Samuel Morrison

Etiology of gall stones: 2. The relationship of the pH of bile to the formation and the dissolution of gall stones.

It has been shown conclusively that the acid bile of the dog’s gall bladder will dissolve human cholesterol gall stones. In the present report the effect on human gall stones of an alkaline bile as is normally found in the guinea pig’s gall bladder was determined. It occurred to us that since human gall stones dissolved in acid bile it was theoretically unlikely that similar dissolution would occur in alkaline bile. Our experiments have shown that gall stones do not dissolve in the guinea pig’s alkaline bile even after a long period of time.

An experimental study of the effect of the thyroid on the motility of the gastro-lntestinal tract

The physiologic mechanism of thyroid action upon the gastro-intestinal tract has not been clearly established in the past. A preliminary study was made to determine the effect of the thyroid and the vagus nerves on gastro-intestinal motility in dogs. Our studies yielded the following results: 1. Desiccated thyroid administered to normal dogs showed an acceleration of gastro-intestinal motility. 2. Motility of the stomach is invariably affected by section of the vagus nerves. This procedure causes a six hour retention in almost every instance. 3. Motility of the intestines is not significantly affected by section of the vagus nerves. The immediate effect of vagotomy on the digestive tract is mainly on gastric motility with very little, if any, effect upon the intestines. 4. Desiccated thyroid administered to vagotomized dogs revealed an acceleration of gastro-intestinal motility thus demonstrating conclusively that thyroid action is independent of the vagus nerves. 5. Removal of the thyroid glands alone had no immediate effect upon gastro-intestinal motility. After a lapse of months, however, it did produce some loss of tone and sluggish motility. 6. Thyroid gland extract given subcutaneously or desiccated thyroid administered orally to the thyroidectomized animals accelerated gastro-intestinal motility. 7. In the combined vagotomized and thyroidectomized dogs, motility studies revealed no immediate changes other than those noted in the vagotomized animals (6 hour gastric retention) indicating that thyroid removal did not influence the changes noted following vagotomy. 8. Desiccated thyroid administered to the animals with combined vagotomy and thyroidectomy revealed a hypermotility of the gastro-intestinal tract with the return of retention after cessation of thyroid medication. 9. Thyroid medication in adequate dosage produced an acceleration of motility of the intestines as well as the stomach.

A contribution to the etiology of gall stones

Our experimental investigations indicate that the change in the hydrogen-ion concentration of gall bladder bile is an important factor in the etiology of gall stones.

The constancy of acid values in a series of 227 peptic ulcer cases studied by repeated gastric analyses.

A study was made of 227 cases in which two or more gastric analyses have been performed to determine the variation of acid values charted over a period of time. The time interval varied from one day to over 16 years. In one instance as many as six gastric analyses have been made. In over one-half of the cases two tests have been made, while in over one-third of the cases 3 or 4 tests have been made. The acid values were divided into four grades. Although there have been variables, the majority fell into the range of lst and 2nd degree acidities. It is of interest to point out that of the 227 cases, there were 154 or 67.8 per cent in whom the acid values were constant over the observation period. In the remaining 73 cases, there were variable gradations of acidity. The literature does not lead one to believe that acid values often tend to he constaut. On the other hand, it is generally thought that acid values are responsive to various agents and this is true within limits. However, the present study would indicate tha the acid values tend to return to their previous levels.

The healing of a primaryduodenal ulcer with the later development of a gastric ulcer

In a study of 500 cases of peptic ulcer, a combined gastric and duodenal ulcer was found in 21 cases or 4.2 percent. Among the 21 cases of combined peptic ulcers, there were 6 instances or 1.2 percent of the entire series or 28.5 percent of the combined ulcers, in which it was clinically and roentgenologically demonstrated that one of the ulcers had been healed completely and the other had remained active. The site of the original ulceration was in the duodenum, and the second ulcer occurred in the stomach. Attention is drawn to the fact that one must not always assume that when there is a recurrence of symptoms it is due to a recurrence of the same ulcer at the original site. It is further emphasized that when a patient is found to have a peptic ulcer which has shown roentgen and clincial evidence of complete healing and the patient has been asymptomatic for an indeterminate period of time, the recurrence of digestive symptoms may indicate the formation of a new ulcer at a different site. A clinical example of the latter type of case is described.

