t.:rt s of urine add 5 cubic centimetre: •,f Iti-ptr-eent. barium-chloride solutior and 5 tubic centimetres of chloroform.
for several minutes. Set aside fat minutes. The chloroform and pre t:i irate of phosphates fall down, carry g with them all the bile-pigment. Now draw off the chloroform and the precipi tate with a pipette. Place in a flat dish, anti stt over a basin of hot water until all the chl )roform has evaporated. Allow tc ol and pour off any fluid from the pre cipitate. The latter will be yellowish. I'lace impure nitric acid in drops here and there on the surface of the precipi tate. If bile-pigment is present a play of colors. appear-3 round each drop." ("Clinical -Methods," by Hutchinson and Rainy.) The stained cellular elements in the urine afford a reliable test for the pres ence of bile-pigment. In chronic cases the urine may contain albumin and pig mented tribe-Casts.
In those slight forms of jaundice in which bile-pigments do not appear in the urine in appreciable quantity the spec troscope furnishes a very delicate and ac curate test. Parrnentier (Gaz. des Hop., r. 139, 'SS).
In ordinary jaundice the color of both skin and urine is due to bilirubin. Leube (Centralb. f. }din. :Med., Nov. 30, '90).
The following recommended as a simple method of detecting bile-pigment in ic teric fluids: To about 11/, fluidrachrns rif serous fluid add twice or thrice its volume of concentrated alcohol, and shake the rnixture. Add as many drops of hydroehlof ie acid (10 to 25 per cent.) as ill be required to dissolve the pre cipitation caused by the addition of the concentrated spirits, when the fluid become clear. Bring the fluid to a boil. and if gall-pigment lie present a blue green color will appear within a minute or so. In a serous exudation containing only 1 part of bilirubin to 250,000 parts of fluid, the blue-green color became very conspicuous. When it is desired to ascer 1 tain the presence of an insignificant quan i tity the coloring matter of the bile in concentrated fluids rich in albumin, the author proceeds as follows: To 2/, or 1 fluidrachm of the fluid add four or five times its volume of concentrated spirit, which will cause the precipitation of all the proteid substances present. Shake
well several times and filter the fluid. Add several drops of hydrochloric acid and boil, when, if gall-pigment be pres ent, a delicate blue-green color will ap pear. Israel Hedenius (Lakliref. forb. vol. xxix, Nos. 7, 8, '95).
Jaundice may be distinguished from the yellow hue caused by malaria, cancer. lead poisoning, and some kidney affec tions by placing a few drops of the urinc in a porcelain dish and causing a coupl€ of drops of nitric acid to flow against it If bile-pigment be present, a greenish tint 11 ill result, followed by blue, violet, and a yellow or brown. John Inglis (Colum bus Med. Jour.; 'Monthly Retrospect, Apr. 15, '98).
As no bile enters the intestine, the fleces are pale or clay-colored, on account of the large amount of fat present. They are pasty and usually fcetid. There is usually constipation, but diarrhcea is not infrequent, owing to the decomposition in the intestines. There may be no rangement of the stomach, but often there is loss of appetite, coated tongue, foul taste, fcetid breath, and epigastric fullness after food.
The clay color of the stools is due to the undigested fat, and in jaundiced pa tients who are fed on free fat food this peculiar odor is not present. Strumpell (Lehrbuch d. spec. Path. und Ther. d. inneren Krank., B. 1, 'SS).
In the absence of bile from the intes tine, in jaundice, there is an increase in undigested fat from 6.9 and 10.5 per cent., the normal amount, to 55.2 and 78.5 per cent. Miiller (Zeit. f. klin. Med., B. I2, H. 1, 2, '88).
Attention called to the difference be t NVCCII icterus from obstruction and true polycholic icterus, in which there is hypersecretion of bile. In the former the stools are alcoholic, while in the latter they retain their normal color. Poly cliche icterus, rare in temperate climates, but very frequent in hot countries, is as sociated with an acute congestion of the liver, and is accompanied by fever. It does not last long unless it occurs in re lapses. Ieterus, not polycholic, yet with out discolorization of the stools, may also occur when there is incomplete compres sion of the small bile-duets. Jaccoud (Jour. de Med. et de Chin Prat., June, '90).