A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt.

  • Oswald Vierordt
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    of an icterus caused by urobilin, which reasons we cannot here dis- cuss.^ D. Gerhardt^ in a series of cases of different kinds of icterus, some of them of the sHghtest degree, always found bilirubin in the blood- serum and in the tissue-lymph. From this we are to infer that, con- trary to what has been said above, icterus would always be caused by biliary pigment. Whether this view will be confirmed is still doubtful. It is uncertain where urobilin is formed. Tissier recently asserted that it is principally formed in the liver. Healthy . liver-cells produce bilirubin out of hemoglobin; diseased liver-cells or those damaged in any manner, however, produce urobilin or certain substances inter- mediate between these two. Severe urobilinuria only makes its appear- ance in cases of chronic disease of the liver if there exists an increased dissolution of red corpuscles. On the other hand, F, Miiller thinks that urobilin is formed in the intestines. He says it is formed by the bacteria of putrefaction by reduction from bilirubin. He did not find it in the feces and the urine when no bile entered the intestines, and likewise as long as there was no putrefaction in the intestines, as in the new-born. But it is not feasible to discuss this interesting question more in detail here. 5. The Bronze Skin.—Unlike cyanosis and jaundice, this is a condition pertaining only to the skin and mucous membrane. We speak of the chief symptom instead of the true anatomical seat of the disease—viz. the suprarenal capsule, the so-called Addison's disease. It is regarded as a disease of the suprarenal capsule, more frequently tubercular. Connected with it is a degeneration of the ganglia and of the ramifications of the sympathetic nervous system. [The association of this peculiar brown discoloration of the skin is not constant in Ad- dison's disease. It is not so constant in cancerous, but is more common with cheesy, degeneration. The latter condition may be present without bronzing of the skin. On the other hand, the skin maybe bronzed, just as in Addison's disease, without the existence of cheesy degeneration or any other change in the suprarenal capsules. These facts have induced many observers to attribute the cutaneous discoloration rather to changes in the neighboring sympathetic nerves —the solar plexus and the semilunar ganglia.] The bronze skin is characterized by a brown, gray to black dis- coloration, especially of the face and hands. There is also the common normal pigmentation of the skin in spots. The discoloration may gradually extend over the whole surface of the body, only the nails and cornea remaining clear. It is very important to notice that the same discoloration appears upon the mucous membrane of the mouth, and more rarely upon the lips, as very sharply circumscribed, frequently quite small, brown specks. The discoloration is caused by deposit of pigment in the rete Mal- pighii. Of course pressure with the finger does not at all diminish it. Arsenical Melanosis.—When arsenic has been administered for a long time, sometimes even though the doses be small, there is pro- duced a discoloration of the skin, and likewise of the mucous mem- ^ See chapter on Urine. ^ Diss,, Berlin, 1889.