Cholesterol Content of “White Bile” from Various Sources,Including Contents of “Hydrops” of Gallbladder.

During experiments on the biliary tract of dogs a number of instances of so-called white bile were observed, one from the gallbladder and the others from the ducts. Several human cases were also encountered in which hydrops of the gallbladder was found at operation. These specimens were all analyzed for their cholesterol content.

The significance of these observations concerns the question of the function of the gallbladder and bile ducts as regards the cholesterol of the bile. Is cholesterol absorbed or is it secreted by the bile duct and gallbladder epithelium? Or is it indifferent to the activities of these cells? Study of “white bile” furnishes one way of getting suggestive information as to these questions since it is well known that this secretion is a product not of the liver but of the duct mucosa. The colorless fluid found in hydrops of the gallbladder must similarly be a product of its wall since in these cases the cystic duct is occluded.

In 4 cases of hydrops in the human 2 gave 0.19, 0.45 mg. per cc. of cholesterol, and 2 cases gave macroscopic cholesterol crystals. Stepp and Nathan 1 found 0.64 mg./cc. of cholesterol in the contents of an “acute hydrops” of the gallbladder. Winternitz, 2 however, in another case finds “cholesterol absent”. The method he used is not mentioned. Naunyn 3 states that cholesterol is present in such fluid, but always in small amounts. Fowweather and Collinson 4 found up to 0.92 mg./cc. in 9 cases. In one of our cases (G. C. C.) no evidence of inflammation was made out on section of the wall, but since the lesion had been present for some months with no acute symptoms it is probable that it had subsided, leaving no trace. The other 3 cases all showed evidence of inflammation.