,frontispiece3 ,plate ,i4 ,occlusion ( !
 ,bile1 & ,pancreatic ,ducts4           
,,jaundice3 ,,its ,,pa?ology ,,&        
,,treatm5t4    ,,) ,,! ,,application ,,(
 ,,physiological ,,*emi/ry ,,to ,,!     
,,detection ,,&  ,,treatm5t ,,(         
,,diseases ,,( ,,! ,,liv] ,,&           
,,pancreas4          ,,by ,,george      
,,h>ley1 ,m4,d41    ,pr(essor ( ,m$ical 
,jurisprud5ce 9 ,univ]sity ,college1    
,london2  ,assi/ant ,physician to       
,univ]sity ,college ,hospital2 ,=m]ly   
,presid5t  ( ! ,p>isian ,m$ical         
,society2 ,cor4 ,memb4 ( ! ,academy (   
,sci5ces  ( ,bav>ia1 & ( ! ,royal       
,academy ( ,m$ic9e ( ,madrid4           
,s rapid is ! advance ( sci5ce1 t ! !ory
 reg>d$ z true  to-day1 may be recognis$
 z false to-morr[4 ,! facts1 h[ev]1 on  
:i* ! !ory is bas$1 if rightly obs]v$1  
rema9 unalt]$1 &  unalt]able4           
,,london3  ,,walton ,,& ,,mab]ly1       
,,upp] ,,g[] ,,/reet1 ,,& ,,ivy ,,lane1 
,,pat]no/] ,,r[4  ,,mdccclxiii4         
,,london3  ,,william ,,/ev5s1 ,,pr9t]1  

#cg1 ,,bell ,,y>d1  ,,temple ,,b>4      
,,to    ,,william ,,%>pey1 ,m4,d41      
,,ll4,d41 ,f4,r4,s41  ,pr(essor (       
,anatomy & ,physiology 9 ,univ]sity     
,college1 ,london1    ,,z ,a ,,small    
,,tok5 ,,( ,a ,,colleague',s ,,e/eem ,,=
 ,a ,,pr(\nd ,,?9k]1 ,a  ,,s\nd         
,,reason]1 ,,& ,a ,,true ,,fri5d4       
,,preface4      ,"t be+ money1 q z mu*  
to ! pr(essional z x is to !  m]cantile 
man1 ! au?or has endeav\r$ 9 !          
accompany+  monograph n only to cond5se 
8 mat]ial1 b to exclude !  consid]ation 
( any "q n directly be>+ ^u ! pa?ology  
or treatm5t ( jaundice2 inde$1 z /at$ 9 
! ,introduction1 "o (  ! *ief objects ( 
! au?or hav+ be5 to po9t out h[ valuable
  an adjunct mod]n physiological1 &     
*emical k is 9 !  diagnosis1 & treatm5t 
( hepatic & pancreatic disease1 he has  
nei!r dwelt on ! lit]ature nor discuss$ 
! old !ories ( !  me*anism ( jaundice1 b
 limit$ himself almo/ entirely to a     
brief  exposition ( 8 own views4 ,= !   
sake ( brevity1 he has at page  #acb put

 into a tabul> =m ! pa?ology ( jaundice1
 accord+ to !  op9ions express$ 9 ! body
 ( ! volume4    ,z ! object ( all !ory1 
& ! aim ( all sci5ce1 is to insure  wise
 practice1 ! au?or desires to call      
special att5tion to t  portion ( ! "w   
devot$ to ! *emi/ry ( ! excretions1     
feel+1 z he does1 t we are ent]+ ^u !   
?re%old ( an  important dep>tm5t (      
m$ical inquiry1 :i*1 soon] or lat]1 w   
be foll[$ by valuable practical results4
 ,he w\ld also direct !  special        
att5tion ( 8 read]s to ! *apt] devot$ to
 treatm5t1  be+ sangu9e en\gh to imag9e 
t ! adoption ( ! pr9ciples he  has      
enunciat$ reg>d+ ! mode ( action1 &     
adm9i/ration ( !  rem$ies usually       
employ$ 9 hepatic affections1 may       
conduce to a m  rational & successful   
me?od ( treatm5t ?an has hi!rto be5     
employ$4 ,he ev5 goes f> en\gh to hope t
 ! result ( !  treatm5t1 z %[n 9 ! cases
 cit$1 w n only ju/ify !  adoption ( !  
pr9ciples on :i* x is f\nd$1 b also     
prove a  /rong inc5tive to o!rs to foll[

