KEABSORPTION OF BILE; JAUNDICE. 273 



geneous blood obtained by dissolving coloured blood-corpuscles acts in this direction. 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, by the injection of 

 bile-acids into the vessels, and by other salts, by phosphoric acid, water, chloral, inhalation of 

 chloroform and ether ; the injection of dissolved haemoglobin into the arteries or into a loop of 

 the small intestine acts in the same way. 



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, part of the haemoglobin is converted into 

 bilirubin, thus causing jaundice ( Virchow, Violet). 



Absorption-Jaundice. When the jaundice is caused by the absorption of bile 

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

 following are the symptoms : 



(1) Bile-pigments and bile-acids pass into the tissues of the body; hence, the most pro- 

 nounced external symptom is the yellowish tint or jaundice. The skin and the sclerotic 

 become deeply coloured yellow. In pregnancy the foetus is also tinged. 



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

 ( 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 ( = haematoidin) crystals occur in the urine ( 266). 



(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 78 per cent, of the fat taken with the food reappears in the faeces 

 (v. Voit) ; they have a very disagreeable odour, because the bile normally greatly limits the 

 putrefaction in the intestine. [V. Voit finds that putrefaction does not take place if fats be 

 withheld from the food.] The evacuation of the faeces occurs slowly, partly owing to the hardness 

 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. 

 Bile-salts injected into the heart produce at first a temporary acceleration of the pulse, and after- 

 wards slowing (Rbhrig). The same occurs when they are injected into the blood, but in this 

 case the stage of excitement is very short. The phenomenon is not affected by section of the 

 vagi. It is probable, that when the action of the bile-salts is long continued, they act upon the 

 heart-muscle. In addition to the action on the heart, there is slowing of the respiration and 

 diminution of temperature. 



(5) That the nervous system, and perhaps also the muscles, are affected, either by the bile- 

 salts or by the accumulation of cholesterin in the blood, is shown by the very general relax- 

 ation, sensation of fatigue, weakness, drowsiness, and lastly deep coma sometimes there is 

 sleeplessness, itchiness of the skin, even mania, and spasms. Lowit, after injecting bile into 

 animals, observed phenomena referable to stimulation of the respiratory, cardio-inhibitory, 

 and vasomotor nerve-centres. 



(6) In very pronounced jaundice there maybe "yellow vision" owing to the impregnation of 

 the retina and macula lutea with the bile-pigment. 



(7) The bile-acids in the blood dissolve the red blood-corpuscles. The haemoglobin is 

 changed into new bile-pigment, and the globulin-like body of the haemoglobin may form 

 urinary cylinders or casts in the urinary tubules, which are ultimately washed out of the tubules 

 by the urine. 



[Influence of Drugs on the Secretion of Bile. On animals one may make either a permanent 

 or a temporary fistula. The latter is the more satisfactory method, and the experiments are 

 usually made on fasting curarised dogs. A suitable cannula is introduced into the common 

 bile-duct (fig. 197), the animal is curarised, artificial respiration being kept up, while the drug 

 is injected into the stomach or intestine. Rbhrig used this method, which was improved by 

 Rutherford and Vignal. Rbhrig found that some purgatives, croton oil, colocynth, jalap, aloes, 

 rhubarb, senna, and other substances, increased the secretion of bile. Rutherford and Vignal 

 investigated the action of a large number of drugs on the bile-secreting mechanism. They 

 found that croton oil is a feeble hepatic stimulant, while podophyllin, aloes, colchicum, euony- 

 min, iridin, sanguinarin, ipecacuan, colocynth, sodium phosphate, phytolaccin, sodium benzoate, 

 sodium salicylate, dilute nitro-hydrochloric acid, ammonium phosphate, mercuric chloride (cor- 

 rosive sublimate), are all powerful, or very considerable, hepatic stimulants. Some substances 

 stimulate the intestinal glands, but not the liver, e.g., magnesium sulphate, castor oil, gam- 

 boge, ammonium chloride, manganese sulphate, calomel. Other substances stimulate the liver 

 as well as the intestinal glands, although not to the same extent, e.g., scammony (powerful 

 intestinal, feeble hepatic stimulant); colocynth excites both. powerfully; jalap, sodium sulphate, 



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