BLOOD AND LYMPH. 571 



bile-pigment, that it becomes impossible for the liver to take away 

 all of it. 



Stadelmann 1 has shown it to be very probable that in spite of the appar- 

 ent unhindered passage of bile into the intestine, nevertheless there may 

 be a stoppage in the flow of the bile. The bile flows under a very slight 

 pressure, so that the slightest obstruction will stop it, and thereby cause 

 an absorption of bile by the lymphatics. This may result from a greatly 

 increased secretion, or from the greater viscosity of the concentrated bile. 

 At all events, according to these observations we are not justified in 

 assuming that the transformation of hematin into bile-pigment takes 

 place in any other organ than the liver. 



We shall mention in addition that the restricted flow of the bile 

 towards the intestines may lead to severe nervous disturbances. Cerebral 

 effects result, causing delirium, convulsions, coma, and finally death. It 

 has never been found possible to establish satisfactorily the cause of these 

 phenomena. It is important to know that they almost invariably result 

 from chronic obstructions to the flow of the bile. It has been assumed 

 that the absorbed constituents, and their segregation in the tissues and 

 blood, were the cause of these severe disturbances. There is no proof of 

 this, however. We must not forget that where there is a chronic obstruc- 

 tion to the flow of the bile, it is certain that the metabolism of the whole 

 liver must suffer as a result. The central position of the liver in the 

 general metabolism has already been indicated. It is clear that if any one 

 of its important functions is entirely abolished, this is likely to affect 

 the entire organism. On the other hand, the objection may be raised 

 that the liver can undergo all sorts of severe treatment without necessarily 

 causing any disturbance in this direction. It may be said, however, that 

 we are not able to draw conclusions solely on the basis of anatomical 

 changes concerning the functional condition of a tissue. It is an open 

 question as to which part is first and most seriously affected. A serious 

 suppression of metabolism in the cells may take place without there being 

 any indication of it in the external appearance of the cells or of the con- 

 tents, and, on the other hand, there may be very great anatomical changes 

 in a tissue without the functions being other than normal, as long as 

 the cell complex or the constituents of the cells do not take part in a 

 pathological process. 



In the transformation of hematin into bilirubin, iron is split off. What 

 becomes of it we do not know. Only a part is eliminated with the bile 

 itself. It is possible that it is immediately utilized again, or that it 

 chooses to be eliminated through the intestines. 



The constituents of the bile, especially cholesterol and the bile- 



1 Arch, exper. Path. Pharm. 14, 231 and 422 (1881); 15, 337 (1882); 16, 118 and 

 221 (1883). 



