408 USES OF THE LIVER DUCTLESS GLANDS. 



case the proportion of cholesterine in the blood was only 0-246 of a part per 

 thousand, considerably below the quantity ordinarily 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 found in health. A few other 

 pathological observations of this kind are on record. Picot, in 1872, re- 

 ported a fatal case of " grave jaundice," in which he determined a great in- 

 crease in the quantity of cholesterine in the blood, the proportion being 

 1-804 per 1000. 



It is probable that organic disease of the liver, accompanied with grave 

 symptoms generally affecting the nervous system, does not differ in its pathol- 

 ogy 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 and its consequent accumula- 

 tion in the system. Like the accumulation of urea in structural disease of 

 the kidney, this produces blood-poisoning ; and this condition may be char- 

 acterized by the name Cholesteraamia, a term expressing a pathological con- 

 dition, but at the same time indicating the physiological relations of choles- 

 terine. 



Koloman Miiller, in 1873, succeeded in injecting cholesterine into the 

 blood-vessels without producing any effects due to mechanical obstruction of 

 the circulation. He made a preparation by rubbing cholesterine with glyc- 

 erine and mixing the mass with soap and water. He injected into the veins of 

 dogs, 2-16 fluidounces (about 64 c. c.) of this solution, containing about 

 69 grains (4-5 grammes) of cholesterine. In five experiments of this kind, he 

 produced a complete representation of the phenomena of " grave jaundice." 



In view of all these facts, an excretory action of the liver, involving the 

 separation. of cholesterine from the blood and its discharge in the faeces in 

 the form of stercorine, must be regarded as established, as well as the exist- 

 ence of cholesteraemia as a definite pathological condition. 



FORMATION OF GLYCOGEF IN THE LIVER. 



In addition to the uses of the liver already described, this organ con- 

 stantly produces in health a substance resembling starch, called glycogen, 

 which is converted into glucose and is carried into the circulation by the 

 hepatic veins. In this way the liver acts as a ductless gland, glycogen being 

 formed by the liver-cells in precisely the manner that the various constitu- 

 ents of the secretions are produced by other glands. The discovery of this, 

 which was first called the sugar-producing office of the liver, was made by 

 Bernard, in 1848. During the present century there have been few dis- 

 coveries which have attracted so much attention, and Bernard's experiments 

 have been repeated and extended by physiologists in different parts of the 

 world. In 1857, Bernard discovered glycogen in the liver and showed that 

 the production of this substance precedes the formation of sugar. In study- 

 ing, then, the mechanism of sugar-production in animals, it will be necessary 

 to begin with the physiological history of glycogen. 



