JAUNDICE. fo^ 



ducing the size of the tumor, or of improving the jaundice and incon- 

 veniences dependent on it, or of permanently maintaining the strength 

 and nutrition of the patient. Nor does the attempt at tapping, made 

 in Griesinger's case, encourage imitation. 



CHAPTER XII. 



BILIARY OBSTRUCTION IN THE LIVER, AND CONSEQUENT ICTERUS 



HEPATOGENOUS ICTERUS [JAUNDICE]. 



ETIOLOGY. The gall-ducts have no contractile elements to urge 

 their contents onward. Hence we are led to the conclusion that the 

 bile in the biliary passages is pressed forward by the same force that 

 caused it to enter the ducts, the secretory pressure. The compression 

 to which the liver is subjected, from the descent of the diaphragm 

 during inspiration, assists the evacuation of the bile-ducts, it is true, 

 but we should not over-value this force, for the gall-bladder, on which 

 the pressure must be greater than on the firm liver, may be greatly 

 distended with bile, while the movements of respiration go on unin- 

 terruptedly. At all events, the forces that pass the bile along its ducts 

 are so weak that they cannot readily overcome even the slightest ob- 

 stacle, and a very inconsiderable obstruction to the evacuation of the' 

 bile suffices to cause it to collect in the liver that is, to induce reten- 

 tion of bile. 



If the bile-ducts and the liver-cells become very full, and the lateral 

 pressure in them attains a certain height, a large part of their contents 

 enters (filters into) the blood-vessels and lymphatics. This is the most 

 frequent cause of jaundice. Recent investigations have placed it be- 

 yond a doubt that, in the icterus due to obstruction and reabsorption 

 of bile (also called resorption jaundice or hepatogenous jaundice, in 

 contradistinction to hcematogenous, which will be described hereafter), 

 not only the coloring matter of the bile, but its other constituents, 

 particularly the acids, are taken into the blood. As has been proved 

 by numerous experiments, these acids possess to a peculiar degree 

 the property of dissolving the red-blood corpuscles. By injecting 

 weak solutions of them into the blood of animals, we may artificially, 

 induce the so-called haematogenous icterus, as the liberated coloring 

 matter of the blood is transformed into biliary coloring matter. As it 

 is firmly established, both that in biliary obstruction the bile-acids 

 enter the blood, and that the absorption of these acids into the blood 

 sets free the coloring matter of the latter and transforms it into biliary 

 coloring matter, we may correctly say that every hepatogenous icterus 

 is accompanied by a haematogenous, or, more accurately, every hepa- 

 togenous induces a haematogenous icterus. 

 46 



