ICTERUS 485 



possibly also when they are broken up within the vessels by hemolytic 

 agents, yet it has generally been considered that a true general icterus 

 does not occur without the liver being implicated. This view rested 

 on evidence of various sorts. First, the classical experiments of 

 ^Minkowski and Nannyn,"^' which demonstrated that in geese the pro- 

 duction of hemolj-sis by means of arseniuretted hydrogen leads to 

 icterus, but if the livers of the geese have been previously removed, 

 no icterus follows the poisoning. Second, the repeated demonstration 

 that in icterus produced by septic conditions, poisoning, etc., which 

 was formerly looked upon as a ''hematogenous" icterus, the urine 

 contains bile salts as Avell as pigment, indicating an absorption of bile 

 from the liver. Third, the finding of histological evidence that in 

 so-called hematogenous icterus there occur occlusions or lesions of 

 some sort in the bile capillaries, which can account for the reabsorp- 

 tion of the bile into the general circulation.®^ Therefore, it was be- 

 lieved that the pigments that produce the general discoloration of 

 icterus are, at least for the most part, manufactured by the liver, 

 whatever the cause of the reabsorption of the bile from the liver into 

 the blood may be. That hemolytic agents cause icterus was explained 

 by the fact that on account of the large amounts of free hemoglobin 

 brought to the liver, excessive amounts of bile-pigments are formed, 

 which render the bile so viscid that it blocks up the fine bile capil- 

 laries; on account of the low pressure at which bile is secreted, a 

 slight obstruction of this kind is sufficient to stop entirely the outflow 

 of bile, which then enters the capillaries of the liver and also, to a less 

 extent, the lymphatics.^^ It is also possible that the hemolytic poisons 

 injure the liver-cells so much that the minute intra- and intercellular 

 bile capillaries become disorganized, and permit of escape of bile into 

 the lymph-spaces and its absorption into the blood-vessels.®^ Swelling 

 of the degenerated liver-cells may also be an important factor in the 

 occlusion of the bile capillaries; swelling of the lining cells of the bile 

 capillaries may also coexist, and fibrin may occlude them in toxic or 

 infectious icterus. 



However, Whipple and Hooper,®* have obtained experimental evi- 

 dence that after intravenous injection of hemoglobin into dogs with 

 the liver excluded from the circulation, bile pigments appear in the 

 urine and icterus is manifested in the fat tissues, from which observa- 

 tions it is concluded that the liver may not be the only place in which 



80 Arch. f. exp. Pathol, u. Pharm., 1886 (21), 1. 



81 See Eppin^er, Ziegler's Beitr.. 1903 (33), 123; Gerhardt, Miindi. med. Wooh., 

 1905 (52), 889. Lang (Zeit. exp. Path. u. Ther., July, 1906 (3), 473) has 

 demonstrated the presence of fibrinogen in the bile in phosphorus-poisoning, which 

 perhaps accounts for the "l)ile thrombi" observed by Eppinger in toxic icterus. 



82 See :Mendel and Underbill, Amer. Jour. Phvsiol., 1905 (14), 252; Whipple 

 and King, Jour. Exp. ]\red., 1911 (13), 115. 



s'? Sterling, Arch. exp. Path., 1911 (64), 468; Fiessinger, Jour. Phvsiol, et 

 Pathol., 1910 (12), 958. 



84 Jour. Exper. Med., 1913 (17), 593 and 612. 



