ELIMINATION OF CHOLESTERINE BY THE LIVER. 457 



assuming that the amount of cholesterine excreted by the liver in twenty-four hours is 

 equal to the amount of stercorine found in the evacuations, the quantity is about ten and 

 a half grains. This corresponds with the estimates of the daily quantity of cholesterine 

 excreted, calculated from its proportion in the bile and the estimated daily amount of 

 bile produced by the liver. 



To complete the chain of the evidence leading to the conclusion that cholesterine is 

 an excrementitious principle which is formed in certain of the tissues and eliminated by 

 the liver, it is only necessary to show that it is liable to accumulate in the blood when 

 the eliminating function of the liver is interrupted. It will be remembered that it was 

 only after extirpation of the kidneys, followed by accumulation of urea in the blood, that 

 Prevost and Dumas were able to demonstrate the preexistence of this principle in the cir- 

 culating fluid and to indicate the mechanism of its separation from the blood by the kid- 

 neys. This mode of study has been applied to certain of the elements of the bile, though 

 without success ; for Miiller, Kunde, Lehmann, and Moleschott, who extirpated the livers 

 from frogs, looked in the blood only for the biliary salts. We have not been able to 

 repeat these experiments upon frogs and analyze the blood for cholesterine, but we have 

 arrived at very positive results in the study of the blood in diseased conditions of the 

 liver, that are interesting alike to the physiologist and the pathologist. 



It has long been recognized that cases of ordinary icterus are not of a grave character, 

 while there are instances in which the jaundice, though less marked as regards coloration 

 of the skin, is a very different condition. Chemists have analyzed the blood, in the hope 

 of explaining this difference by the presence, in the grave cases, of the taurocholate and 

 glycocholate of soda ; but their failure to detect these principles leaves the question still 

 uncertain. The real distinction, arguing from purely theoretical considerations, would lie 

 in the proposition that, in cases of simple jaundice, there is merely a resorption from the 

 biliary passages of the coloring matter of the bile, and, in grave cases which are almost 

 invariably fatal there is retention of cholesterine in the blood. 



We have not been able, on account of the insolubility of cholesterine, to observe the 

 effects of injecting it into the blood-vessels, but we have had an opportunity of making 

 an examination of the blood of a patient in the last stages of cirrhosis of the liver, accom- 

 panied with jaundice, and we compared it with an examination of the blood of a patient 

 suffering from simple icterus. Both of these patients had decoloration of the faeces ; but 

 in the first the icterus was a grave symptom, accompanying the last stages of disorgani- 

 zation of the liver, while in the latter it was simply dependent on duodenitis, and the 

 prognosis was favorable and verified by the result. As icterus accompanying jaundice is 

 of very infrequent occurrence, we were fortunate in having an opportunity of comparing 

 the two cases. 



Without giving in full the details of these cases and the examinations, which are con- 

 tained in our original memoir on cholesterine, it is sufficient here to state the main results 

 of the examinations of the blood and faeces. 



In the case of simple jaundice from duodenitis, in which there was no great disturb- 

 ance of the system, a specimen of blood, taken from the arm, presented undoubted evi- 

 dences of the coloring matter of the bile, but the proportion of cholesterine was not 

 increased, being only 0*508 of a part per thousand. The faeces contained a large propor- 

 tion of saponifiable fat, but no cholesterine or stercorine. 



In the case of cirrhosis with jaundice, there were ascites and great general prostra- 

 tion. This patient died a few days after the blood and fa3ces had been examined, and 

 the liver was found in a condition of cirrhosis, with the liver-cells shrunken, and the 

 gall-bladder contracted. In this case the blood contained 1-850 pt. of cholesterine per 

 thousand, more than double the largest quantity we had ever found in health. The faeces 

 contained a small quantity of stercorine. 



Inasmuch as cases frequently present themselves in which there are evidences of cir- 

 rhosis of the liver, with little if any constitutional disturbance, while others are attended 



