I7tt PATHO 
difeafe preceded by acrimonious ingefta 5 hyderia, or fome 
■violent paflion of the mind; and generally fubfiding 
within a few days after thefe are removed. 
4. Ifterus hepaticus. The courfe of the bile obflrufted 
by the derangement of the liver from fchirrhus or infarc¬ 
tion : occafional retching and dyfpepfia. 
5. Ifterus infantum. The courfe of the bile obflrufted 
by vifcid meconium ; without pain or dyfpepfia. See 
Parturition, p. 715. 
Jaundice is found fymptomatically in pregnancy, colic, 
coprodafis, and fevers of various kinds; efpecially in the 
yellow fever. 
Thecaufes of jaundice are fufficiently explained by the 
above claflification, which is indeed founded almoft en¬ 
tirely on their variety. The infpiflation of bile which 
occurs in the firft fpecies is faid by Dr. Saunders to have 
been found in the gall-bladder, and prefenting there a 
vifcid and pitchy confidence. Dr. Powell, on the other 
hand, dates, that it does not feem to block up the large 
dufts, nor their entrance into the duodenum, but rather 
accumulates in the liver itfelf, the deviation from a 
date of fluidity rendering its paflage through the fmaller 
canals difficult. He conceives that this date of the fecre- 
tion is connefted with the ufe of fpirits. 
Inaftivity of the dufts is another caufe of the reten¬ 
tion of bile. Some authors have indeed edimated the 
contraftile powers of thefe parts at a very low rate ; but 
we trud that we fhall be able to fhow, in the proper 
place, that their contraction, though flow, is powerful 
and well marked. It cannot however be doubted, but 
that other powers aflid the paflage of the bile; as for in¬ 
dance, the occafional didention or relaxation of the flo- 
mach, the motions of the diaphragm, bowels, and abdo¬ 
minal mufcles. Hence a life of indolence and inactivity 
feems to be a frequent fource of the malady in quedion. 
Hence too literary men, and thofe who are engaged in 
fedentary occupations, in which for the mod part the 
body is inclined forwards, and the gall-dufts obvioufly 
liable to fuft'er condant compreflion between the liver and 
adjoining parts, are frequently jaundiced. But, indepen¬ 
dently of the deficiency of thefe aids to the propulfion of 
bile, a want of contraftile power in the gall-bladder will 
produce jaundice. Dr. Powell mentions a cafe in which 
the powers of contraction were lodfrom over-didention ; 
the accumulation of bile having become fo great, as to 
produce a tumour externally, and an evident fluctuation. 
Want of exercife operates powerfully in the production 
of the fecond fpecies likewife. Biliary concretions are 
comparatively more frequent in women than in men ; 
thofe men who are engaged in literary purfuits are very 
liable to them; and in either fex they are mod common 
after the aCtive period of life is pad. Haller noticed the 
frequency of their occurrence in criminals whofe death 
had been preceded by long confinement. They are often 
found in . the • gall-bladders of oxen which have been 
flailed during the winter-months; and Dr. Powell believes 
that they occur in a larger than common proportion of 
maniacs who have been long confined. 
Of the exiflenceof the third fpecies fome doubts have 
been entertained : Dr. Cullen particularly mentions it, 
and Dr. Powell deems it well efiablifhed. It is faid by 
Sydenham to come on occafionally during hyderics ; and 
it has been obferved to follow violent fits of anger, and 
other emotions of the mind. But the accurate Dr. He- 
berden denies the correftnefs of Sydenham’s obfervation, 
in refpeft to hyderia, both from his own experience and 
the authority of many other petitioners. With refpeft 
to the influence of the paflions, Dr. Saunders remarks, 
that anger not only augments the quantity of bile fe- 
creted very confiderably, but likewife vitiates it: hence 
it is, that, being carried into the duodenum in large 
quantities, and regurgitated into the flomach, it produces 
the fame effefts as an emetic; and hence probably the 
term choleric , as applied to paffionate people. If the 
duftus communis do not tranfmit it as fad as it is fe- 
LOGY. 
