Nitrogen Content of the Bile of Normal and Diseased Gall Bladders. ∗

Abstract

A series of recent papers have indicated the possibility that simple bacterial infection is not sufficient to explain the onset of at least part of the clinical cases of cholecystitis. Not only has the diseased gall bladder in about half the cases defied the attempts of bacteriologists to grow organisms from it, but, as Feinblatt 1 and others have pointed out, the histological picture is not consistent with that to be expected in a purely infectious process. The evidence in this matter has recently been summed up by one of us. 2 , 3 With these points in view the following series of studies of the possible or probable chemical constituents of the bile has been undertaken in order to elucidate the possibilities of a purely chemical cholecystitis.

While each of the normal constituents of bile has at some time or other been accused as the causative agent of cholecystitis in man, very little work has been done on its nitrogen content. The striking conclusions found by Gundermann 4 have received but little attention. He found that the total nitrogen content of the human gall bladder was much higher in cholecystitis while in stone-containing gall bladders, it was variable. Boekelman, 5 by aspirating human bile from the duodenum, arrived at similar conclusions.