JAUNDICE. 



127 



forms a sheath for the portal vessels, the hepatic artery, and biliary 

 ducts. The thickening of this cellular sheath may compress the 

 biliary ducts, and so cause jaundice, or the portal veins, and so cause 

 ascites. Finally, the thickened cellular sheath shrinks and becomes 

 atrophied, and by its shrinking compresses the hepatic artery, and 

 so causes general atrophy of the organ ; whilst by its shrinking it 

 leaves the lobules projecting as little rounded eminences like the 

 heads of nails. 



The appearance called nutmeg liver, is a mere consequence of 

 congestion. If after death the hepatic vessels, which run in the 

 centre of each lobule, are injected, the liver presents on its surface 

 numerous red spots, with pale interstices. If, on the contrary, the 

 portal system only is injected, it will display pale spots correspond- 

 ing to the lobules, with red interstices. 



Abscess ill the liver may burst either externally, in which case 

 the liver first adheres to the parietes of the abdomen, so as to pre- 

 vent the escape of the pus into the peritoneal cavity; or in less for- 

 tunate cases, it may burst into the pleura, or peritoneum, or lung, 

 or intestines, generally with a fatal result. 



Treatment, — The general rules in treating chronic hepatic 

 disease are, to diminish congestion of the portal vessels ; to keep up 

 the secretion of the urine, to allay irritation, and support the 

 strength. Small doses of mercury with squill; saline aperients, 

 and diuretics; taraxacum; sulphate of manganese; muriate of 

 ammonia; iodine; colomba, and 'other light tonics; nitro-muri- 

 atic acid, given internally, and used as a bath for the legs; occa- 

 sional leeching, blistering, or frictions with mercurial ointment, or 

 with iodine; Cheltenham waters; and a light nourishing diet, are 

 the main remedies. 



JAUNDICE. 



The term jaundice is applied to a yellowish tinge of the skin 

 and eyes, depending on the presence of bile in the circulating fluids. 



Causes. — These are, diseases of the liver; obstruction to the free 

 passage of bile into the duodenum ; congestion of the portal system, 

 or excessive secretion of bile; gastro-duodenitis, &c. 



Si/mptoms, — The symptoms of jaundice will evidently depend 

 on the nature of the cause which has given rise to the unnatural 

 colour of the skin. The yellow tinge is the most prominent 

 sign; it usually commences in the face, and thence may extend 

 over the whole body, being most clearly distinguished underneath 

 the conjunctivse. The digestive functions are deranged; the 

 bowels usually costive, and the fa3ces -untinged by bile; the urine 

 is high coloured, and more or less of a saffron tint; the tongue is 

 foul and covered with a yellow fur; the patient complains of 

 headache, and very often of pain in the region of the liver. The 



