Conclusions based on a study of jaun dice and its treatment: 1. Long-con tinued biliary stasis, compromising the secreting cells of the parenchyma of the liver and producing a certain aninia of the organ, markedly reduces and some times suppresses the secretion of the biliary acids. The gravity of the phe nomena described under the name of binary intoxication does not, therefore, depend upon the action of these acids.
2. The scarcity or absence of bile in the intestinal canal modifies very seriously the chemical processes there taking place.
3. One of the niost common of the gastric changes in the icterus is the suppression of hydrochloric-acid secretion. 4. There is little or no loss of carbonate of sodium in these cases. 5. The reaction of the contents of the stomach is usually alka line, less often neutral or faintly acid.
6. The physiological activity of the bile and of the pancreatic juice in the in testine is retarded. 7. The chlorides in the urine is increased; there is a dimi nution of urea, with an abundance of products of the aromatic series. 8. The more marked these characters, the graver the disease and its clinical manifesta tions. 9. Alkaline treatment does not modify these conditions. The effect of the acid treatment is, however, to dimin ish the chlorides, to restore the normal acidity of the urinary reaction, to in crease the excretion of urea, and to re duce that of the aromatic products; and, at the same time, there is a. progressive increase in the weight of the body. Alivia (Med. Rec., Apr. 14, '94).
sis I 2 l5 eases of simple (*Mar tha! itttrus in Senator's clinic. Nearly ptr at. tettured ithin the first dciailt in the second deeade the num bt r drot pi il to 10 per cent. of the whole: in the third decade it rOse again and %%cot to 27 per cent. lt w. as there fore by far most frequent in the first dtcaile, but it w as notable that it prac tically nevtr affected sucklings. As to t he se., feina \\ en' some w ha t more at-rotted in the first five years of life, tt hile in the third and fourth decade it affected men more commonly. These conditions are exactly similar to those that are observed in epidemic jaundice. Also in stutlyimr the time of the year at. w hich the jaundice occurred the author noticed at once that the frequency ays rose pronouncedly in the first and fourth quarters of the year; in. other . words, in the winter months; it then dropped. This is exactly the same con dition as is observed also in epidemic jaundice. Likewise it is often seen that simple jaundice improves and then there is a relapse. This is much more readily explained by attributing the jaundice to the infection and the relapse to a rein fection than by attributing the whole matter to a simple catarrhal gastro enteritis. The jaundice was distributed
extrentely irreg.ularly throughout the city and showed no relation to the water supply, lint careful study showed that it sought out from year to year certain districts of the city, and this is believed to be further testimony that the cause is an infection and that the infectious agent remains active in certain regions when it once acquires a lodgment. .Neumann 1\led. Jour., from Dent. med. AVoch., Aug. 31, '99).
Case of severe recurrent jaundice in which a hard tumor under the right costal margin led to an explorato7 in eision. The tumor was found to be a floating kidney, which pressed on the gall bladder and bile-ducts. The kidney was returned to its normal position and fixed hy sutures. The jamidiee disap peared and the patient has been in per fect health .sinee. P. C. Fenwick (Lan cet, Nov. 11, '99).
Treatment.—The prognosis and treat inent are further considered in dealing with the various diseases that give rise to obstructive jaundice. (See LIVER, DtsnAsEs oF.) Successful treatment of catarrhal jaun dice consists simply in the rectal injec tion daily of 1 to 2 pints of cold water at first of a temperature of 57° F., then of 59° to 65° F. The knees became colored in the second to the fourth day and general symptoms rapidly improved. Krull (13erliner klin. Woch., p. 159, '87).
The following substances have becu found by experiment to increase the flow of bile: Group 1. -Urea, oil of turpentine, and terpine. Chlorate of potassium in creased the flow by once or twice the normal. Further, benzoate and salicylate of sodium, salol, euonymin, and muscarin used subcutaneously increase the secre tion two or three times the normal amount. Group 2. Substances producing only a slight or doubtful and inconstant increase are: alkaline salts, Carlsbad salts, propylamin, antipyrine, aloes, can tharitie acid and rhubarb, hydrastis Can adensis, ipecac, and boldo. Thus, cathar tics and the alkaline s.alts are not chola gogic non-cathartie doses. Group 3. Substances diminishing the secretion: iodide of potassium, calomel, iron and copper, atropine, and strychnine. In re gard to calomel. the writers have not been able to confirm Rutherford, who be lieved that what cholagogic action calo mel had was due to the transformation into corrosive sublimate. The last-named substance given by itself produced no in crease. Prevost and Binet (Revue Med. de la Suisse Rom., May to July, '88).