84 BILE. 



titis ; while the only diseases in which it is almost constantly pre- 

 sent are those of the biliary ducts and acute yellow atrophy. If 

 an accumulation of actual (chemically recognisable) biliary matters 

 were induced in the blood by the suppression of the hepatic secre- 

 tion, jaundice would necessarily occur just as frequently in the 

 above-named diseases, which affect the parenchyma of the liver, 

 as in impeded excretion of the bile. It is true that these diseases 

 rarely attack the whole parenchymatous structure (indeed, hepatitis 

 never does so, and jaundice seldom occurs in this affection), so 

 that a portion of the liver could always provide for the separation of 

 the bile from the blood : but again, on the other side, the facts may 

 be urged that, in association with jaundice, there may be an abun- 

 dant flow of bile into the intestine (as, for instance, may occur in 

 pysemia, yellow fever, after the bites of poisonous snakes, and 

 even in cases of pneumonia accompanied by icterus), and especially 

 that jaundice may occur in diseases in which no organic change 

 either of the parenchyma or the gall-ducts can be detected. At 

 all events this much is obvious, that we are unable to draw any 

 conclusions from the presence of jaundice regarding a disturbance 

 of the secretion of the liver or the separation of bile, and that 

 it yields us no means of arriving at an opinion regarding the 

 suppression of the biliary secretion or the formation of bile in the 

 liver. Positive data are still required in order to enable us to de- 

 cide, from the occurrence of jaundice, whether there is ajmere sepa- 

 ration or a secretion of bile ; the different conditions which accom- 

 pany or give rise to its occurrence are still so little investigated, 

 that we are by no means justified in concluding that there is a 

 formation of true bile in the blood, even in such cases as acute yellow 

 atrophy of the liver (in which, in addition to the sudden access of 

 jaundice, we find even the hepatic cells atrophied and destroyed). 



In connexion with this subject we would merely direct attention 

 to some few points which have hitherto not been sufficiently re- 

 arded, in reference to pathological conditions. Thus, for instance, 

 it is still undecided whether other biliary matters, and more parti- 

 cularly the coagulated resinous acids, are found in the blood simul- 

 taneously with icterus ; and it would even appear probable, from 

 certain observations, that icterus may be present when no biliary 

 acids are found in the blood. If it could have been shown which 

 biliary acid, that is to say, whether a conjugated acid or cholic 

 (Strecker's cholalic) acid or choloidic acid occurred in the blood of 

 persons affected with icterus or in healthy individuals, it might 

 have been determined whether its resorption was effected from the 



