322 RESORPTION OF BILE. 



5. Stasis of bile occurs in the bile-ducts even from relatively slight 

 resistance. 



A manometer fastened in the gall-bladder of a guinea-pig balanced a column 

 of water more than 200 mm. high. Up to this pressure, therefore, secretion 

 took place. If this pressure were increased or maintained for an excessively 

 long time, absorption of the water of the bile into the blood took place on the part 

 of the liver, up to about four times the weight of the liver, as a result of which 

 solution of red blood-corpuscles by the bile absorbed took place at the same time, 

 with the passage of hemoglobin into the urine. 



Various substances that enter the circulation readily pass over into the bile, 

 particularly the metals, which are also deposited in the hepatic tissue. Further, 

 potassium iodid, bromid, and ferrocyanid, potassium chlorate, arsenic, oil of 

 turpentine, bile injected into the blood (also that from other animals), indigo- 

 carmine and xanthophyllin pass over; less readily, cane-sugar and grape-sugar, 

 sodium salicylate and carbolic acid. Sugar has been found in cases of diabetes, 

 leucin and tyrosin in cases of typhoid fever, altered hemoglobin in the presence 

 of blood-degeneration, lactic acid and albumin under other pathological con- 

 ditions. 



Some substances promote the secretion of bile, olive-oil most intensely; 

 further, oil of turpentine, sodium salicylate, alkalies and laxatives, bile and salts 

 of the biliary acids (particularly from other species of animals), which, after ab- 

 sorption, are again secreted by the liver. Pilocarpin and atropin diminish the 

 secretion. The so-called lymphagogues induce marked secretion of bile in conse- 

 quence of increased hepatic activity; the increase of lymph, on the part of the 

 liver, is thought to depend upon the latter. 



RESORPTION OF BILE. 



Symptoms of Jaundice (Icterus; Cholemia). If an obstruction occurs to the dis- 

 charge of bile into the intestine, as, for example, a plug of mucus or a gall-stone 

 occluding the common bile-duct, or a tumor or pressure from without, rendering 

 the duct impervious, the biliary passages become distended, and, through their 

 distention, cause enlargement of the liver. The pressure in the biliary passages 

 is naturally increased under such conditions. As soon as this pressure has reached 

 a certain point, in the dog up to 275 mm. of a column of the excreted bile as 

 must soon take place with the continued production of bile resorption of the 

 bile from the greatly distended bile-ducts of larger size into the lymph-vessels 

 (not into the blood-vessels) of the liver occurs. In this way the biliary acids 

 and the biliary coloring-matter enter the blood. Ligation of the thoracic duct 

 therefore prevents the entrance of the substances into the blood. Also when 

 the pressure within the portal vein is abnormally low, it is thought that bile can 

 pass over into the blood without occlusion of the bile-ducts. This is said to 

 be partly the case in the presence of icterus neonatorum, as blood no longer 

 enters the portal vein from the umbilical vein after the umbilical cord has been 

 tied; further, in the presence of the " hunger - icterus " observed during the 

 state of hunger, as in the stage of inanition, the distribution of the portal vein is 

 relatively empty, on account of deficient absorption from the intestine. 



Cholemia may, however, result also from the excessive production of bile 

 (hypercholia) , which cannot be completely discharged into the intestine, and 

 thus is resorbed. This takes place when erythrocytes, which furnish the material 

 for the manufacture of the bile, are destroyed in excessive amount. From this 

 material only the liver can elaborate bile. Under such circumstances a plug 

 of inspissated secretion at times forms in the bile-ducts, as a result of which, 

 in consequence of the stagnation of the bile, its resorption is in turn favored. The 

 transfusion of heterogeneous blood acts in this way, in consequence of destruction 

 of the red blood-corpuscles. Therefore icterus is a frequent symptom under 

 such conditions. The author has encountered the same phenomenon after excessive 

 transfusion of blood from the same species, the blood being in part likewise dis- 

 solved later. Such a solvent effect upon the erythrocytes is exerted also by the 

 injection of some heterogeneous sera, of salts of the biliary acids, of water, of vari- 

 ous acids, as, for example, phosphoric acid, and by the administration of large 

 amounts of chloral, chloroform, and ether. Further, injections of hemoglobin in 

 solution into the blood-stream or into the intestine, from which it is absorbed, 

 have the same effect. (The subject is further considered on p. 34 1 .) 



