458 SECRETION. 



with grave nervous symptoms, it seemed an interesting question to determine whether it 

 be possible for cholesterine to accumulate in the blood without the ordinary evidence of 

 jaundice. We had an opportunity of examining the blood in two strongly-contrasted 

 cases of cirrhosis, in neither of which was there jaundice. 



One of these patients had been tapped repeatedly (about thirty times), but the ascites 

 was the only troublesome symptom, and his general health was pretty good. In this case 

 the proportion of cholesterine in the blood was only 0*246 of a part per thousand, con- 

 siderably below the quantity that we had found in health. 



The other patient had cirrhosis, but he was confined to the bed and was very feeble. 

 The proportion of cholesterine in the blood in this case was 0'922 of a part per thousand, 

 a little above the largest proportion we had found in health. 



Like the examinations of the blood in the three cases of paralysis, these pathological 

 observations are not sufficient, in themselves, to establish the function of cholesterine ; 

 but, taken in connection with our other experiments, they fully confirm our views with 

 regard to the excretory function of the liver. It is pretty certain that organic disease of 

 the liver, accompanied with grave symptoms generally affecting the nervous system, does 

 not differ in its pathology from cases of simple jaundice in the fact of retention of the 

 biliary salts in the blood ; but these grave symptoms, it is more than probable, are due 

 to a deficiency in the elimination of cholesterine the true excrementitious principle of 

 the bile and its consequent accumulation in the system. Like the accumulation of urea 

 in structural disease of the kidney, this produces blood-poisoning ; and we have charac- 

 terized this condition by the name Cholestersemia, a term expressing a pathological con- 

 dition, but at the same time indicating the physiological relations of cholesterine. 



Since the first publication of the preceding observations, numerous experiments have 

 been made upon the relations of cholesterine to nutrition and disassimilation ; but most of 

 those observations in which attempts were made to produce toxic effects by injecting cho- 

 lesterine into the blood have been unsuccessful. In 1873, Koloman Muller ( Ueber Choles- 

 terdmie. Archivfiir experimentelle Pathologic und Pharmakologie, Leipzig, 1873, Bd. i., 

 S. 213, et seq.) succeeded in injecting cholesterine without producing any bad effects by 

 mechanical obstruction of the blood-vessels. He made a preparation by rubbing choles- 

 terine with glycerine and mixing the mass with soap and water. He injected into the 

 veins of dogs, 2'16 fluidounces of this solution, containing about 69 grains of choles- 

 terine. In five experiments of this kind, he produced a complete representation of the 

 phenomena of "grave jaundice." Mtiller's experiments are in exact accordance with 

 our views concerning the physiological and pathological relations of cholesterine. Picot 

 (Journal de V anatomic, Paris, 1872, tome viii., p. 246, et seq.) has reported a fatal case 

 of "grave jaundice," in which he determined a great increase in the proportion of choles- 

 terine in the blood, the quantity being 1-804 per 1,000. 



In view of all of these facts, the missing link in our own chain of evidence having 

 been supplied by the experiments of Muller, the excrementitious function of the liver, 

 consisting in the separation of cholesterine from the blood and its discharge in the fasces 

 in the form of stercoriue, must, we think, be regarded as definitely established. 



Production of Sugar in the Liver, 



It was formerly supposed that the chief and the only important office of the liver was 

 to produce bile, and all physiological researches into the functions of this organ were 

 then directed to the question of the uses of the biliary secretion; but, in 1848, it was 

 announced by Bernard that he had discovered in the liver a new and important function, 

 and he proceeded to show, by an ingeniously-conceived series of experiments, that the 

 liver is constantly producing sugar of the variety that had long been recognized in the 

 urine of persons suffering from diabetes mellitus. The great physiological and pathologi- 

 cal importance of the discovery, attested, as it was, by experiments which seemed to be 



