1907.] The Pressure of Bile Secretion, etc. 525 



Part II. — Absorption of Bile from the Bile Passages in the Liver. — 



Previous Observations. 



Ligature of the common bile duct in the living animal is followed sooner 

 or later by the presence of the constituents of bile in the blood. It was at 

 one time believed that the bile enters the blood directly in the liver. 

 Haller (6) stated that communications exist in the liver between the hepatic 

 veins and bile ducts, and in support of this adduced the fact that injection of 

 the bile ducts with fluid is followed by its escape into the veins. 

 Saunders (16), in 1795, published the results of experiments performed on 

 dogs. In a living dog he ligatured the common bile duct and killed the 

 animal two hours afterwards. He found the lymphatics of the liver 

 distended with bilious fluid and the thoracic duct filled with moderately 

 diluted bile. There was no appearance of jaundice as indicated by the 

 conjunctiva, and he stated that it was probable that bile was only just 

 beginning to enter the blood vessels. 



Tiedemann and Gmelin(17), in 1827, recognised that most of the 

 observations of Saunders were correct. They found jaundice appeared not 

 earlier than the third day after ligature. Frerichs (4) noted a yellow tinge 

 of the conjunctiva first appearing between the 60th and 70th hour after 

 ligature. He challenged the statement of Saunders that bile is found in the 

 blood after two hours. 



That the bile is absorbed by the lymphatics of the liver in obstructive 

 jaundice has received abundant confirmation from the works of 

 V. Fleischl (2), Heidenhain, Yaughan Harley (7), and many other observers. 

 Heidenhain determined experimentally the site of the escape of bile from the 

 bile channels into the lymphatics. He injected a solution of indigo-sulphate 

 of soda into the bile ducts and found that the skin, mucous membranes, and 

 urine were rapidly coloured blue. Examination of sections of the liver 

 showed him that there was no coloration of the interior of the lobules, the 

 blue was present in the interlobular bile ducts, but not in the bile capillaries. 

 •Secretion of bile must have been going on while absorption was taking place. 

 Heidenhain concluded that the bile escapes from the interlobular bile ducts 

 into connective-tissue spaces and is carried away by the lymphatics. 



Most observers, and especially Yaughan Harley, have insisted that in 

 obstructive jaundice the bile reaches the blood solely by the lymphatics. 

 Nauwerck (14), on the other hand, denies this and believes that the bile 

 •enters the blood directly through fine channels in the liver cells. 



Mall (13) has recently stated that when the lymphatics of the liver are 

 injected from the bile duct there is always an extravasation in the centre of 