creted, and the gall-bladder is fo full that it cannot ye» 
ceive the excefs; then it will be forcibly returned upon 
the hepatic fyflem, and, by entering the blood-veflels, 
produce jaundice. Some have fuppofed that, during the 
general commotion of the paflions, a gall-done may have 
been pufhed from the bladder into the duft, and thus 
produced jaundice 5 but the whole attack has often been 
too tranfitory, and too free from the general fymptoms 
of the paflage of a gall-done, to allow of fuch a fuppofi- 
tion. The fymptoms of fpafm, affefting the parts in 
quedion, are, however, generally confidered as being 
fimilar to thofe of the paflage of a concretion. So that, 
on the whole, the explanation which Dr. Saunders has 
given, of the influence of the paflions in producing a 
temporary jaundice, appears to be the mod probable. 
The fourth fpecies is generally traceable to drinking, as 
is likewife a thickening of the coats of the biliary dufts, . 
by which their calibre mud be diminifhed, as mentioned 
by Morgagni (De Caufis et Sedibus Morborum, Epid. 
xxxvii. art. 10.) who gives an indance of the total obli¬ 
teration of the common duft. Dr. Saunders remarks, 
that this contraftion of the canal of the duft is pro¬ 
duced by the extenfion of difeafed flrufture, originally 
produced in the flomach by the abufe of fpirituous li¬ 
quors, to the biliary dufts. “ In the difleftion of thofe 
who have been intemperate dram-drinkers, the difeafed 
flrufture may be traced,” he fays, “ from the flomach 
along the courfe of the duftus communis ; and I have 
frequently feen thefe dufts fo contrafted and thickened, 
that they could not tranfmit bile.” A fimilar effeft, 
from inflammation of the liver extending to the gall¬ 
bladder and dufts, which often lays the foundation of an 
incurable jaundice, has been obferved by Dr.Pemberton: 
the inflammation of the duft may be removed, he ob- 
ferve«, but the thickening remains, a permanent evil. 
In addition to the feries of caufes already detailed, ari- 
fing from obdruftion to the paflage of the bile into the 
duodenum, it has farther been a quedion, whether any 
obdruftion to its difcharge from the bowels, after it has 
cleared its appropriate dufts, may not likewife occafion 
its abforption into the fydem, and therefore produce 
jaundice. It would appear, from an experiment of M. 
Portal, that this may happen. He palled a ligature round 
the intedine of dogs, a little below the opening of the 
duftus communis choledochus; and obferved that, in 
five or fix hours afterwards, their eyes acquired a yellow 
tinge ; and, upon examining the lafteals, he found them 
filled with bile. (Mem. deTAcad. des Sciences, 1777.) 
In fome of the cafes of obdinate coflivenefs, accompa¬ 
nied by jaundice, that are on record, it is probable, there¬ 
fore, that the jaundice was a fymptom, rather than a 
caufe, cf the coflivenefs. This feems to be the cafe, in 
the flight jaundice of infants, which fpeedily vaniihes 
when the bowels are unloaded. 
It is of confequence that the fchirrhous date of the 
liver fliould not be miflaken for a mere congedion of 
blood or turgefcence of the veflels throughout the liver, 
which may prefs upon and block up the biliary dufts, 
and thus occafion the abforption of that bile to the fecre- 
tion of which it miniders. Hepatitis, or inflammation of 
the liver, is fometimesaccompanied by jaundice; and this 
would probably happen more frequently were it not in ge¬ 
neral confined to a fmall part of the vifcus, or to its invefl- 
ing membrane. Moreover, after the intermittent fevers of 
this country, and the analogous remittents of warmer 
climates, a jaundice often comes on towards the con- 
clufion, which has been confidered as forming no very 
unfavourable prognoflic ; for there does not generally 
appear to be any other difeafe of the liver, in fuch cafes, 
than an increafe of its fize, with great accumulation of 
blood through its fubdance. Dr. Powell mentions the 
cafe of a woman who died of confumption, and whofe 
lungs were found to be alinod one mafs of ulcerated tu¬ 
bercle; within the lad three days of her life, jaundice 
had come on to a very intenfe degree. Yet, on diflec¬ 
tion. 