 ! l9e ( diagnosis he has  /riv5 to     
inculcate4    ,9 "s portions ( ! volume 
! /atem5ts ( ! au?or may1  p]haps1 appe>
 to be r dogmatic2 if s1 he w\ld rem9d 8
  read]s t ?is has aris5 f ! circum/ance
 ( s _m old  dogmas1 & deeply-root$     
prejudices hav+ to be combat$1 = he is  
q alive to ! fact1 t :at we reg>d z     
sci5tific tru? is 9  no case            
incontrov]tible c]titude1 & t !         
d$uctions ( to-day1  9 an advanc+ sci5ce
 l t ( m$ic9e1 may require mat]ial      
alt]ation :5 view$ 9 ! light ( ! morr[4 
,b he is equally  conv9c$ ( ! fact1 t if
 m5 fold _! arms1 & refra9 f  act+ until
 e l9k 9 ! *a9 ( k is =g$1 all  progress
 w be arre/$1 & ! day ( c]ta9ty /ill    
fur!r  po/pon$4    ,too long h we rev]s$
 ! natural ord] ( ?+s1 & comm5c$  ! /udy
 ( m$ic9e :]e we ought r to h left x (f4
 ,too  long h we /riv51 by /udy+        
pa?ology ere we 7 suffici5tly  acqua9t$ 
) physiology1 to place ! pyramid on its 
apex in/ead (  on its base2 & ?us x is  
we rema9$ s long ignorant ( !           

fundam5tal doctr9e1 t ! same laws :i*   
regulate heal?1  regulate disease4      
,nature does no?+ on a small scale1 & ! 
m we  /udy h] ! m we admire ! uni=mity1 
& ext5sive  applicability ( h] laws4 ,if
 we pry into ! ultimate /ructure ( our  
bones1 we f9d !y receive _! nutrim5t by 
a sy/em ( irrigation1  c>ri$ on ?r\gh   
lakes1 & riv]s 7lacun1 & canaliculi72 & 
if  we exam9e ! p]io/eum surr\nd+ !m1 ! 
ligam5ts atta*+  !m1 or ! muscles cov]+ 
!m1 we /ill f9d1 t1  not)/&+ ! div]sity 
9 /ructure1 & use1 ! "o sy/em (         
irrigation p]vades !m all4 ,we may ev5 g
 a /ep fur!r1 & say  t ! same law :i*   
gov]ns ! animal gov]ns also ! vegetable 
k+dom4 ,inde$1 ! fur!r sci5ce advances1 
! m app>5t does  x become1 t n only !   
animal1 & vegetable1 b ev5 !  organic1 &
 inorganic1 =m b "o _w1 regulat$ by !   
same laws4    ,a k ( organization1      
important ?\gh x be1 is yet less        
indisp5sable to ! physician ?an a k (   
heal?y function1  = x is ! latt] :i*    
elucidates ! d>k problems ( life1 x is  

! latt] :i* proves ! gold5 key to !     
compreh5sion ( disease4    ,al?\gh n ev5
 ! mo/ ard5t admir]s ( m$ic9e c say1 t x
  z yet m]its ! "n ( an exact sci5ce1   
?is ought nei!r to  de/roy our hopes nor
 trammel our lab\rs4 ,) ! /e!scope1     
microscope1 & o!r physical means (      
diagnosis a new era dawn$ ^u  our art2 &
 n[ ! memb]s ( ! new s*ool :i* is ris+  
up1 &  c>ry+ *emi/ry into ! doma9s (    
m$ic9e1 are ! pione]s (  ! revolution   
:i* is soon to foll[4 ,if we look back  
to :at !  exact sci5ces ( to-day 7 9 =m]
 times1 we %all f9d !y 7  mu* less      
p]fect !n1 ?an m$ic9e is n[4 ,a/ronomy &
 *emi/ry  7 b a/rology & al*emy4 ,if1   
!n1 we draw a picture ( !  future f !   
progress ( ! pa/1 we ne$ h no hesitation
 9  say+ t *emi/ry rightly appli$1 &    
physiology ju/ly  int]pret$ w1 ere _m   
g5]ations pass away1 reveal ! deepe/    
secrets ( diseas$ action1 & al?\gh      
unable to bani% dea?1 w  yet enable !   
practition] to foll[ ) un]r+ c]ta9ty !  
v>i\s morbid *anges occurr+ 9 ! frame4  

