ICTEEUS NEONATORUM. 403 



Catarrhal Jaundice is usually considered to be an infective 

 inflammation of the common bile duct, extending from the 

 duodenum. Occlusion of the common duct by inflammatory 

 swelling of its lining membrane is favoured by the following 

 anatomical conditions the terminal portion of the duct traverses 

 the duodenum very obliquely; the walls of the duct are thick 

 and do not easily stretch ; its lumen is narrow, and in addition, 

 the pressure under which bile is secreted is very low. 



In a very large percentage of cases the common bile duct 

 is completely embraced in the head of the pancreas, and in the 

 remainder it lies in a deep groove in the gland. It is therefore 

 possible that inflammatory swelling of the head of the pancreas may 

 be the cause of some of the cases of so-called catarrhal jaundice. 



Slight jaundice is easily recognised in the ocular conjunctiva. 

 When looking for it in this situation the presence of yellow sub- 

 conjunctival fat in the parts remote -from the cornea should 

 be borne in mind, and attention particularly directed to the 

 conjunctiva immediately surrounding the cornea where the fat 

 is absent. 



Jaundice in the Newly-born is usually transitory and in all 

 probability due to inspissatioii of the bile and slight catarrh 

 of the duct. There are, however, graver forms. Obliteration 

 of some part of the bile passages may be present. There 

 appears to be no special site for this, for the stenosis may 

 be found anywhere in the course of the bile ducts from their 

 commencement in the liver to their termination in the duode- 

 num ; at the same time the gall bladder may present inflamma- 

 tory changes and multilobular cirrhosis be present. In other 

 instances the jaundice is due to obstruction of the ducts by 

 perihepatitis, for Glisson's capsule becomes invaginated into the 

 liver at the portal fissure, and so comes into close relation with 

 the ducts, and when inflamed may compress them. Another 

 variety is that in which the umbilical vein, becoming infected 

 at the umbilicus, gives rise to a portal pyaemia. General pyaemia 

 may also result, since, at this age, the ductus venosus connects 

 the portal and systemic venous systems. 



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