An appraisal of the psychological relationship of coronary disease to peptic ulcer.

In 1,522 consecutive autopsies of all ages, the incidence of peptic ulcer was 6.6 per cent. This incidence is somewhat higher statistically than generally found in consecutive autopsy studies of all ages. The incidence of peptic ulcer associated with coronary occlusion in the same series of autopsies was 10.5 per cent. The difference of 3.9 per cent in the incidence of peptic ulcer in our general autopsy data and that found among cases of coronary occlusion may not be of statistical significance. However, there were many significant similarities when the factors associated with peptic ulcer and coronary disease are considered. These factors are briefly discussed and emphasized.

The effect of insulin on motility of the stomach following bilateral vagotomy

These experiments show the following effects of insulin on the motility of the stomach. 1. In the normal animal the administration of insulin accelerates the motility of the stomach. 2. In the bilaterally vagotomized animal there is a greater inhibition of gastric motility, exceeding that observed after bilateral vagotomy without insulin. 3. In addition to the gastric motility inhibition, insulin further diminishes the gastric tone and causes an increased gastric retention and greater dilatation of the stomach than that observed following bilateral vagotomy without insulin. 4. It would appear that the effects of insulin are mediated through the vagus nerves. Finally it is suggested that on the basis of the data presented, a roentgen insulin test for the determination of vagotomy could be developed.

An experimental study of the hydrogen-ion concentration and chemistry of bile, its effect upon stones, and a suggestion as to therapeutic application of ox-bile in gall bladder disease

1. In a study of gall bladder bile of different species one of the most striking features is the apparent immutability of its characteristic hydrogenion concentration. 2. The pH of bile does not readily change following various forms of therapy. 3. It is our belief that various foods do not significantly alter the pH of gall bladder bile. 4. The feeding of large doses of powdered extract ox-bile U. S. P. changes the dog’s normal acidic bile to alkaline and also dilutes the chemical constituents. Feeding of smaller doses does not change the pH of gall bladder bile in the dog nor does it have any diluting effect. 5. The feeding of keto bile acids (0.7 gram per day) did not change the pH of gall bladder bile in the dog nor did it bring about as great a dissolution of the stones as is noted in the normal and ox-bile fed animal. This dosage of keto bile acids approximated the human dose. The diluting effect was much less marked than in feeding large doses of ox-bile. 6. The pH of bile is not the sole criterion in the dissolution of gall stones, as is demonstrated by the fact that even though large doses of ox-bile change the pH of dog’s acidic gall bladder bile to the alkaline side, they do not significantly influence the degree of dissolution of implanted human cholesterol stones. In our opinion, the dissolution of the stones by the alkaline bile after the feeding of large quantities of ox-bile, is due to its cholagogue effect.

An experimental study of the effect of the pituitary on the motility of the gastro-intestinal tract. A preliminary report.

Though they may be modified by the more or less indirect method of approach the following conclusions seem justifiable: 1. Gastro-intestinal motility in normal dogs is not affected by the subcutaneous administration of anterior lobe pituitary extract therapy. 2. Gastro-intestinal motility is not affected by hypophysectomy. 3. The administration of anterior Iobe pituitary gland to these hypophysectomized animals had no effect upon gastro-intestinal motility. 4. Gastric test meals in these operated but otherwise untreated dogs revealed normal secretory values.

An experimental study of the effects of the pituitary and thyroid glands on carbohydrate metabolism. A preliminary report.

1. The administration of anterior Iobe pituitary extract to the normal dog produces a hyperglycemic (diabetogenic) effect. 2. Sugar tolerance tests in hypophysectomized dogs with and without thyroidectomy, reveal an increased tolerance or hypoglycemic effect. 3. Sugar tolerance tests in hypophysectomized dogs with and without thyroidectomy to whom anterior lobe pituitary extract had been administered show relatively normal curves. 4. The effect of thyroid therapy upon the blood sugar of normal dogs is to produce a hyperglycemia. 5. Thyroid therapy in hypophysectomized dogs with and without thyroidectomy, produces an effect approximating a normal curve.