Jaundice, Icterus, the Yellows. 459 



B. Jaundice Independent of Mechanical Obstruction of 

 the Bile Ducts. 



/. Poisons in the blood interfering with the normal metamor- 

 phosis of bile. 



1. The poisons of the various specific fevers (Anthrax, Texas 



fever, Hog-cholera, Swineplague, Petechial fever, 

 Pyaemia, Septicaemia, etc.). 



2. Animal poisons : snake poison. 



3. Mineral'poisous : phosphorus, mercury, copper, antimony, 



etc. 



4. Chloroform, ether, etc. 



5. Acute atrophy of the liver. 



II. Impaired or deranged innervation interfering with the 

 normal metamorphosis of bile. 



1. Severe mental emotions : fright, anxiety, etc. 



2. Concussion of the brain. 



III. Deficient oxygenation of blood interfering with the nor- 

 mal metamorphosis of bile. 



IV. Excessive secretion of bile, more of which is absorbed 

 than can undergo the normal metamorphosis. 



Congestion of the liver : a. Mechanical, b. Active, c. Pa.ssive. 



V. Undue ab.sorption of bile into the blood from habitual or 

 protracted constipation. 



Mechanical obstruction, by tying the bile ducts in a dog, 

 caused in two hours yellow coloration of the contents of the he- 

 patic lymphatics and thoracic duct, and also of the blood in the 

 hepatic veins (Saunders). That this jaundice is due to reab- 

 sorption and not to suppre.ssed secretion of bile, already present 

 in the blood, may be fairly inferred, from the complete absence of 

 icterus, where, from general di.sease of the liver, the secretion of 

 bile has been entirely su.spended, and in which the gall ducts and 

 bladder contain only a little gray mucus (Haspell, Frerichs, 

 Budd, Murchison), also from the fact that after complete extirpa- 

 tion of the liver in frogs not a trace of biliary acids nor pigment 

 can be detected in the blood, urine, or muscular tissue (Miiller, 

 Runde, Lehmann, Moleschott). Bile acids and bile pigment are 

 formed in the liver by disintegration of blood globules, and when 

 present in excess in the blood it is by virtue of reabsorption. 



