444 THE LIVER. 



researches of several investigators l that the iron is, at least chiefly, 

 retained by the liver as a ferruginous pigment or protein substance. 



What relation does the formation of bile-acids bear to the forma- 

 tion of bile-pigments? Are these two chief constituents of the bile derived 

 simultaneously from the same material, and can we detect a certain 

 connection between the formation of bilirubin and bile-acids in the liver? 

 The investigations of STADELMANN teach us that this is not the case. 

 With increased formation of bile-pigments the amount of bile-acids 

 is decreased, and the introduction of hemoglobin into the liver strongly 

 increases the formation of bilirubin, but simultaneously strongly decreases 

 the production of bile-acids. According to STADELMANN the formation 

 of bile-pigments and bile-acids is due to a special activity of the cells. 



An absorption of bile from the liver, and the passage of the bile con- 

 stituents into the blood and urine occurs in retarded discharge of the 

 bile, and usually in different forms of hepatogenic icterus. But bile- 

 pigments may also pass into the urine under other circumstances, espe- 

 cially when a solution or destruction of the red blood-corpuscles takes 

 place in animals through injection of water or a solution of biliary salts, 

 through poisoning by ether, chloroform, arseniureted hydrogen, phos- 

 phorus, or toluylenediamine, and in other cases. This also occurs in man 

 in severe infectious diseases where the red blood-corpuscles are dissolved 

 or destroyed. It has also been claimed many times that a transformation 

 of blood-pigments into bile-pigments occurs elsewhere than in the liver, 

 namely, in the blood. Such a belief has been made very improbable 

 and in some of the above-mentioned cases, as after poisoning with phos- 

 phorus, toluylenediamine, and arseniureted hydrogen, it has been dis- 

 proved by direct experiment. 2 In these cases we are also dealing with 

 an abundant working up of the blood-pigments in the liver. 



Bile Concretions. 



The concrements which occur in the gall-bladder vary considerably 

 in size, form, and number, and are of three kinds, depending upon the 

 kind and nature of the bodies forming their principal mass. One group of 

 gall-stones contains lime-pigment as chief constituent, another cholesterin, 

 and the third calcium carbonate and phosphate. The concrements 

 of the last-mentioned group occur very seldom in man. The so-called 

 cholesterin-stones are those which occur most frequently in man, while 



*See Naunyn and Minkowski, Arch. f. exp. Path. u. Pharm., 21; Latschenberger, 

 I.e.; Neumann, Virchow's Arch., Ill, and the literature in footnote 2, p% 383. 



* The literature belonging to this subject is found in Stadelmann, Der Icterus, etc., 

 Stuttgart, 1891. 



