676 DISEASES OF THE LIVER. 



to obstruction and reabsorption of bile ; on the other hand, numbers 

 of the livei^cells have been destroyed, and the formation of bile is thus 

 greatly limited Hence we may readily see why icterus is hardly ever 

 absent in cirrhosis, and, at the same time, why it rarely attains a high 

 grade. Generally, a slight degree of icterus, in advanced cirrhosis, is 

 an indication that one factor, the destruction of the liver-cells, prevails ; 

 a higher grade of icterus indicates that the other factor, compression 

 of the gall-ducts, is in excess, or that, from complication, there is some 

 new obstruction to the flow of bile. These complications, particularly 

 catarrh of the bile-ducts, or their obstruction by gall-stones, occur quite 

 frequently in cirrhosis. If the escape of the bile be entirely prevented, 

 even the slight amount formed by the remaining cells is sufficient to 

 cause intense icterus. The light-gray color of the faeces also depends 

 mostly on the compression of the gall-ducts; as this compression 

 hardly ever causes their absolute closure, perfectly pale, clay-colored 

 stools, such as occur in other forms of icterus, are not seen in cirrhosis. 

 The urine usually contains traces of bile pigment, but is far more re- 

 markable for its richness in urates, and in peculiar coloring matters, to 

 which we shall again refer. 



Besides the symptoms due to compression of the portal vein and 

 bile-ducts, there are others which depend on the extensive destruction 

 of the liver-cells. When speaking of the icteroid symptoms, we said 

 that the atrophy of the liver-cells diminished the production of bile ; 

 and, probably, the discoloration of the faeces depends as much on lim- 

 ited formation as on retention of the bile. Little as we know of all of 

 the functions of the liver, we are, nevertheless, certain that the forma- 

 tion of bile is not the sole function of the cells of the liver. (The 

 times when fel tauri inspissatum was given in pill, or the patient took 

 fresh ox-gall by the spoonful, " to replace the functions of the liver," 

 are not long past, it is true, but the belief from which such prescrip- 

 tions started is obsolete.) The liver is very important for the general 

 nutrition, and particularly for the blood, and it is certain that an ex- 

 tensive destruction of liver-cells affects the general health very severely. 

 The affection of the nutrition in patients with cirrhosis of the liver de- 

 pends partly on the existing gastric and intestinal catarrh ; perhaps, 

 also, the excessive fulness of the intestinal veins prevents the entrance 

 of substances from the intestines into these vessels ; but there must be 

 another cause for the disturbance of nutrition, for the patients become 

 weaker, more emaciated, and have a dryer skin and more cachectic ap- 

 pearance than those have who are suffering from simple gastric and 

 intestinal catarrh, and in whom the escape of blood from the intestinal 

 veins is obstructed in some other way. Physiology does not, at present, 

 teach us whether the affection of the nutrition depends on arrest of 



