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444 THE LIVER.
researches of several investigators * 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 haemoglobin 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, ars3niureted 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
< Naunyn and Minkowski, Arch. f. exp. Path. u. Pharm., 21; Latschenberger,
\.c; Neumann, Virchow’s Arch., Ill, and the literature in footnote 2, p. 383.
2
The literature belonging to this subject is found in Stadelmann, Der Icterus, etc.,
Stuttgart, 1891.
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