Murchison classified this group as fol lows:— 1. Obstruction by foreign bodies within the duct, as gall-stones, inspis sated bile, parasites, etc.
Catarrhal jaundice is not merely a me chanical plugging, of the bile-ducts with mucus, or a closure of the duets with in flammatory swelling. but is really toxic in character, ordinary catarrhal jaundice being due to toxic substances developed in the alimentary canal. Obstructive jaundice is due to gall-stones, tumors, hepatic abscesses, and cirrhosis. If jaun dice is associated with gallstones, it is generally due to inflammation rather than to obstruction. Renvers (Modern Med. and Bact. Review, Apr., '97).
2. Obstruction by inflammatory tume faction of the duodenum, or of the lining membrane of the duet and exudation into its interior.
Catarrhal or simple jaundice results from the following causes: 1. Duodenal catarrh, in whatever way produced, most commonly following an attack of indi gestion. It is most frequently met with in young persons, but may occur at any age. and may follow not only errors in diet, but also cold, exposure, and malaria, as \yell as the conditions associated with portal obstruction, chronic heart disease, and Bright's disease. 2. Emotional dis turbances may be followed by jaundice, which is believed to be due to catarrhal swelling. Cases of this kind are rare and the anatomical condition is unknown.
3. Simple or catarrhal jaundice may oc cur in epidemic form. 4. Catarrhal jaun dice is occasionally seen in the infectious fevers, such as pneumonia and typhoid fever. William Osier ("Principles and Pract. of Med.." p. 430).
3. Obstruction by stricture or obliter ation of the duct, as may result from perihepatitis, or from a cicatrix in the duct or at its mouth in the duodenum.
Case of chronic obstructive jaundice due to a narrowing of the ductus corn munis choledoehus by a eicatricial band situated just at the junction of the cystic and hepatic ducts. The gall-bladder was atrophied. The liver and spleen con tained pure cultures of the bacillus coli communis. Benzaeon (Bull. de la So
ciet6 Anat., -No. 6, '93).
The occurrence of jaundice is, as a rule, only possible when there is an obstruc tion of the common bile-duct. There are one or two exceptions, viz.: a rare form of blood-dyscrasia and yellow fever. Biliousness is the result of functional de rangement of the liver, while jaundice is the result of obstruction of the common duct. Jacob Michaux (Gaillard's Med. Jour., vol. lxvii, No. I).
Case of fatal infantile jaundice from congenital narrowing of the bile-duct. J. A. C. Kynoch (Edinburgh Med. Jour., July, '96).
4. Obstruction by tumors closing the orifice of the duct or growing into its interior.
Causes of ieterus gravis: I. Mechan ical occlusion of the lumen of the cystic and common, ducts by calculi, hepatic growths, enlarged head of the pancreas, carcinoma of the duodenum, tumors of the transverse colon, etc. 2. Acute yel low atrophy. 3. Terminal stage of atro phic cirrhosis. Mester (Deutsche med. Woch., Nov. 27, '90).
Four cases in which death followed symptoms of obstructive jaundice due to cancer of the ductus choledochus com munis with signs of excessive amount of colloid material in the thyroid gland. In those cases, the antitoxic function of the liver having been notably impaired, the thyroid was excited to vicarious action by the toxic substances circulating in the blood. Lindemann (Archiv fiir pathol. Anat., etc.; Gaz. Hebdom. de Mkl. et de Chir., Nov. 28, '97).
Examination of the liver from a woman, aged 53, who had died after symptoms of obstructive jaundice. There was a large caseating gland surrounded by a dense mass of fibrous tissue involv ing the hepatic duct. There was also some perihepatitis with several small abscesses throughout the liver. Whyte (Brit. Med. Jour., Jan. 1, '93).
5. Obstruction by pressure on the duct from without by (a) enlarged glands, (b) hepatic tumor, (c) tumor of the pylorus, (d) tumor of the pancreas, (e) tumor of the kidney, (f) omental tumor, (g) an abdominal aneurism, (it) fmcal accumula tion in the colon, (i) ovarian or uterine tumors.