1892.] Icterus in Occluded Ductus Choledochus. 



115 



By careful post-mortem examination it was ascertained that in every 

 case in which bile appeared in the urine, after ligaturing the thoracic 

 duct, the bile had reached the general circulation by the development 

 of collateral lymphatic vessels. These were found to leave the thoracic 

 duct at a point under the first rib and proceed from thence to join the 

 right innominate vein. The only other occasions on which bile was 

 found in the urine, after ligature of the thoracic duct, were in those 

 cases where rupture of the bile duct occurred, and allowed its contents 

 to escape into the peritoneal cavity. 



In every case examined, not only was bile pigment, but also bile 

 acid, found in the lymph of the dilated thoracic duct. 



Tiedemann and Gmelin,* Fleischl,| and KunkelJ had already 

 pointed out that when the ductus choledochus is ligatured and the 

 lymph collected from the thoracic duct it is rich both in bile pigment 

 and bile acid, whereas the blood remains entirely free from bile. 



The analyses of the bile taken from the gall-bladders of the dogs 

 in which a communication between the thoracic ducts and the right 

 innominate vein had been established by the development of collateral 

 lymphatic vessels, thereby permitting bile to reach the general cir- 

 culation, showed that, in these instances, the bile neither contained 

 an increased quantity of soluble substances nor of taurocholate of 

 soda, but merely an excessive amount of mucin. 



The following table contains the results obtained from the analyses 

 of bile taken from the gall bladders of four of the dogs operated upon, 

 and of two other healthy dogs. The amount of taurocholate of soda 

 was calculated from the quantity of sulphur found in an absolute 

 alcohol extract of the dried residue left after the removal of mucin, 

 and other substances soluble in ether (cholesterin, fat, and lecithin). 



Analyses of Bile from Gall Bladders. 



No. of 

 experiment. 



Lived. 



Mucin. 



Dried residue. 



Taurocholate 

 of soda. 



13 

 15 



5 

 8 



Normal dog 



23 days 

 31 „ 

 18 „ 

 18 „ 



3 '706 p.c. 

 1-991 „ 

 1-231 „ 

 1-183 „ 



0-746 „ 

 0-691 „ 



16-164 p.c. 

 7-974 „ 

 11-810 „ 

 15-084 „ 



22-460 „ 

 11-732 „ 



13 -359 p.c. 

 4-628 „ 

 7-661 „ 

 9-415 „ 



6-620 „ 



In those cases where the bile did not appear in the urine for some 



* Tiedemann u. G-melin, ' Die Verdauung nach Versuchen,' vol. 2, 1827, p. 40. 

 t E. Fleischl, 'Arbeit, d. physiol. Anst. zu Leipzig,' 1875, p. 24. 

 t A. Kunkel, ibid., 1876, p. 116. 



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