JAUNDICE. 



707 



color of the skin, conjunctiva, and urine (of which we shall speak more 

 particularly when describing the objective symptoms of the disease), 

 as soon as the body is opened we notice the lemon-color of the fat in 

 the subcutaneous tissue, mesentery, pericardium, and elsewhere. The 

 fibrinous coagula in the heart and blood-vessels, the fluid in the peri- 

 cardium, and any pathological transudations or exudations of the peri- 

 cardium, pleura, and peritonseum, have a distinctly jaundiced appear- 

 ance. The less red the normal color of the different tissues is, the 

 more marked is the pathological yellow color; hence it is more evident 

 in the serous and fibrous membranes, the walls of the vessels, the 

 bones, cartilages, etc., than in the muscles, spleen, etc. Only the brain, 

 spinal marrow, and nerves form an exception, as only a slight color 

 can be seen in them. Frerichs supports the previous observations, 

 according to which the secretions proper, the saliva, tears, and mucus, 

 contained no bile-pigment, while the albuminous and fibrinous exuda- 

 tions are rich in it. The changes in the kidneys, which were first fully 

 described by the above observer, are very interesting. In old and in- 

 tense cases of icterus he found the kidneys of an oh' ve-green color, and 

 some of the uriniferous tubules filled with a brown or black deposit. 

 On more careful examination, in the pale uriniferous tubules, he saw 

 the epithelial cells, which were really perfect, colored brown by pig- 

 ment : the dark uriniferous tubules were filled with a coal-black, hard, 

 brittle mass. The pigmentation of the epithelium began in the Mai- 

 pighian capsule, increased in the convoluted tubuli uriniferi, while 

 the black, coal-like masses were chiefly found in the straight tubules. 



SYMPTOMS AND COTJESE. Premonitory symptoms almost always 

 precede the characteristic signs of biliary obstruction. These consist 

 of the symptoms of the disease that lead to contraction and closure 

 of the bile-ducts ; and, as this is most usually catarrh of the duode- 

 num, they are most frequently those of gastro-duodenal catarrh. If 

 these have existed for a longer or shorter time, the passage of the 

 catarrh to the ductus choledochus, or the closure of the bile-ducts in 

 any way, is almost always first shown by the peculiar dark color of the 

 urine, and the light color of the faeces. But generally it is not these 

 symptoms, but it is yellowness of the skin and eyes, that induces the 

 patient to seek medical aid. Sometimes the skin is only slightly yel- 

 low, sometimes it is an intense saffron color ; later, and in the highei 

 grades, called melan-icterus, it may be greenish or even mahogany 

 color. At those parts of the body where the epidermis is thin, so that 

 the deeper layers of the rete Malpighii, where the pigment is located, 

 shine through, the color is most intense, as on the forehead, alse nasi, 

 elbows, breast, etc. The yellow hue of the sclerotic, which may also 

 be quite dark, is very characteristic of icterus, and is important in tho 



