THE CHEMISTRY OF THE LIVER 655 



The changes which occur in the liver in phosphorus poisoning are very 

 similar to those seen in acute yellow atrophy. In phosphorus poisoning, 

 aromatic acids and lactic acid have also been found in the urine. 



Van Slyke and Stadie believe that unaltered arnino acids in relatively 

 large quantities are found in the urine only when the liver is profoundly 

 involved as is the case in acute yellow atrophy. 



Cholelithiasis. According to Bacmeister, 10 per cent of all human 

 beings carry gall stones. Women are particularly predisposed, for they 

 are likely to suffer from stasis of bile in the gall bladder due to pregnancy 

 and the wearing of corsets. Pregnancy is associated with hypercholesterol- 

 emia and a diminished amount of cholesterol in the bile. At its termina- 

 tion, the cholesterol decreases in the blood and increases in the bile, and 

 it is possible that crystallization in the gall bladder occurs at this time. 

 Hypercholesterolemia occasionally occurs in cholelithiasis, even in the 

 absence of jaundice. 



The work of Aschoff and Bacmeister has shown that gall stones may 

 develop in a perfectly aseptic gall bladder provided that the outflow of 

 bile is interfered with. Under these circumstances, a solitary calculus 

 may develop consisting almost entirely of cholesterol and presenting a 

 radiate crystalline appearance when cut and polished. The presence of 

 the calculus predisposes to infection, and the bacteria and the calcium 

 rich mucus which is secreted favor the formation of additional stones. 

 The stones which are found in infected gall bladders usually consist of 

 bilirubin combined with calcium and cholesterol. The crystallization of 

 cholesterol is known to occur in aseptic bile in vitro, especially when 

 epithelial cells are present. 



Another condition which may favor the crystallization of cholesterol 

 is a diminution of the concentration of the bile acids which are known to 

 form soluble compounds with this substance. A study of the bile from this 

 angle might furnish additional information regarding the mechanism of 

 gall stone formation. 



