ICTERUS WITHOUT RE ABSORPTION OF BILE. 715 



There is now no doubt that some of the formerly enigmatical forma 

 of icterus are due to the disintegration of blood-corpuscles, and the 

 transformation of the freed coloring matter circulating in the blood 

 Into bile-coloring matter. This is particularly true of those cases of 

 icterus occasionally caused by poisoning from chloroform or ether ; for, 

 as experiment proves, these substances possess the power of dissolving 

 blood-corpuscles. The slight icterus in excessive hydraemia also 

 doubtless depends on the fact that blood-corpuscles are destroyed by 

 a large amount of water in the blood. 



This mode of origin is very probable, although not absolutely 

 proved for other varieties of jaundice as in that occurring after snake- 

 bites, in that observed constantly in yellow fever, quite often in recur- 

 rent fever, septicaemia, and puerperal fever, and more rarely in other 

 infectious and acute febrile diseases. It is a very interesting fact that 

 in the latter diseases even the older physicians suspected a dissolutio 

 sanguinis when they ran a pernicious course, when the fever was very 

 high, when there was great prostration, and when severe nervous 

 symptoms, jaundice of the skin and conjunctiva, appeared. We will 

 not discuss the question as to whether the disintegration of the blood- 

 corpuscles in the above diseases is the result of the high temperature, 

 or whether in high fever products form from the excessive transforma- 

 tion of tissue which dissolves the blood-corpuscles, but I must repeat 

 my former assertion that every hepatogenous icterus leads to a haema- 

 togenous one through absorption of the biliary acids. These, being 

 prevented from escaping from the system by their natural channel, 

 remain in the blood and induce cholsemic intoxication. 



The jaundice in pylephlebitis also, and even some of the cases 

 where it occurs with abscess of the liver, belong to the haematoge- 

 nous form. A short time since I had the opportunity of observing 

 a patient with a large abscess of the liver, who suffered from symp- 

 toms of jaundice as long as an intense fever, with very typical inter- 

 mittent course and severe chills, lasted. When the fever ceased, 

 the bile-coloring matter and the albumen that had occured coinci- 

 dently in the urine disappeared, and the jaundiced hue of the skin 

 and conjunctiva were soon lost. The jaundice which, as previously 

 stated, occasionally occurs with ulcerative endo-carditis appears 

 also to be hsematogenous, but I doubt if icterus neonatorum ever 

 belongs here. 



ANATOMICAL APPEARANCES. Jaundice that is not due to reten- 

 tion and reabsorption of bile rarely reaches a high grade ; on autop- 

 sy we usually find only a faint yellow color of the outer coat of fat 

 and of the other tissues. A more important point in the post-mortem 



