CHAP. VI.] FRERICHS' DOCTRINE OF POLYCHOLIA. 



361 



pressing upon, it. Without denying, or even doubting, that the specific 

 biliary constituents normally exist preformed in the blood, and that 

 the function of the liver is to 'excrete them, they recognised two 

 great varieties of jaundice, viz. a jaundice due to obstruction and a 

 jaundice due to non-elimination. This view has found supporters up 

 to the present day, and it is only within a comparatively recent 

 period 1 that facts have accumulated which prove that jaundice 

 is always due to an obstruction to the normal efflux of already 

 secreted bile an obstruction which may affect the flow of bile along 

 the minutest hepatic ducts. 



The experiments of Kunde and of Moleschott, had shewn that 

 after the extirpation of the liver of frogs, the blood and tissues of 

 these animals are free from all traces of the specific biliary con- 

 stituents. In spite of these facts, which have received remarkable 

 confirmation and extension, the assumption was made by some 

 (Budd, Harley) that the liver only forms the bile acids, whilst it 

 excretes from the blood ready formed bile colouring matters. Re- 

 lying on the altogether erroneous assertion that the bile acids are 

 absent from the urine in cases of jaundice in which no obvious 

 obstruction exists, a supposed distinction (based on the non-elimina- 

 tion of bile acids) was attempted to be established between these 

 cases and cases of jaundice in which the existence of an obstruction 

 was obvious. 



Frerichs' Whilst admitting the already proved fact that the 



doctrine of bile acids and bile colouring matters are formed in the 

 poiychoiia'. ii ver) Frerichs 2 advanced the theory that, in spite of 

 absence of all obstruction to the outflow of bile, jaundice may arise 

 from the reabsorption of bile already excreted into the intestine. 

 Normally, according to Frerichs, the constituents of the bile are in 

 great part reabsorbed from the intestine, and then undergo in the 

 economy oxidations, by which they are destroyed. If, however, the 

 quantity of bile secreted is greater than can be disposed of in this 

 way, the biliary constituents will accumulate in the blood, stain the 

 tissues, and be excreted in the urine, in short all the phenomena 

 of jaundice will be induced by a condition which may be termed 

 'poiychoiia.' The views of Frerichs were supported by many 

 altogether erroneous facts as, for instance, that by the action of 

 sulphuric acid on the bile acids, bile pigments can be produced, and 

 that when the bile acids are injected into the blood they are con- 



1 The development of our knowledge on this subject will be appreciated by the 

 reader who refers to the article Jaundice by the late Dr Murchison in Quain's 

 Dictionary of Medicine, London, 1882. The theoretical explanations of cases of 'jaun- 

 dice independent of mechanical obstruction of the bile-duct' given by this distinguished 

 physician are already as obsolete as are those advanced by Morgagni, Boerhaave and 

 van Swieten. 



2 Fr. Th. Frerichs, Klinik der Leberkrankheiten. In zwei Banden, Braunschweig, 

 1858. Refer to Vol. i. p. 94 et seq, * Der verminderte Verbrauch, der geringere Umsatz 

 der Galle im Blute.' 



