SECTION II 

 DISEASES OF THE GALIr-DUCTS. 



CHAPTER I. 



CATARRH OF THE GALL-DUCTS ICTERUS CATARRHALIS. 



ETIOLOGY. The larger bile-ducts of the liver, the ductus hepati- 

 tis, cysticus, choledochus, and the gall-bladder, are lined with a mucous 

 membrane, having cylindrical epithelium and racemose glands. This, 

 like other mucous membranes of similar texture, is quite often the seat 

 of catarrhal inflammation. The small calibre of the gall-ducts and excre- 

 tory passages gives peculiar importance to this otherwise mild disease. 

 The narrow canals are easily obstructed by the swelling of their mucous 

 membrane, and by collections of mucus, and these are the most frequent 

 causes of obstruction and reabsorption of bile. 



In some cases catarrh of the bile-ducts results from excessive hyper- 

 demia of the liver, in which the mucous membrane of the bile-ducts par- 

 ticipates. Thus hyperaemia of the parenchyma of the liver and of the 

 gall-ducts accompanies the development of cancer of the liver. If this 

 reach a high grade, it may lead to catarrh of the bile-ducts, and thus 

 to icterus. Too little attention has hitherto been paid to this mode 

 of origin of icterus in carcinoma of the liver. Cases of carcinoma of 

 the liver occur in which there is not the slightest doubt that the icterus 

 depends on this catarrh of the bile-ducts. If the jaundice be only tem- 

 porary, and the faeces are more or less discolored as long as the jaun- 

 dice lasts, and are again normally colored when it disappears, we can- 

 not refer the jaundice to compression of the bile-ducts or excretory 

 passages by a cancerous tumor, but must refer it to a cause that comes 

 and goes, or at least increases and diminishes. "We have such a cause 

 in the hyperaemia which is present in all organs in the vicinity of new 

 formations, particularly of carcinoma, and which occasionally becomes 

 excessive, and at other times diminishes. The same is true of the 

 temporary icterus in multilocular echinococci, and in many of the cases 



