JAUNDICE. 



ever, the faeces acquire a weak, bilious color, without the bile-ducts 

 naving become pervious. This depends on then* admixture with jaun- 

 diced blood-serum, or jaundiced inflammatory products. (Even in high 

 grades of icterus the intestinal mucus contains no bile-coloring mat- 

 ter, otherwise the fasces would never lose their color.) Small haemor- 

 rhages into the intestines, such as quite frequently occur during con- 

 tinued obstruction of the excretory bile-ducts, most commonly lead to 

 error ; they do so the more readily, as a very slight admixture of blood 

 with the faeces does not induce any characteristic color, particularly when 

 the blood-serum is jaundiced. 



If the biliary obstruction continue for some time, or if it depend on 

 causes that cannot be removed, the jaundice attains the highest grade, 

 and the nutrition may suffer so much that the patient will finally die 

 of marasmus or dropsy. 



In rare cases the final result is hastened by the occurrence of gastric 

 01 intestinal haemorrhage. These result from the same causes as in 

 cirrhosis and pylephlebitis. The escape of blood from the vessels of the 

 gastric and intestinal mucous membrane is just as much obstructed in 

 the former case by the compression of the capillaries of the liver from 

 the distended gall-ducts, as it is in the latter by the compression of the 

 hepatic vessels from the contracting connective tissue, or by the ob- 

 struction of the portal vein. But in explaining these haemorrhages, 

 besides the mechanical obstruction to the flow of blood, we must also 

 take into consideration the disturbed nutrition of the gastric and in- 

 testinal capillaries, especially as, in the course of icterus, haemorrhages 

 also occur in other parts, particularly in the skin, as petechiae. We 

 have repeatedly said that the inclination to bleeding, the so-called 

 haemorrhagic diathesis, can only be explained by disturbed nutrition 

 of the walls of the vessels, and that the latter very frequently occurs in 

 advanced anaemia and cachexia. 



The occurrence of severe disturbances in the nervous system during 

 an attack of jaundice is far more dangerous. These rarely begin with 

 delirium or convulsions ; they are rather apt to commence with para- 

 lytic symptoms. The patients are insuperably sleepy, finally become 

 soporose, and die in tiiis state. Henoch calls attention to the fact that 

 Hippocrates had recognized the bad prognostic indication of this sign, 

 for he says, Ex morbo regio fatuitas aut stupiditas mala est. The 

 most varied hypotheses have been started about the occurrence of these 

 brain and nervous symptoms. Recently the inclination has been 

 mostly toward the view that these symptoms depend on poisoning bj 

 the bile-acids, for, on injecting these into the blood of animals, we ob 

 serve symptoms of poisoning indicative of paralysis of the nervous 

 system. To this it is objected that the bile-acids exist in the blood in 



