104 DISEASES OF THE DIGESTIVE APPARATUS 



The other changes in the peritoneum have no special value. Tu- 

 bercular masses, sarcomas, and carcinomas have been already men- 

 tioned; also parasites. Plerocercoides barleti are found free or partially 

 encysted, also the pentastomum denticulatum was found by Rochcfon- 

 taine in great numbers in the subperitoneal cyst of the liver and mesen- 

 tery, and here also have been found the bladder cysts of the taenia 

 echinococcus. 



DISEASES OF THE LIVER. 



Catarrhal Jaundice. 



(Icterus Catarrhalis; Icterus Gastro-duodenalis .) 



Etiology. — In catarrh of the stomach we often find symptoms of 

 jaundice with that disease, especially where the inflammation of the 

 mucous membrane extends to the duodenum, and the ductus cholcdochus 

 l)ccomes closed by the swelling of its mucous membranes and prevents 

 the exit of the bile. As soon as such an ol)st ruction occurs, the bile can 

 no longer flow into the intestines; it becomes stagnant and dams back, 

 causing a pressure on the bile-ducts, and being unable to escape, it finally 

 enters the lymphatic vessels of the liver, from them into the blood through 

 the thoracic duct. After this there follows a series of symptoms that 

 have been named jaundice (icterus). In the early stages of the disease 

 we have to deal with an icterus that is produced by stagnation of the 

 bile. It has been found by observers that the pathological or artificial 

 stoppage of the flow of the bile, and, consequently, damming back of 

 the bile, will produce jaundice in forty-eight hours. This has a number of 

 names — stagnating icterus, icterus of reabsorption, or hepatogenous 

 icterus. While the swelling of the mucous membrane is generally the 

 cause of this disease, still there are a number of other causes that may also 

 produce it, such as foreign bodies in the ducts (parasites, gallstones, etc.), 

 from ulceration of the mucous membrane, by the cicatricial contraction of 

 tumors, or abscesses in or near the liver, from intestinal parasites invad- 

 ing the bile-duct, from the bile being very dense and flowing slowly, by 

 disturbance of the liver cells and the bile driven in an opposite direction 

 (Minkowski), and diffuse icterus (icterus per paranedesen) , in disturbance 

 of the blood circulation due to throml;)us in the portal artei'ies, the pres- 

 ence of bacteria, from the eating of decayed meat and from certain in- 

 fectious diseases, in cases of poisoning from phosphorus. The stop- 

 ping of the flow of bile sets up an inflammation of the tissues and some- 

 times forms abscess of the liver, but as the great majority of cases are 

 caused by the catarrhal form, we will desci'ibc that. Any cause that 

 will produce catarrh of the stomach will finally produce icterus, such as 



