CATARRH OF TUE GALL-DUCTSICTERUS CATARRHAL1S. 727 



accompanying heart-disease, emphysema of the lungs, and other dis- 

 eases which impede the escape of blood from the liver. We shall 

 epeak in a separate chapter of the intense catarrh caused by gall- 

 stones, as they readily induce ulceration, and then lead to severe and 

 peculiar symptoms. Lastly, perhaps the irritation from abnormal bile 

 may induce catarrh of the bile-ducts ; but this has never been proved, 

 and is very problematical. 



By far the most frequent cause of catarrh of the bile-passages i8 

 the propagation of the catarrhal inflammation about the opening of 

 the ductus choledochus into the duodenum. This duodenal catarrh is 

 almost always accompanied by gastric catarrh, and hence the jaundice 

 caused by it is usually called gastro-duodenal jaundice, or icterus sim- 

 plex, on account of its frequency, freedom from danger, and its mild 

 course. The gastric and duodenal catarrh which extends to the gall- 

 ducts may arise from the most various causes, and for the etiology of 

 gastro-duodenal jaundice we refer to what has been said of the etiology 

 of gastric and intestinal catarrh. 



ANATOMICAL APPEARANCES. In acute catarrhal inflammation the 

 mucous membrane of the gall-ducts is reddened, relaxed, and swollen. 

 Its surface is covered with mucous and epithelial masses. If the swell- 

 ing of the mucous membrane be considerable, the ductus choledochus 

 becomes impassable, particularly that part which traverses the wall of 

 the duodenum transversely, running for some lines between the layers 

 of the wall (the " portio intestinalis "), while the bile-ducts in the liver 

 are dilated, and filled with bile containing more or less mucus. The 

 parenchyma of the liver also shows the previously-described characters 

 of moderate biliary obstruction. After the catarrh has lasted some 

 time, the redness of the mucous membrane subsides, but its swelling 

 and hypertrophy, together with a plug of mucus and epithelium, form 

 an insuperable obstacle to the flow of bile. In such cases the bile- 

 ducts are often enormously dilated, and the enlarged liver shows the 

 signs of great biliary obstruction. The dilatation and distention with 

 bile often commence in the ductus choledochus immediately above the 

 obstructed portio intestinalis. (For the state o the gall-bladder in 

 contraction or closure of the excretory bile-ducts, see Chapter HI.) 



SYMPTOMS AND COURSE. In most cases catarrh of the bile-ducts is 

 readily recognized by the symptoms of obstruction and reabsorption 

 of bile. When these appear gradually, and increase slowly, our sus- 

 picions should first be directed toward catarrh of the bile-ducts, be- 

 cause catarrhal jaundice is so frequent, as compared with other forms 

 of the disease. But this is scarcely ever a primary affection ; it almost 

 always accompanies catarrh of the gastric and intestinal mucous mem- 

 brane ; hence it is almost characteristic of catarrh of the bile-ducts, 



