RESORPTION OF BILE. 323 



If, as a result of compression of the placenta in the uterus, too much blood 

 has been carried to the new-born infant, a portion of this excess of blood in the 

 body may be dissolved during the first days of life, the hemoglobin being trans- 

 formed into bilirubin, with symptoms of icterus. Under such circumstances 

 also there is excessive destruction of erythrocytes, as, indeed, of all of the tissues, 

 because in the new-born infant, with insufficient nourishment the metabolic 

 processes must be more active for the maintenance of respiration, heat-production 

 and digestive activity. 



The jaundice that is exemplified by the foregoing symptoms is also designated 

 hepatogenic, or resorption-icterus, because it is due to the absorption of bile 

 already prepared in the liver. 



Cholemia is accompanied by a series of characteristic symptoms: 



1. Biliary coloring-matter' and the biliary acids enter into the tissues of 

 the body, giving rise to the most striking objective symptom (and therefore 

 designated also jaundice). The external integument, particularly the sclera, ac- 

 quires an exquisitely yellow color. In pregnant women the fetus also is discolored. 

 Hematoidin-crystals have been found in the kidneys, the blood and the fatty tis- 

 sue of icteric children. In exceptionally rare cases, as in the presence of hemi- 

 plegia, only one-half of the body has been found jaundiced. 



2. The biliary acids and the biliary coloring-matters appear in the urine, 

 though not in the saliva, the tears or in mucus. When the coloring-matter is 

 present in large amount the urine acquires a deep yellowish-brown color, while 

 its foam is intensely lemon-yellow. Immersed strips of paper or linen are stained 

 the same color. Occasionally crystals of bilirubin are present. 



3. The feces become clay-colored, because of the absence of hydrobilirubin 

 derived from the bile-pigment; extremely hard, because the diluting bile does 

 not reach the intestine; rich in fat, because the fats, particularly the more 

 solid, are not sufficiently digested in the intestine in the absence of bile (so that 

 even as much as 78 per cent, of the fat ingested passes out in the feces; principally 

 fatty acids and soaps appear in the feces, and but little neutral fats) ; and highly 

 offensive, because, under normal conditions, the bile poured out into the intestine 

 inhibits putrid decomposition of the intestinal contents. The evacuation of 

 the feces takes place sluggishly, partly on account of their hardness, partly because 

 of the absence of bile, which excites peristaltic movements in the intestines. 



4. The heart-beats are reduced to about 40 in the minute. This is due to 

 the salts of the biliary acids, which at first stimulate the heart and then enfeeble 

 it. Injection of the salts of the biliary acids into the heart causes, therefore, 

 at first, transitory increase in the heart-beats, followed by slowing. The same 

 result is brought about if these substances are injected directly into the blood, 

 although under such circumstances the brief stage of stimulation is much less 

 marked. Division of the pneumogastric nerve has no influence on this phenom- 

 enon. In addition to the action on the heart, there is marked dilatation of 

 the smallest blood-vessels, slowing of the respiration and lowering of the tem- 

 perature. 



5. An influence on the nervous system, either through the salts of the biliary 

 acids or through the cholesterin accumulated in the blood, perhaps also upon 

 the muscles, is shown by the great general relaxation, fatigue, weakness and 

 somnolence, finally deep coma; at times by insomnia, pruritus, even delirium 

 and convulsions. In experiments on animals Lowit observed symptoms, after 

 injections of bile, indicative of stimulation of the respiratory, cardio-inhibitory 

 and vasomotor centers. Direct application of bile or its salts to the cerebrum 

 causes convulsions. 



6. Jaundice of marked degree is attended with yellow vision, in consequence 

 of impregnation of the retina with yellow biliary coloring-matter. 



7. The biliary acids in the blood dissolve the erythrocytes, and this leads 

 to the further formation of bile. The dissolved hemoglobin is transformed into 

 new bile-pigment, while the globulin-body of the disintegrated hemoglobin mav 

 form casts in the renal tubules, which later are washed into the urine. Should 

 dissolution not take place, the erythrocytes become swollen and exhibit increased 

 solubility. 



After ligation of the bile-duct, the protoplasm of the liver-cells disappears, 

 and according to some observers partial necrosis of the hepatic tissue occurs, with 

 secondary reactive inflammation, connective-tissue hyperplasia. cell-multiplica- 

 tion of the epithelial cells of the biliary passages. The stagnating bile diminishes 

 in amount and exhibits further an increase of mucus and cholestenn, but on 

 the other hand a reduction in taurocholic acid (in the dog)- 



