704 JAUNDICE. 



Tliis condition is probably largely operative in many serious 

 alterations of the liver-structure and in certain specific blood- 

 cbanges : in tbe one, the minute secretory elements are at 

 fault ; in the other, the material presented to them is not in a 

 condition favourable to carry on the normal exchanges. 



By the second, the bile, although properly formed, is shown 

 to be unable to reach its natural destination, the alimentary 

 canal, and is in part reabsorbed into the blood from which 

 it. originally came, in this way contaminating it somewhat 

 similarly to the first form. 



Kegarding the appearance of jaundice as presenting itself to 

 us in the horse, it seems certain that, although it may not un- 

 frequently be seen as associated with some pecuhar blood 

 disturbances and diseases of other viscera, that still its most 

 frequent exhibitions and most persistent and serious invasions 

 are as concomitants to disturbance and disease of the liver. 



It is probably more frequently as connected with disturbed 

 function or actual tissue-change of the liver that jaundice is 

 presented for our consideration, being often present in cases of 

 disturbed circulation, as congestion and varied forms of hepatic 

 inflammation, also in the more serious alterations of struc- 

 ture or adventitious depositions or growths. That it may some- 

 times be found in alliance with catarrhal states of the bile- 

 ducts, or obstruction to their free discharge of bile, caused by 

 morbid growths and parasitic invasion, is probably true ; while 

 its association with haemal impurities, the result of specific 

 fever, is not improbable. 



In treatment it is often of advantage to be able to determine 

 whether this condition, when undoubtedly developed as an 

 accompaniment of hepatic disturbance, is the result of non- 

 elaboration of bile, or of its reabsorption after elaboration. 

 These points have been attempted to be determined by chemical 

 tests. The one ordinarily employed, known as Pettenkofer's, 

 depending upon the manner in which the bile acids comport 

 themselves when strong sulphuric acid is added to urine having 

 a moderate amount of cane-sugar mixed with it, is rather 

 crude and not to be depended upon, seeing there are many 

 conditions operating to modify largely this mode of applying 

 the test. 



To be carried out with any degree of certainty the bile acids 



