716 DISEASES OF THE LIVER. 



diagnosis of haematogenous icterus, and for distinguishing it from the 

 hepatogenous, is the circumstance that in the former the liver is nol 

 strongly jaundiced, while in the. latter the signs in the liver of reab- 

 sorption of bile are always the most prominent. The normal color of 

 the contents of the intestines, particularly the greenish hue of the con- 

 tents of the duodenum, as well as the positive observation that the 

 bile-ducts and excretory passages are quite pervious, leaves no doubt 

 that it is a case of haematogenous icterus. But, in judging of the per* 

 viousness of the bile-ducts, we must guard against mistakes. The fact, 

 that by pressing on the gall-bladder we may press a few drops of bile 

 from the ductus choledochus into the duodenum, does not at all prove 

 that during life this passage was perfectly free ; on the contrary, this 

 may be done where, from the presence of a gray plug of mucus and 

 epithelium, in the intestinal portion of the ductus choledochus, we may 

 be quite certain that there was catarrh of the duct, and a hepatogenous 

 icterus. Buhl and Liebermeister have the credit of first calling 

 attention to the changes found in the liver and other organs in haema- 

 togenous icterus. According to Liebermeister, the changes in the 

 liver-cells and in the epithelium of the uriniferous tubules consist 

 " in an excessive collection of small and fine fat globules, or else only 

 of cloudy, probably albuminous substance in them ; " in other cases, 

 " the cells have fallen into detritus and numerous fat globules have 

 appeared ; analogous changes also occur in the substance of the heart." 

 These parencliymatous degenerations (Liebermeister) of the liver, 

 kidneys, and heart, show that, under the influence of the same injurious 

 causes that induce a disintegration of the blood-corpuscles (that is, a 

 parenchymatous degeneration of the blood), the firm tissues of the 

 body may be affected in the same way. 



SYMPTOMS AND COURSE. As we have already shown, haemato^ 

 genous icterus is only one symptom of extended disturbances. Hence 

 we cannot well give an exact description of its symptoms and course, 

 and we must confine ourselves to calling attention to those points 

 which, occurring in icterus, show that it is not due to reabsorption of 

 retained bile, but to a transformation of the coloring matter of the 

 blood into that of the bile in the circulation. 



Attention to the etiology aids us greatly. If icterus occurs after 

 the action of the injurious influences mentioned in the first part of this 

 chapter, or in the course cf some of the diseases there mentioned, the 

 presumption is that the case is one of haematogenous icterus. This 

 supposition is strongly supported if the faeces appear of a normal or 

 7ery dark color. If, with the commencement of the symptoms of jaun- 

 dice, the beat of the heart and pulse become irregular and intermittent ; 

 rf, along with the coloring matter of the bile, albumen appear in the 



