The claim that diseases of the liver and gall bladder produce toxemia is based upon four facts:

1. That bile itself, when absorbed into the system, acts as a poison and produces a definite toxemia.

2. That the liver is a destroyer of auto-toxins, therefore any diminution of the functional mass of the liver impairs this important property with resulting toxemia.

3. That the absence of bile from the intestinal tract favors putrefaction and consequently auto-intoxication.

4. That hepatic disease may be produced experimentally by substances allied to the auto-toxins.

The experiments of Croftan cited in Part II show the very close analogy between the phenomena obtained in experiments with the bile salts and those symptoms so commonly observed in cases of jaundice. The slowed heart, the lessened coagulability of the blood, the reduced motor and sensory irritability, and the constriction of the peripheral circulation, all are practically identical.

That the liver is a destroyer of certain poisons as well as auto-toxins appears in experiments in which nicotin, morphin, hyoscyamin, were shown to be retained, in part at least, by the liver, which also acts as a storage place for metals such as iron, manganese, lead, copper, silver, and antimony. The researches of Herter show that the liver is the chief organ for the removal of indol from the circulation. He showed, too, that extracts of tetanus, pyocyaneus, and typhoid bacilli lost much of their toxicity in traversing the liver substance, and analysis of the resulting substances showed that these toxins were chemically changed.

The absence of the bile from the intestinal tract favors those conditions which result in intoxication chiefly by the obstinate constipation which it induces. In this connection one naturally recollects the success which so often attends the clinical use of ox gall in this affection. Bohm (15) not only observed that intestinal putrefaction very commonly occurred in cases of catarrhal icterus, but also found that the urine contained an excess of ethereal sulphates in the urine together with other evidences of auto-intoxication. The absence of bile with its consequent lack of normal intestinal antiseptic and peristaltic stimulant is quite enough to inaugurate all of the well-known symptoms of "bilious indigestion."