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

  • John Thomson
Date:
1892
Catalogue details

Licence: Public Domain Mark

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

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    CAUSE OF II/EVIOKKHAGES, In several cases on our table no jaundice was observed until a week or more after birth ; and it is interesting to note that no hfemorrhage, umbilical or otherwise, took place in these before the jaundice was seen, although the obstruction of the ducts had cer- tainly been complete in some of them at an early period of intra- uterine life. It is also of interest that in no case does there appear to have been any sign of hajmorrhage having occurred during intra-uterine life. iv. I have more than once heard it suggested that the obstruc- tion to the outflow of the bile interfered with the hjemocyte- destroying function of the liver, and in this way conduced to haemorrhages by causing a sort of plethora. This theory cannot, however, be seriously entertained, because there is, as a fact, no increase of the number of these corpuscles in jaundice, but rather the reverse.-^ V. Another theoiy comes naturally to one's mind on reading the results of recent pathological research,, and certainly, so far as it goes, it seems to be much more satisfactory than any of the above. It is that the heemorrhagic tendency is caused by the presence in the blood, not of bile-acids, but of ptomaines, or some similar organic poisons, formed in the process of ordinary digestion, which the diseased liver is not able to render innocuous, as it would do if it were in a state of health. ^ The facts suggesting this hypothesis may be briefly stated as follows:— Firstly, One of the recognised functions of the liver in the animal economy is to render innocuous in some way various sorts of poisons in the blood.^ Among the poisons which it acts on thus are the organic ones which are formed in the alimentary canal in the process of digestion. Secondly, It has been found by Eoger^ that this important func- tion of the organ is closely connected with the amount of glycogen it contains, and varies accordingly, so that when the liver contains no glycogen a very much smaller dose of these organic poisons is required to produce a given result than would be necessary if the organ were healthy in this respect. This has been tested in the ^ J. C. H. Mackay, he. cit. 2 Laiider Brunton, Pharmacology and Therapeutics, third edition, p. 402. 3 Roger, Gaz. des H6p., No. 66, p. 525, 1887.
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