488 PATHOLOGICAL PIGMENTATION 



mentary jaundice of congenital hemolytic icterus. There is also an 

 increase in the cholesterol in the blood, which may be related to the 

 "xanthomas" that form in chronic icterus."^ 



A remarkable tendency to spontaneous hemorrhages, frequently ob- 

 served in icterus, probably depends upon injury to the capillary 

 endothelium by the bile salts,"^ while the protracted, often uncontrol- 

 lable, hemorrhage that may occur from operation wounds in icteric pa- 

 tients, is related to the slowed coagulation of the blood observed in 

 icterus. The cytotoxic effect of the bile salts is also shown by the 

 albuminuria of icteric persons, which frequently results from the 

 renal lesions the bile produces. Although bile itself is toxic to many 

 bacteria, especially the pneumococcus,^^ yet in icterus the bactericidal 

 power of the blood is lowered, and infections are prone to develop and 

 to be severe; moreover, the growth of several species of bacteria is 

 favored by bile."*^ 



Croftan ^^ summarizes the physiological effects of bile acids as fol- 

 lows: (1) A powerful cytolytic action, affecting both blood-cor- 

 puscles and tissue-cells. (2) A distinct cholagogue action. (3) In 

 small doses (1-500) they aid coagulation. (4) In large doses (1-250 

 and over) they retard coagulation. (5) Slow the heart action.*'^'^ 

 (6) In small doses they act as vasodilators; in large doses, as vasocon- 

 strictors. (7) Reduce motor and sensory irrita-bility. (8) Act on 

 the higher cerebral centers, causing coma, stupor, and death. Sel- 

 lards °* found that injection of bile salts into guinea pigs causes ulcer- 

 ation and hemorrhage in the stomach. 



It is difficult to decide how much of the profound intoxication that 

 is sometimes present in icterus (''cholemia" and "icterus gravis") 

 to ascribe to the reabsorbed bile, for frequently there is an accompany- 

 ing infection, and even if there is no infection the impairment of liver 

 function by the obstruction of bile outflow must also be reckoned 

 with. The liver is not only the great destroyer of toxic substances 

 absorbed from the alimentary canal, but it is also an important seat 

 of nitrogenous metabolism, interference with which may lead to ac- 

 cumulation of many toxic nitrogenous substances in the blood. ^ The 

 long duration of severe icterus in some cases of occlusion of the bile- 

 ducts, with relatively slight evidences of intoxication, would seem to 

 indicate, however, that on the whole the bile is not so nuich respon- 

 ds ChaufTard, Prosso Mr>d., 1913 (21), SI; Chvostok. Zcit. klin. Med., 1!)11 (73), 

 470; Pinkiis and Pick, Dout. med. Woch., 1008 (34), 1427. 



n-tSpo Morawitz, Areh. cxp. Path.. 1907 (56), 115. 



"•'> Roe Noiifpld and TTaendpl, Inr. cit. 



n« See Mcyorstoin, fVnt. f. Pnkt.. 1907 ^44), 434. 



f'7New York Mod. .Tour., inn; (;.3). SIO; see also Faust, "Die tiorisohe Cifto," 

 Braunschwoifr, 1906, p. 29. 



oTaSoo Porti, Oaz. depli Ospod.. 1910 (37), 1233. 



!>«Aroli. Tnt. Mod., 1909 (4), .'>02. 



1 See Bickel, Exper. Untersuch. liber der Pathol, der Cholaemie, Wiesbaden, 

 1900. 



