On congenital obliteration of the bile-ducts / by John Thomson.

John Thomson

Date:: 1892

Credit: On congenital obliteration of the bile-ducts / by John Thomson. Source: Wellcome Collection.

36/86 page 18

$the bowel can become decolorised in time, as bile shut up in the gall-bladder sometimes does;' for, if so, we should have this occurring also where the liver and ducts were normal. Nor can we reasonably suppose a morbid condition of the liver to have existed before, of such a nature as to give rise to colourless bile like that secreted in congenital syphilitic cirrhosis. (e.) Motions.—In about twenty of the cases the motions seem to have been white, greyish, or cream-coloured from the beginning, and in most of the others they became so immediately after the meconium had been passed. In a few, however, we are told that the motions sometimes contained coloured matter at a late stage of the case. These may be divided into two distinct c\a.^^Q%,—firstly, those in which there was not complete obstruction to the flow of bile from the liver to the duodenum, such as cases 18, 21, 29, and 80, in which a varying amount of yellow, green, or brown matter was observed; and, secondkj, a few in which green matter was passed along with the grey or w^hite faeces, although the obstruc- tion to the bile-duct must have been quite complete at the time; for example, Mr Morgan's case (No. 2), in which the motions contained greenish-brown matter after a dose of grey powder; and two other cases (Nos. 12 and 17) in which green lumps were seen, and in which no mention is made of their following the administration of mercury. The former class requires no discussion, but the causation of the green matter (of non-hepatic origin) in the freces in the latter class is a matter of some interest and obscurity. The subject does not seem to have been as yet very thoroughly worked out, and I have nothing new to offer in explanation of the facts; but it may be worth while to mention briefly a few facts and statements from different sources bearing on them, and these will suggest various possible explanations of the problem as it presented itself in our cases. Firsthj, then, although no bile is entering the intestines in the ordinary way, it is possible that a slight amount of green or yellow colour may be imparted to the faeces by their being mixed with intestinal mucus which is jaundiced, just as the blood and urine are.2 This, however, explains very little indeed. Secondly, It is now believed that the well-known green stools produced by 1 Courvoisier, Casuistisch-statistische Beitrage s. Path, und Ghirurg. d. Gallenwege, Basel, 1890. 2 Osborne, Dublin Qaarterhj Med. Journal, vol. xv., 1853, p. 106.$

On congenital obliteration of the bile-ducts / by John Thomson.

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