Pathogenesis of “White Bile.” ∗

Abstract

White bile is a relatively rare but clinically important condition on account of its grave prognostic significance. My own previous work on this subject (experimental production of white bile in rabbits) gave the following results; that one might expect to find it when there was present an active infection in the bile ducts, and that it was also dependent upon the activity of the liver cells.

Ligations of the common duct were made in the dog and 4 weeks later bacteria were injected into the bile tracts in order to see what influence infection had on the production of white bile.

Eleven dogs were operated upon of which 4 died from 2 to 20 days after the operation (Group 1). In 6 dogs 4 weeks later bacteria† were injected into the gall-bladder. One dog was kept as a control without the second operation. Three of the 6 dogs survived the second operation for only from one to 13 days (Group 2). The remaining 3 and the control dog remained alive and were sacrificed after 4 1/2 to 5 1/2 months (Group 3). All 3 dogs of Group 3 had white bile. In one dog of Group 2 there was very light colored bile. Both of the other dogs of Group 2, the control dog of Group 3 and all the dogs of Group 1 had frank green bile. Chemical analysis of bile in Group 3 showed a marked diminution or a complete lack of the main constituents of bile (bilirubin, cholesterol and bile salts). In the cases with white bile from Group 3, the following common characteristics were noted. There was the clinical picture of a severe infection lasting several months.