DISEASES OF THE LIVER 



CHAPTER XIII. 



ICTEKUS WITHOUT HEABSORPTION OF BILE HEMATOGENOUS ICTERUS. 



ETIOLOGY. Physicians have long observed that there are cases of 

 jaundice that cannot be referred to retention and reabsorption of bile. 



The supposition, that in severe and extensive degenerations of the 

 liver the constituents of the bile collect in the blood, because they are 

 not excreted by the affected organ, is completely refuted by the reli- 

 able observation that the bile and its constituents are not formed in 

 the blood and simply excreted by the liver, but that the bile is first 

 formed by the liver. 



The attempt also to refer some cases of jaundice to spasm of the 

 excretory bile-duct, because no obstruction to the excretion of the bile 

 could be found on autopsy, may be regarded as a failure. As the ex- 

 cretory bile-ducts contain muscular elements, it is of course possible 

 that they may be temporarily closed by spasmodic contraction, but it 

 is excessively improbable that such a spasm would continue so long, 

 as physiological experiments prove is necessary, as to induce the grade 

 of biliary obstruction requisite for the passage of bile from the bile- 

 ducts into the blood-vessels and lymphatics, and the production of 

 icterus. The occurrence of icterus spasticus is more than doubtful. 



Lastly, it is also very improbable that, under certain circumstances, 

 more bile is prepared than the bile-ducts can accommodate, and that 

 icterus is induced because part of the excess of bile enters the blood- 

 vessels and lymphatics. 



Frerichs has advanced a new hypothesis for the explanation of this 

 form of jaundice : he considers it probable that a filtration of bile from 

 the bile-ducts into the blood-vessels results not only from an overfill- 

 ing of the bile-ducts, but from too little fulness of the blood-vessels. 

 The icterus not unfrequently seen with thrombus of the portal vein is 

 explained thus : blood is supplied to the liver only by the hepatic 

 artery, and thus the hepatic vein and capillaries are not so well filled ; 

 some cases of icterus neonatorum are explained by the sudden cessa 

 tion of the supply of blood to the liver through the umbilical vein, and 

 the icterus in yellow fever because the roots of the portal vein aro 

 emptied by the large intestinal haemorrhages. 



The views regarding the occurrence of jaundice without retentior 

 and reabsorption of bile have totally changed since the observations ot 

 Virchow, Kuhne, and Hoppe-Seyler have shown that bile-coloring 

 matter may be formed from the free coloring matter of the blood with 

 out the action of the liver; and we may induce artificial jaundice iu 

 animals, by injecting substances that dissolve the blood-corpuscles. 



