PHENOMENA OF JAUNDICE. 363 



vessels) of the liver (Saunders, 1795); the bile acids pass into the lymphatics of the 

 liver. [The lymphatics can be seen at the portal fissure filled with a deep yellow- 

 coloured lymph]. The lymph passes into the thoracic duct, and so into the blood 

 (Fleischl, Kunkel, Kufferath). Even when the pressure is very low within the 

 portal vein, bile may pass into the blood, without any obstruction to the bile-duct 

 being present. This is the case in Icterus neonatorum, as after ligature of the 

 umbilical cord, no more blood passes through the umbilical vein; farther, in the 

 icterus of hunger, as the portal vein is relatively empty, owing to the feeble absorp- 

 tion from the intestinal canal (Cl. Bernard, Voit, Naunyn). 



II. Cholaemia may also occur, owing to the excessive production of bile (hyper - 

 cholia), the bile not being all excreted into the intestine, so that part of it is 

 reabsorbed. This takes place when there is solution of a great number of blood- 

 corpuscles (178, 6), which yields material for the formation of bile. Thick 

 inspissated bile accumulates in the bile-ducts, so that stagnation, with subsequent 

 reabsorption of the bile, takes place (Afanassiew). The transfusion of heterogeneous 

 blood by dissolving coloured blood- corpuscles acts in this direction (p. 201). 

 Icterus is a common phenomenon after too copious transfusion of the same blood. 

 The blood-corpuscles are dissolved by the injection into the blood of heterogeneous 

 blood-serum (Landois), by the injection of bile acids into the vessels (Frerichs), 

 and by other salts, by phosphoric acid, water (Herrmann), chloral, inhalation of 

 chloroform, and ether (Nothnagel, Bernstein); the injection of dissolved hsemo- 

 globin into the arteries (Kiihne), or into a loop of small intestine, acts in the same 

 way (Naunyn). 



Icterus Neonatorum. When, owing to compression of the placenta within 

 the uterus, too much blood is forced into the blood-vessels of the newly-born 

 infant, a part of the surplus blood during the first few days becomes dissolved, 

 whereby the haemoglobin passes into bilirubin, thus causing jaundice (Virchow, 

 Violet). 



When the jaundice is caused by the absortion of bile already formed 

 in the liver, it is called hepatogenic or absorption-jaundice. The 

 following are the symptoms : 



Phenomena. (1.) Bile pigments and bile acids pass into the tissues of the 

 body ; hence, the most pronounced external symptom is the yellowish tint or 

 jaundice. The skin and the sclerotic become deeply coloured yellow. In preg- 

 nancy the fetus is also tinged. 



(2. ) Bile pigments and bile acids pass into the urine (not into the saliva, tears, or 

 mucus), and their presence is ascertained by the usual tests ( 177). When there 

 is much bile pigment, the urine is coloured a deep yellowish brown, and its froth 

 is citron yellow ; while strips of gelatin or paper dipped into it also become 

 coloured. Occasionally bilirubin ( = ha3matoidin) crystals occur in the urine. 



(3.) The faeces are "clay coloured" (because the hydrobilirubin of the bile is 

 absent from the faecal matter) very hard (because the fluid of the bile does not 

 pass into the intestine) ; contain much fat (in globules and crystals), because the 

 fat is not sufficiently digested in the intestine without bile, so that more than 

 60 p.c. of the fat taken with the food reappears in the faeces (v. Voit) ; they have 

 a very disagreeable odour, because bile normally greatly limits the putrefaction in 

 the intestine. The evacuation of the fceces occurs slowly, partly owing to the hard- 

 ness of the faeces, partly because of the absence of the peristaltic movements of the 

 intestine, owing to the want of the stimulating action of the bile. 



(4.) The heart-beats are greatly diminished, e.g., to 40 per minute. This is due 

 to the action of the bile salts, which at first stimulate the cardiac ganglia, and then 

 weaken them. The injection of bile salts into the heart, produces at first a tem- 

 porary acceleration of the pulse (Landois), and afterwards slowing (Rb'hrig). The 



