The practice of medicine / by Thomas Hawkes Tanner.

  • Thomas Hawkes Tanner
Date:
1867
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Licence: Public Domain Mark

Credit: The practice of medicine / by Thomas Hawkes Tanner. 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 excretion.* As cholesterine is not found as such in the faeces (not- withstanding the contrary statement by many authors on physiological <jhemistry), Dr. Flint has made many experiments to determine what changes it undergoes ; and the result of his investigations is, that it is converted into stercorine (or seroline). The retention, then, of choles- terine in the blood produces toxaemia, just in the same way as we have ursemic poisoning from the accumulation of urea. The difference in the gravity of the symptoms in the two varieties of jaundice (that from re- tention and that from suppression) is due to this circumstance, viz,., that in simple jaundice, dependent on the retention of the bile in the excre- tory passages, and the absorption of its coloring matter, the amount of -cholesterine in the blood is not necessarily increased : while in jaundice connected with structural change cholesterine is retained, and acts as a poison. Dr. Harley has recently publishedf some valuable observations which tend to confirm the opinion that jaundice has a twofold origin,—from reabsorption^ owing to some obstruction to the escape of bile, and from supjjrcssion with retention in the blood of the matters which should be formed into bile by the liver. But he also believes that the liver is an excretive as well as a formative organ of the bile. The liver manufac- tures glycocholic and taurocholic acids. But it only separates from the blood the biliverdinj or coloring matter of the bile, and the cholesterine: which substances are not peculiar to the liver, but are always found in the blood independently of the presence or absence of the liver. In jaundice from suppression the substances which the liver generates will be entirely wanting; while those which it merely excretes from the blood will collect in this fluid. Consequently the biliverdin accumulates till the serum is saturated with this pigment, from which it exudes and stains the tissues, producing the color we term jaundice. The elimina- tion of this matter by the kidneys gives the urine a saffron color. Hence Dr. Harley regards these symptoms as due to the imperfect excretion of biliverdin, quite independent of the presence or absence of the other constituents of the bile. The bile acids, not the bile-pigment, induce the symptoms of poisoning. And from this it is argued, that when the coloring matter alone is found in the urine the jaundice is due to sup- pression ; but when the biliary acids are present, it is clear that they must have been formed by the liver, and owing to some obstruction have been reabsorbed into the blood. According to Dr. Beale, the view that in certain cases of jaundice there is suppressed action of the liver, that bile is not produced, and * American Journal of the Medical Sciences. New Series, volume xliv, p. 337. Philadelphia, 1862. f .Jaundice: its Patholoe^y and Treatment. London, 1863. + There seems to be a repugnance on the part of chemists, in the present day to work upon any suljject without coinin*^ one or more new names. This extravagance only leads to confusion ; for unfortunately, though two authorities Avrite upon the same matter, at the same time, they will not adopt the same nomenclature. They only agree in discarding the terms which have been ])reviously received. It is difficult to say by how many difterent denominations the bih'-pigment is known. Dr. Thu- dichum (A Treatise on Gall-stones, p. 90. London, 18()3) employs the word choioehrovic to designate coloring nuitter of bile and all its varic^ties. For the br(nvn coloring matter he r(!tains the nniuc.cho/dphccine, for the green variety cho/orh/oive. The older names of cholcpyrrhine, bili|»h:eine, and bilifulvine may be regarded as synonymous with cholophaiine. iJiliverdin and cliolechlorine are the synonyms of cholochloine.