Jaundice in some of its aspects : a clinical lecture delivered at St. Bartholomew's Hospital / by T. Lauder Brunton.

  • Brunton, Thomas Lauder, Sir, 1844-1916.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Jaundice in some of its aspects : a clinical lecture delivered at St. Bartholomew's Hospital / by T. Lauder Brunton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    lessened absorption even of such food as has been digested, and also a tendency to emaciation. There was emaciation in both the cases I have referred to, but in one of them we got no jaundice, in the other jaundice was present to a marked degree. Now, jaundice depends upon the presence of highly coloured matter in the tissues, and it reaches the tissues through the blood. When I was a student, the view was held that bile pigment was formed in the blood and was excreted by the liver. This view has now been given up, and it is now held that bile pigment is formed only in the liver. In my student days there were therefore two divisions of jaundice—one was called hrematogenous and the other hepatogenous. The hoematogenous jaundice was that due to increased formation of bile pigment within the blood and lessened excretion through the liver; hepatogenous jaundice was due entirely to the diminished excretion from the liver. This view of the hsematogenous origin of jaundice was given up for a while, but it has now reappeared under a somewhat altered form. The altered form is, that we no longer consider that bile pigment is formed in the blood, but we do consider that alterations in the blood may lead to a very greatly increased formation of bile pigment in the liver; so that we may really get a kind of jaundice, the starting point of which lies in alterations in the blood. Although the pigment may not be formed directly in the vessels, yet it is formed from altered blood, and the alteration takes place in the liver; so that there is certainly some ground for the old view of hsematogenous and hepatogenous jaundice. The hepatogenous jaundices are, however, much more frequent, and much more practically interesting, inasmuch as the hematogenous is generally associated with such severe blood changes that medical art has very little power over it, whereas over hepatogenous jaundice we are frequently able to exercise a great influence and to do in many cases a great deal of good. Jaundice is generally due to interference with the flow of bile out from the liver, and this may be due to many causes. One of the most common causes is a catarrhal condition, either of the duodenum or of the bile ducts. This catarrhal condition thickens the mucous membrane of the duodenum and tends to obstruct the opening of the common bile duct; or the catarrh may be present by itself, and so plug the duct by a thick cork, as we may term it, of mucus. This catarrhal jaundice is generally recognised by its having very few symptoms. The patient does not emaciate, and there is very little to be found on examination except that perhaps the liver is a little larger and a little more tender than usual, so that pressure upon it makes the patient wince. Catarrhal jaundice, as a rule, runs a course of its own, and although you may do some good, I confess that I do not think a very great deal can be done for it. As a rule, catarrhal jaundice runs a course of about six weeks. You may get it cleared away in less than that time,
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