#gg1 ,,h>ley ,,/reet1 ,,cav5di% ,,squ>e1
    ,m>*1 #ahfc4          ,,cont5ts4    
,,page  ,,introduction 4 4 4 4 4 4 4 4 4
 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4    
#a    ,pa?ological conditions ) :i*     
jaundice is associat$--,^?      ( ! liv]
 itself--,^? ( ! bile-ducts--,g5]al     
affections ( o!r organs ( ! body ex]t+  
an influ5ce      on ! bili>y            
secretion--,zymotic diseases--,! effects
 (      c]ta9 poisons  4 4 4 4 4 4 4 4 4
 4 4 4 4 4 4 4 4 4 4 4 4 4 4    #c      
,fr]i*s's !ory ( jaundice--,!ory (      
jaundice hi!rto mo/      fav\r$ 9       
,engl&--,dr4 ,budd z its expon5t  4 4 4 
4 4 4 4 4    #f    ,nature (            
bile--,biliv]d9e--,bile acids2          
glyco*olic1 &      tauro*olic           
acids--,*ole/]9e--,bile                 
res9--,sug>--,inorganic                 
con/itu5ts--,specific gravity1 reaction1
 & col\r ( normal      bile 4 4 4 4 4 4 
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4 4    #g    ,mann] 9 :i* bile is     
secret$--,liv] bo? a =mative &          

excretive organ--,animals )\t           
gall-bladd]s--,effects (      food on ! 
col\r & quantity ( ! bile  4 4 4 4 4 4 4
 4 4   #aa    ,is bile ess5tial to      
life8--,effect on ! sy/em ( abs5ce (    
bile 9 ! dige/ive process--,dea? f      
/>vation z a      result--,b5efit d]iv$ 
f an additional quantity (              
food--,uses ( bile 9 ! animal           
economy--,necess>y to !      absorption 
& assimilation ( food--,bile z a        
dige/ive      ag5t--,its action on !    
*yme--,exp]im5ts on its influ5ce        
ov] ! absorption ( fatty matt]--,its    
relation to !      pancreatic           
juice--,bile tak5 int]nally by ,caffres 
4 4 4 4 4 4   #ac    ,g5]al view ( !    
me*anism ( jaundice--,two great         
divisions--,jaundice f suppression1 &   
jaundice f      re-absorption--#a/      
subdivision3 jaundice aris+ f           
en]vation1 disord]$ hepatic circulation1
 & abs5ce (      secret+ sub/ance--#bnd 
subdivision3 jaundice aris+ f           
cong5ital defici5cy ( ! bile-ducts1 & f 

accid5tal      ob/ruction ( ! bile-ducts
  4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4   #ai 
,g5]al view ( ! pa?ology ( jaundice f   
suppression1      %[+ h[ ! coloration ( 
! sk91 & ur9e is produc$      9 su*     
cases  4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
 4 4 4 4 4 4 4   #bj    ,me*anism (     
jaundice z a result (                   
en]vation--,influ5ce (      n]v\s sy/em 
on secretion--,effect ( m5tal emotion on
      bili>y secretion1 z obs]v$ 9 dog )
 bili>y      fi/ula--,action ( fright 9 
p>alyz+ n]ve =ce  4 4 4 4 4   #bb       
,me*anism ( jaundice f hepatic          
conge/ion--,active                      
conge/ion--,g5]al view ( ! effects (    
conge/ion on      gl&ul>                
secretion--,reason :y ! bili>y secretion
 is n      usually completely arre/$--,!
 abs5ce ( pipe-clay /ools               
expla9$--,example ( jaundice f hepatic  
conge/ion--,jaundice f zymotic disease1 
& o!r cases (      blood-poison+1 h a   
simil> me*anism--,example ( jaundice    
foll[+ ^u ague--,effect on !            

ur9e--,analysis ( !      ur9e a clue to 
! nature ( ! case 4 4 4 4 4 4 4 4 4 4 4 
4   #bd    ,passive conge/ion ( ! liv] z
 a cause ( jaundice--,cases             
associat$ ) he>t disease1 pneumonia1    
c4--,explanation (      ! reason :y     
jaundice is s frequ5tly abs5t 9 su*     
cases    #bi    ,me*anism ( jaundice    
aris+ f suppression consequ5t ^u        
abs5ce ( ! secret+ sub/ance--,canc]1    
tub]cle1      c4--,effects ( ! position 
( ! morbid deposit 9      modify+ !     
result 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
 4 4 4 4   #ca    ,jaundice aris+ f     
acute1 or yell[ atrophy ( ! liv]--,/ate 
( ! ur9e 9 su* cases--,pres5ce (        
bile-acids--,pett5k(]'s te/--,tyros9e & 
leuc9e 9 !      ur9e--,an example ( !   
affection occurr+ 9 a "y                
woman--,excit+ cause--,/ate ( ! liv]    
tissue--,poison\s      effects (        
glyco*olate ( soda inject$ into !       
circulation    #cd    ,me*anism (       
jaundice aris+ f ! re-absorption ( !    
secret$ b reta9$ bile--,jaundice aris+ f

