

CHAPTER VI. 



THE MODE OF PRODUCTION AND THE PHENOMENA OF 

 ICTERUS, OR JAUNDICE. ICTEROGENIC POISONOUS 

 AGENTS. THE MODIFICATIONS IN CHEMICAL COM- 

 POSITION WHICH THE BILE EXHIBITS IN DISEASE. 

 THE INFLUENCE OF DRUGS ON THE SECRETION OF 

 BILE CHOLAGOGUES. THE ELIMINATION OF MEDICI- 

 NAL AND POISONOUS AGENTS BY THE BILE. 



SECT. 1. THE MODE OF PRODUCTION AND THE PHENOMENA OF 

 ICTERUS OR JAUNDICE. ICTEROGENIC POISONOUS AGENTS. 



JAUNDICE is a condition characterised by a more or less deep 

 yellow, or greenish-yellow, colour of the skin and conjunctivas and by 

 the presence of bile colouring matters in the urine. It invariably 

 depends upon causes which either completely obstruct the flow of 

 bile, or which modify the pressure under which the bile normally 

 flows along the biliary ducts. 



When, from any cause, the pressure increases in the bile ducts, 

 the bile colouring matter and the bile acids enter the lymphatics of 

 the liver and are conveyed in the lymph through the thoracic duct 

 into the blood (v. Fleischl 1 , Kunkel 2 ). If the thoracic duct, as well 

 as the common bile duct, be ligatured, no jaundice results and biliary 

 constituents cannot be detected in the urine (Kufferath 3 ). Vaughan 

 Harley 4 in a recent research, conducted under Ludwig's direction, has 

 confirmed in a remarkable manner the results of v. Fleischl, Kunkel 

 and Kufferath. Having ligatured the common bile duct and the 

 thoracic duct, he found that dogs often survive the operation, with- 

 out any appreciable inconvenience and without jaundice supervening ; 

 neither bilirubin nor bile acids passed into the urine, though in 



1 v. Fleischl, 'Von der Lymph und den Lymphgefassen der Leber.' Ludwig's 

 Arbeiten, 1874, p. 24. 



2 Kunkel, Ludwig's Arbeiten, 1875. 



3 Kufferath, ' Ueber die Abwesenheit der Gallensauren im Blute nach dem Verschluss 

 des Gallen- und des Milchbrustganges ' (Aus d. phys. Inst. zu Leipzig). Du Bois 

 Reymond's Archiv, 1880, pp. 9294. 



4 Dr Vaughan Harley, 'Leber und Galle wahrend dauernden Verschlusses von 

 Gallenund Brustgang' (Aus d. phys. Inst. zu Leipzig). Du Bois Reymond's Archiv, 

 25th May, 1893, p. 291 et seq. 



