaction in over 200 cases of cholelithiasis. Our attempts to make this test on biles obtained by duodenal drainage have been unsuccessful thus far, due probably to the factors of dilution and interfering substances. We are reporting our observations at this time, in the hope of stimulating work by others which may lead to a valuable clinical test for cholelithiasis.
The characteristic phenomenon is observed when 1 cc. of N/12 sulphuric acid is added to 1 cc. of fresh bile, removed by needle and syringe at operation, or autopsy soon after death, from patients with cholelithiasis. An immediate precipitation of a pale, yellow-green, gelatinous substance occurs. This precipitate, once seen, will not be confused with the fine, particulate precipitate produced by the same procedure in biles free from calculi. The amount of the characteristic precipitate which appears is roughly proportional to the bulk of the stones found in the gall-bladder, and our predictions in this regard, based on tests of biles without preceding knowledge of the surgical pathology, have been surprisingly accurate. We have been unable to make any correlation between the occurrence of the characteristic precipitate and the concentration, viscosity, protein, or cholesterol content of the bile which we tested.
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