 a      cong5ital defici5cy ( !         
ducts--,hi/ory ( a case  4 4 4 4   #ci  
,pa?ology ( jaundice result+ f !        
accid5tal ob/ruction (      !           
bile-ducts--,mode ( =mation (           
gall-/ones--,jaundice      only pres5t  
:5 ! /one is lodg$ 9 common duct--,h[   
gall-/ones may imp]il life )\t induc+   
jaundice--,modes      ( escape f !      
gall-bladd]--,pres5ce ( =eign bodies1   
su* z *]ry-/ones 9 gall-duct--,jaundice 
aris+ f      hydatids impact$ 9 ! common
 duct 4 4 4 4 4 4 4 4 4 4 4 4 4   #db   
,me*anism ( p]man5t jaundice f          
ob/ruction--,result+ f      organic     
disease--,canc] ( head (                
pancreas--,effect ( !      dilatation ( 
! bile-ducts 9 ! liv]--,effect on !     
nutrition ( ! p>5*yma ( liv]--,diff]5t  
/ages 9      size ?r\gh :i* ! liv]      
passes--,difficulties (                 
diagnosis--,cause (t5 obscure--,key to  
its detection 4 4 4 4 4   #df           
,analysis ( ! inte/9al secretion an aid 
to ! diagnosis (      obscure cases (   

abdom9al disease--,col\r1 nature1 &     
*emical composition ( ! /ools--,*anges  
produc$ 9 !m      by diff]5t foods1 &   
rem$ies 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4   
#ea    ,exam9ation ( ! r5al             
secretion--,diagno/ic value ( ! col\r   
( ! ur9e--,col\r produc$ by urohmat9 to 
be      di/+ui%$ f t produc$ by         
biliv]d9e--,simple me?od      ( sep>at+ 
! pigm5t f ! ur9e--,advantage ( at !    
same "t asc]ta9+ ! quantity ( uric acid 
pres5t--,effect ( ! bile pigm5t becom+  
deposit$ 9 !      kidneys--,production (
 second>y disease 4 4 4 4 4 4 4 4 4 4 4 
#ee    ,diagno/ic value ( ! pres5ce ( ! 
bile-acids 9 !      ur9e--,views (      
,fr]i*s1 ,/dl]1 & ,khne--,hoppe's me?od 
( detect+ ! bile-acids--,fr]i*s's !ory (
 !      trans=mation ( bile-acids into  
biliv]d9e %[n to be      unt5able  4 4 4
 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
 4 4 4   #eh    ,diagno/ic value ( !    
pres5ce ( tyros9e1 & leuc9e 9 !         
ur9e--,microscopic appe>ances ( ^!      
sub/ances--,mode (      sep>at+ !m f    

ur9e--,*emical te/s 4 4 4 4 4 4 4 4 4 4 
#fc    ,melan9e 9 ! ur9e 9 cases ( canc]
 ( ! liv]--,!      *>act]s by :i* x is  
to be di/+ui%$ f bile      pigm5t--,case
 relat$ %[+ ! value ( ! te/  4 4 4 4 4  
#fh    ,diagno/ic value ( asc]ta9+ !    
quantity ( urea1 & uric      acid1 z    
well z ! pres5ce ( sug> 9 ! ur9e 9      
obscure      cases ( jaundice--,hi/ory (
 a case illu/rat+ ! value (      su*    
k--,significance ( ! pres5ce ( fatty    
acids 9      ! fces 9 ! diagnosis (     
pancreatic disease--,pancreat9e         
adm9i/]$--,effect ( bile-poison+ on !   
memory--,analysis      ( ! pati5t's     
ur9e--,diagno/ic value ( ! quantity (   
its con/itu5ts po9t$ out--,appe>ance (  
sug> z !      =]unn] ( a fatal t]m9ation
 allud$ to--,disappe>ance (             
bile-acids1 & appe>ance ( tyros9e &     
leuc9e 9 !      latt] /ages ( !         
disease--,po/-mortem appe>ances         
describ$--,occlusion ( bile1 &          
pancreatic ducts--,analysis      (      
heal?y & diseas$ bile--,*ange 9 !       

