368 THE BILE IN DISEASE. [BOOK II. 



The absence Cases have been recorded where the bile found in 

 of bile colour- the gall bladder after death has been colourless. Some 

 ing matters o f these have been doubtless cases of the ' hy drops 

 Ue ' cystidis fellese 1 which will be referred to below, the fluid 

 found in the gall-bladder being a secretion of its mucous membrane 

 and not true bile. Hitter 1 has published analyses of colourless, or 

 nearly colourless, bile, in which, the other biliary constituents being 

 present, the bile colouring matters alone were absent, or nearly so. 

 In certain of these cases there was fatty degeneration of the liver, 

 though absence of biliary pigment is by no means characteristic of 

 this condition. The greatest interest attaches, however, to the obser- 

 vations of Noel Paton and Balfour who found, in their case of biliary 

 fistula (p. 275), that the bile always became markedly paler during 

 pyrexia and on several occasions was quite colourless. When the 

 patient was suffering from acute tonsilitis, the bile was totally des- 

 titute of colouring matter. ' Throughout the course of the feverish 

 days, in the early morning, when the temperature was lowest, the 

 bile was always well coloured, and it was towards the afternoon, when 

 the temperature rose, that the diminution in the pigment was to be 

 observed V 



Summary of During pyrexia, the quantity of bile is diminished and 



the changes the colouring matter, as above stated, may diminish to 

 observed in the guch an extent that the liqui( j may be colourless 3 . 



under arti * ^ n con g es *i n f the liver due to venous obstruction, the 



cular diseases ^ile sometimes, though not invariably, contains albumin. 



In fatty degeneration of the liver, the bile has been 

 noticed to be deficient in colouring matter, though this is by no means 

 always the case. In amyloid degeneration of the liver, Hoppe-Seyler, on 

 one occasion, found the bile highly pigmented and containing a large 

 quantity of solid matters, of which the larger part was insoluble in alco- 

 hol 4 . In acute yellow atrophy, the bile, like the other fluids of the body, 

 contains leucine and tyrosine. 



In diabetes, the bile contains sugar. In uraemia, whether due to 

 affection of the kidneys or to cholera, the amount of urea in the bile is 

 increased. In cholera, the mucous membrane of the gall bladder may or 

 may not be affected. In the latter case, the gall bladder contains a ' rice- 

 water' liquid, i.e. a white turbid liquid mixed with flakes of detached 

 epithelium, resembling the liquid which is found in the intestinal canal. 

 In the former case, the gall bladder contains a dark coloured and very 

 concentrated bile, concerning which it is impossible to say whether it is 

 secreted in the condition in which it is found, or whether it has become 

 concentrated in its passage along the biliary ducts 5 . 



1 Bitter, Comptes Rendus, Vol. LXXIV. p. 813, and Journal de V Anatomic et de la 

 Physiologie, 1872, p. 181. The reader may also refer to a paper by V. Hanoi entitled, 

 * Notice pour servir a 1'histoire de 1'acholie.' Comptes rendus de la Societe de biologie, 

 1884, pp. 41 and 336. 



2 D. Noel Paton and J. M. Balfour, op. cit. (Kefer to p. 211). 



3 Noel Paton and J. M. Balfour, op. cit., (p. 211 and 212 refer also to p. 204). 



4 Hoppe-Seyler, Physiolog. Chemie, p. 318. 



5 Hoppe-Seyler, Physiolog. Chemie, p. 316. 



