Prolonged chloroform anesthesia causes an acute suppression of bile, as evidenced by the secretion of a thin "white bile" from which bilirubin, cholesterol, and bile salts are absent. The failure of the liver to secrete bilirubin under such circumstances is not due to failure of the pigment to be formed within the body. Indeed an unusual amount is elaborated after chloroform anesthesia because of a blood destruction. The evidence all goes to show that the bile suppression is consequent upon a functional disturbance of the liver, not upon obstruction to outflow. Even uncomplicated biliary obstruction, as when the common duct is tied in animals otherwise normal, results in a disturbance of the liver cells such that their secretory function is impaired, as shown by the inability to take up and secrete sodium indigotate.
The various circumstances under which white bile may be formed are considered and the clinical implications of the phenomenon are discussed.