href="@public@vhost@g@gutenberg@html@files@48499@[email protected]#page70" class="pginternal" tag="{http://www.w3.org/1999/xhtml}a">Diagnostic value of ascertaining the quantity of urea, and uric acid, as well as the presence of sugar in the urine in obscure cases of jaundice—History of a case illustrating the value of such knowledge—Significance of the presence of fatty acids in the fæces in the diagnosis of pancreatic disease—Pancreatine administered—Effect of bile-poisoning on the memory—Analysis of the patient's urine—Diagnostic value of the quantity of its constituents pointed out—Appearance of sugar as the forerunner of a fatal termination alluded to—Disappearance of bile-acids, and appearance of tyrosine and leucine in the latter stages of the disease—Post-mortem appearances described—Occlusion of bile, and pancreatic ducts—Analysis of healthy and diseased bile—Change in the proportion of the organic greater than in that of the inorganic constituents—Microscopic appearances of liver—Presence of crystals of cystine, as well as of tyrosine in the hepatic parenchyma

Jaundice from obstruction in its latter stage complicated with jaundice from suppression

Epidemic jaundice—Among soldiers—Among pregnant women—Among the entire civil population—Its mechanism—Its cause—Case of jaundice supervening upon scarlatina

Artificial jaundice—Mode of production—Experiments related—Tyrosine, and leucine supposed to be the result either of the arrested, or of the retrograde metamorphosis of glycocholic, and taurocholic acids—Biliary acids detected in the blood—Poisonous nature of the constituents of the bile—Condition of the blood in bile-poisoning

Treatment of jaundice—Totally different in jaundice from suppression and in jaundice from obstruction—Benefit of mercury in cases of jaundice—General theory regarding the action of mercurials—Benefit of acids, and of alkalies—Their mode of action explained—Theory of their action in cases of gall-stones—Lithia water—Treatment of jaundice by benzoic acid—Cases illustrating its mode of action—Podophyllin a bane, and an antidote in cases of jaundice—Its pernicious effects in cases of obstruction pointed out—Author's theory of its action in such cases—Method of detecting gall-stones in the stools—Sulphuric ether, and chloroform in cases of gall-stones—Taraxacum

Difficulties in the treatment of jaundice from obstruction pointed out—Derangements arising from absence of bile in the digestive process—Good effects of an additional quantity of food—Establishment of an artificial biliary fistula shown to be less hazardous than usually imagined—Mode of operation explained—Treatment of permanent jaundice by prepared bile—New mode of preparing bile pointed out—Theory of its action—Time of administration shown to be of much importance—Bile put into capsules—Benefits derived from bile given in this form

Tabular view of the pathology of jaundice according to the author's views

INDEX

DESCRIPTION OF PLATES AND WOODCUTS.

PLATE I.

Represents the condition of the parts in a fatal case of permanent jaundice, in which both the bile, and pancreatic ducts were completely occluded.

(a) Atrophied liver.

(b) Transverse section of the left lobe, showing the mouths of the enormously distended gall-ducts.

(c) Enlarged gall-bladder.

(d) Dilated cystic duct.

(e) Distended hepatic, and common duct.

(f) Ulceration in duodenum, in the situation of the opening of the gall-duct into the intestines.

(g) Pancreas with enlarged head (h), and enormously distended duct.

PLATE II.

External surface of the left kidney, denuded of its capsule, in a case of permanent jaundice.

(a) Small specks of bile pigment deposited in the renal tissue, and blocking up the urine tubes.

(b) Small abscesses scattered throughout the tissue of the kidney.

WOODCUTS.

Fig. 1. Crystals of glycocholate of soda, mag. 90 diam.

Fig. 2. Taurocholate of soda, as found in the form of globules of various sizes.

Fig. 3. Crystals of cholesterine.

Fig. 4. Crystals of pure tyrosine.

Fig. 5. Spiculated balls of tyrosine, from the urine of a case of acute atrophy of the liver.

Fig. 6. Globules of leucine.

Fig. 7. Cholesterine crystals.

Fig. 8. (a) Crystals of cystine.
(b) Hepatic cells, showing entire absence of fat globules.
(c) Caudate or spindle-shaped cells, from epithelial lining of hepatic ducts.

JAUNDICE:

PATHOLOGY AND TREATMENT.

INTRODUCTION.

Having entitled this monograph "Jaundice, its Pathology and Treatment," it may, perhaps, be necessary for me to state at the beginning that by so doing it is not to be supposed that I regard jaundice as a disease per se. On the contrary, I look upon it in the same light as I do albuminuria, which is not of itself a disease, but only the most prominent symptom of