540 DISEASES OF THE l.IVER. 



Jaundice is a state of the body in which most of the tissues and fluids 

 become stained by the colouring matter of the bile. Hamilton considers that 

 *' all cases of true jaundice resolve themselves into jaundice from obstruction," 

 when, as we have just seen, the bile is prevented from getting into the small 

 intestine. Murchison held that jaundice might take place when there is no 

 obstruction, but from some cause, such as an excessive secretion of bile, 

 especially when conjoined with constipation, by which this fluid, having 

 gained access to the intestine, is not changed into new products, eis it ought 

 to be, but becomes absorbed into the blood, and consequently stains the skin 

 and other tissues. 



The depression and debility experienced in jaundice may, to some extent, 

 be owing to the presence in the blood, of bile acids, which destroy the red 

 corpuscles. It is, however, more probable that they are due to the retention, 

 in the blood, of various impurities, which the liver, when it is in a diseased 

 state, is unable to transform, with sufficient quickness, into products which the 

 kidneys can readily remove; for we find that the injection of bile into the 

 blood gives rise to no special symptoms of depression. The fact of the various 

 tissues being stained with the colouring matter of bile does not, in all cases, 

 imply the existence of debility. 



PRINCIPLES OF TREATMENT.— To relieve the congestion of the vessels 

 of the liver, and also to get rid of noxious materials contained in the blood, 

 we may use a purgative, the effect of which will be to draw blood away from 

 that organ to the intestines, and, also to cause the evacuation from the blood 

 of a quantity of its watery fluid, which holds the hurtful materials in solution. 

 The aperient I Avould recommend is sulphate of magnesia (Epsom salts). 

 Its action should be assisted by keeping the horse on laxative food, such as 

 bran mashes, roots, and green fodder. Two or three enemas of warm water, 

 in order to clear out the rectum, might be administered. As the kidneys and 

 skin (to a less degree) are the organs which remove the bile that has been 

 absorbed into the blood, we may with advantage stimulate them. For this 

 object, I would advise the use of nitre, which acts on the kidneys, or of sweet 

 spirits of nitre, Avhich acts on the kidneys and skin, and is also a stimulant ; 

 warm fomentations over the region of the liver (the right side) ; and warm 

 clothing. To aid in overcoming the great debility, as well as to stimulate the 

 kidneys and skin, the employment of sweet spirits of nitre is, I think, specially 

 indicated. Care should be taken to allow the animal a plentiful supply of 

 fresh water, in order to keep the blood in a sufficiently fluid condition. 

 Moderate exei'cise and a full supply of fresh air are essential. 



While we have thus endeavoured to reduce the congestion of the liver, to 

 remove bile which has been absorbed into the blood, and to overcome the 

 constipation of the bowels, we have in ij^ecacvanha a valuable agent for 

 relieving the obstruction to the flow of bile into the intestines ; for restoring 

 the gland to its healthy function ; for mitigating the congestion ; and for 

 allaying the fever, by its sedative properties. It appears to act by stimu- 

 lating involuntary muscular fibre, and thus relieves congestion of the blood- 

 Vessels of the liver by causing their muscular coats to contract ; and, in the 

 same manner, the obstruction in the bile-ducts is relieved, and the secretion 

 is allowed to flow into the intestine. The action of this drug, here, is very 

 similar to that which it has in relieving the distressing symptoms of bronchitis 

 in the human subject ; for when the mucous membrane of the bronchial tubes 

 is dry and inflamed, it alleviates the congestion of the blood-vessels and 

 causes a healthy secretion of mucus ; and if the bronchial tubes are blocked 

 up by mucus (phlegm), it stimulates their muscular coats to expel it. I am 

 indebted to Mr. Kettlewell, V.S., Bengal Studs, for having directed my 

 attention to the employment of ipecacuanha in the treatment of congestion 

 and inflammation of the liver. I have used it in many cases of these affections, 

 and always with marked success. Dr. J. Macphorson, late Inspector General 

 of Hospitals, Bengal Army, speaks highly of its employment, in large doses, 

 for inflammation of the liver in human practice. 



