Whereas a specimen of normal bile taken from the gall-bladder of a woman aged sixty-one, was of a specific gravity of 1020, and contained in 1000 parts:—
| Water | 933·27 |
| Solids | 66·73 |
| 1000·00 | |
| ====== |
| Pigment Bile-acids Cholesterine | Organic matter | 56·73 |
| Soda Potash Iron | Inorganic salts | 10·00 |
The difference in composition of these two biles is very striking. The one contains more than four times as much solid matter as the other; and if the relative amount of organic, and inorganic substances be compared, the curious fact is observed, that the difference in the amount of solids in the two cases, is almost entirely due to the change in quantity of organic matter. The inorganic salts have not even so much as doubled themselves in the abnormal bile. Whence is this? Soda is the chief inorganic substance found in bile, and we have seen that it occurs in the form of glycocholate, and taurocholate of soda, substances which, as before remarked, are re-absorbed from the distended ducts, and gall-bladder into the circulation, from whence they are constantly being eliminated with the urine; and this, no doubt, is one of the causes why the inorganic salts are proportionally in such small quantity in the abnormal bile of jaundice from obstruction.
Fifthly,—In the abdomen was a considerable quantity of dark straw-coloured serum, which on the addition of strong sulphuric acid became of a fine emerald-green colour, in consequence of the presence of bile. Traces of sugar were also present in the effused liquid. The serum had only collected in the latter weeks of the patient's life, and after the shrinking of the liver was observed to have begun.
Sixthly,—The liver was small in size, excessively dense, and very heavy. Externally, it had a dark olive hue, and on section presented a most curious appearance. The section was of an almost uniform yellowish-green colour, and studded over with excavations ([Plate I.], b), from which thick bile streamed in all directions. The apparent excavations were nothing more or less than immensely distended ducts. On looking into the ducts, it was observed that they presented the appearance of possessing valves. On microscopical examination, the hepatic cells were found smaller than normal, as if partially atrophied. The nuclei were unusually well marked, in consequence of the fat granules being almost entirely absent. (Fig. 8, b.) In the field of the microscope were a number of caudate or spindle-shaped cells (Fig. 8, c.), from the epithelial lining of the ducts. In the hepatic tissue were found some beautiful stellate crystals, as well as a number of separate needles of tyrosine. A few small crystals of cystine were also found. (Fig. 8, a.)
| FIG. 8. |
Seventhly,—The kidneys were enlarged, pale, and fatty-looking; and all over the surface of the section, as well as immediately under the capsules, which were very loosely attached, were small abscesses. The surface was also studded with numerous minute dark bile-pigment points, and it is possible that the abscesses were the result of the blocking up of the capillary vessels by the pigment deposit, as previously alluded to, [page 57].