JAUNDICE. 



flow of bile into the intestines, is their more or less complete discolora- 

 tion. Where the excretory duct of the bile is incompletely 'closed, or 

 the biliary obstruction partial, they have a loamy color, while they are 

 clay-colored where the ductus hepaticus or choledochus is completely 

 obstructed. As the amount of bile poured into the intestines during 

 twenty-four hours is estimated at about two pounds, we may readily 

 understand why the faeces are almost always dry. But, moreover, 

 physiology teaches that, by excluding bile from the intestines, the ab- 

 sorption of fat is restricted, if not arrested ; this explains the long- 

 known fact that the faeces of jaundiced patients contain far more fat 

 than do those of healthy persons. Professor Trommer, who examined 

 the faeces of two of my students, who ate exactly the same amount of 

 bread, butter, and cold meat, but of whom one was jaundiced, the 

 other perfectly healthy, found far more fat in the faeces of the former 

 than in those of the latter. Lastly, the putrid decomposition of the 

 contents of the intestines appears to be avoided by the action of the 

 bile on them ; hence patients, in whom no bile is emptied into the 

 bowels, usually suffer from flatulence, and the flatus passed, as well 

 as the faeces, have a very disagreeable odor. 



Besides the abnormal color of the skin, sclerotica, urine, sweat, milk, 

 and besides the discoloration of the faeces, and the difficulties connected 

 with the absence of bile from the intestines, we find that almost all 

 patients with jaundice due to biliary obstruction rapidly emaciate, 

 and become very languid and sleepy. As both the amylacea and 

 protein substances are digested while there is no bile in the intestines, 

 if there be no coincident gastric and intestinal catarrh, the emaciation 

 can only be ascribed to the change in the absorption of fat. As has 

 been previously stated, Bischoff has experimentally shown that a 

 plentiful supply of fat may cause less consumption of the tissues of 

 the body. It is very probable that the withdrawal of fat may have 

 the opposite effect, and induce an increased use of the fat collected in 

 the body. Even the exceptions, where jaundiced patients remain well 

 nourished, although no bile reaches their intestines, do not disprove 

 this explanation. For it has been observed that, while most dogs with 

 artificial biliary fistula emaciate greatly, some remain well nourished, 

 and it is particularly those that eat a great deal. In the same way, 

 it has been observed that it is just those persons that have an excellent 

 appetite and good digestion during their jaundice, who do not emaciate. 

 Hence we may assume that failure of the supply of fat can be re- 

 placed by increased supply of hydrocarbons, and protein substances. 

 The discovery, that in icterus the bile-acids are reabsorbed, and that 

 their presence in the blood induces the disintegration of the red-blood 

 corpuscles, shows another cause for the poverty of the blood, the emaci 



