Having stated that bile as at present employed more frequently does harm than good, by retarding instead of hastening the digestive process, I have now to point out the manner in which it may be given with advantage.
If bile be administered, as I propose, at the end of stomachal digestion, it will, as in the healthy organism, act on the chyme at the proper moment, and thereby render it fit for absorption. In order still further to ensure the action of the bile being delayed until the food is in a condition favourable to its action, that is to say, until it is ready to pass from the stomach into the duodenum, I have had the bile, as above prepared, put into capsules,31 which are not readily acted on by the gastric juice. While in the stomach, the capsules, however, swell up from the size of a pea to that of a small gooseberry, and at the same time become so soft that they will readily burst in passing the pylorus into the duodenum, and thereby allow the bile to escape, and come in contact with the food at the precise moment its action becomes requisite in the digestive process.32 The capsules not only preserve the active properties of the bile for an almost indefinite period, but they have the advantage of most effectually preventing the patient tasting the remedy.
31 The capsules were made by Savory and Moore, and I have every reason to be satisfied with the manner in which they accomplished the object in view.
32 Prepared bile, made up into an ordinary pill, dissolves in gastric juice in a quarter of an hour. When the pill is silvered it is dissolved in half an hour, and when gilded, in forty minutes. Whereas, in the same specimen of gastric juice, the capsules prepared for me by Savory and Moore, although swollen to more than three times their original size, were nevertheless intact at the end of an hour and a half. They readily broke on being gently squeezed between the finger and thumb, it is not therefore probable that they would pass the pylorus in this condition without giving way, and allowing their contents to escape.
Each capsule contains five grains of the prepared bile; and five grains is equal to one hundred grains of liquid bile fresh from the gall-bladder. Two capsules therefore represent two hundred grains of pure bile, a quantity (though less, perhaps, than the healthy organism consumes during each digestion) which in most cases would be sufficient for the wants of the system. If, however, a larger amount be considered necessary, there is no reason why three or more capsules should not be given. By the administration of prepared bile in the manner here described, the physician is enabled to imitate nature, and supply an important element to the system; which, although incapable of curing the disease, can nevertheless ward off for a time the fatal termination.33
33 It is not alone in cases of jaundice that the prepared bile may be of service, but also in the various forms of duodenal dyspepsia, so common among the literary classes, consequent upon either a deficient quantity, or an abnormal quality of bile.
TABULAR VIEW OF THE PATHOLOGY OF JAUNDICE, ACCORDING TO THE AUTHOR'S VIEWS.