728 DISEASES OF THE GALL-DUCTS. 



that symptoms of gastric and intestinal catarrh precede the jaundice 

 for days, or even weeks, and continue while the disease lasts. In this 

 sense, we may consider the coated tongue, bad taste, eructations, and 

 other dyspeptic symptoms, as among the premonitions and symptoms 

 of catarrhal jaundice. The longer the catarrh of the bile-ducts con- 

 tinues, and the more completely the excretory duct is closed by it, the 

 greater will be the discoloration of the fasces, and the more intense thor 

 jaundiced color of the skin and urine, and the more the general health 

 and nutrition of the patient will suffer. The liver appears distinctly 

 swollen in many cases, and in some of them it is considerably en- 

 larged. 



If the disease run a favorable course, the improvement shows itself 

 in a week or two, by a return of appetite, by the tongue cleaning off, 

 and by decrease of the dyspeptic symptoms. Then we may hope that 

 the catarrh of the bile-ducts will subside with the gastro-duodenal 

 catarrh, and in fact, after a few days, the returning color of the faeces 

 shows that the ductus choledochus is open, and the clearer color of the 

 urine indicates that the biliary obstruction is less, and that less bile is 

 reabsorbed. The bile-pigment deposited in the rete Malpighii disap- 

 pears more slowly. After the fasces are strongly colored with bile, 

 and the urine has regained its normal tint, the skin remains jaundiced 

 for a time, and finally this last symptom of the disease disappears. In 

 other cases the catarrh of the bile-ducts, as well as that of the stomach 

 and duodenum, becomes chronic. The disease drags on for weeks or 

 months, the jaundice becomes excessive, the patients emaciate de- 

 cidedly, and the liver enlarges considerably. But these cases also 

 almost always terminate in recovery, particularly under proper and 

 energetic treatment ; and the biliary obstruction caused by catarrh of 

 the ducts very rarely runs an unfavorable course with the symptoms 

 before described. 



TREATMENT. Experience teaches that catarrh of the bile-ducts 

 rapidly disappears when the catarrh of the intestinal mucous mem- 

 brane, which has attacked the gall-ducts, subsides. Hence the causal 

 indications require the same measures that we have recommended in 

 the treatment of gastric and intestinal catarrh. Under the circum- 

 stances there mentioned, an emetic may be indicated ; in other cases 

 diaphoretics, in still others, careful regulation of the diet suffices. We 

 shall not repeat in detail what we have previously said, but only call 

 attention again to the excellent effect in gastric and intestinal catarrh 

 of the carbonates of the alkalies, particularly as existing in the Karls- 

 bad and Marienbad waters. While we have denied all direct influence 

 of the Karlsbad waters on biliary obstruction and jaundice, still there 

 is no better treatment for most patients than the use of these waters. 