proportion ( !      organic great] ?an 9
 t ( ! inorganic                        
con/itu5ts--,microscopic appe>ances (   
liv]--,pres5ce (      cry/als ( cy/9e1 z
 well z ( tyros9e 9 ! hepatic           
p>5*yma 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4 4 4 4 4 4 4 4 4   #gj    ,jaundice f
 ob/ruction 9 its latt] /age complicat$ 
)      jaundice f suppression  4 4 4 4 4
 4 4 4 4 4 4 4 4 4 4 4 4 4   #hi        
,epidemic jaundice--,among              
soldi]s--,among pregnant wom5--,among ! 
entire civil population--,its           
me*anism--,its cause--,case (           
jaundice sup]v5+ ^u sc>lat9a 4 4 4 4 4 4
 4 4 4 4 4 4 4   #ij    ,artificial     
jaundice--,mode ( production--,exp]im5ts
      relat$--,tyros9e1 & leuc9e suppos$
 to be ! result      ei!r ( ! arre/$1 or
 ( ! retrograde metamorphosis (         
glyco*olic1 & tauro*olic acids--,bili>y 
acids detect$ 9      ! blood--,poison\s 
nature ( ! con/itu5ts ( !               
bile--,condition ( ! blood 9            
bile-poison+ 4 4 4 4 4 4 4 4   #ie      

,treatm5t ( jaundice--,totally diff]5t 9
 jaundice f      suppression & 9        
jaundice f ob/ruction--,b5efit (        
m]cury 9 cases ( jaundice--,g5]al !ory  
reg>d+ !      action (                  
m]curials--,b5efit ( acids1 & (         
alkalies--,_!      mode ( action        
expla9$--,!ory ( _! action 9 cases (    
gall-/ones--,li?ia wat]--,treatm5t (    
jaundice by b5zoic      acid--,cases    
illu/rat+ its mode ( action--,podophyll9
 a      bane1 & an antidote 9 cases (   
jaundice--,its p]nici\s      effects 9  
cases ( ob/ruction po9t$ out--,au?or's  
!ory      ( its action 9 su*            
cases--,me?od ( detect+ gall-/ones      
9 ! /ools--,sulphuric e!r1 & *lor(orm 9 
cases (      gall-/ones--,t>axacum 4 4 4
 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4  #aja
    ,difficulties 9 ! treatm5t (        
jaundice f ob/ruction po9t$             
out--,d]angem5ts aris+ f abs5ce ( bile 9
 !      dige/ive process--,good effects 
( an additional quantity (              
food--,e/abli%m5t ( an artificial bili>y

 fi/ula %[n to      be less haz>d\s ?an 
usually imag9$--,mode ( op]ation        
expla9$--,treatm5t ( p]man5t jaundice by
 prep>$      bile--,new mode ( prep>+   
bile po9t$ out--,!ory ( its             
action--,"t ( adm9i/ration %[n to be (  
mu*      importance--,bile put into     
capsules--,b5efits d]iv$ f bile         
giv5 9 ?is =m 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4 4 4 4 4 4 4 4  #abb    ,tabul> view 
( ! pa?ology ( jaundice accord+ to !    
au?or's views 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4 4 4 4 4 4 4 4 4 4  #acb    ,,index  
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4 4 4 4 4 4 4 4 4  #acc               
,,description ,,( ,,plates ,,&          
,,woodcuts4      ,,plate ,i4            
,repres5ts ! condition ( ! p>ts 9 a     
fatal case ( p]man5t  jaundice1 9 :i*   
bo? ! bile1 & pancreatic ducts 7        
completely  occlud$4    7a7 ,atrophi$   
liv]4    7b7 ,transv]se section ( ! left
 lobe1 %[+ ! m\?s ( !  enorm\sly di/5d$ 
gall-ducts4    7c7 ,enl>g$ gall-bladd]4 
7d7 ,dilat$ cy/ic duct4    7e7 ,di/5d$  

hepatic1 & common duct4    7f7          
,ulc]ation 9 duod5um1 9 ! situation ( ! 
op5+ ( !  gall-duct into ! inte/9es4    
7g7 ,pancreas ) enl>g$ head 7h71 &      
enorm\sly di/5d$ duct4      ,,plate     
,,ii4    ,ext]nal surface ( ! left      
kidney1 d5ud$ ( its capsule1 9 a case  (
 p]man5t jaundice4    7a7 ,small specks 
( bile pigm5t deposit$ 9 ! r5al tissue1 
&  block+ up ! ur9e tubes4    7b7 ,small
 abscesses scatt]$ ?r\gh\t ! tissue ( ! 
kidney4      ,,woodcuts4      ,fig4 #a4 
,cry/als ( glyco*olate ( soda1 mag4 #ij 
diam4--,page #h4        #b4 ,tauro*olate
 ( soda1 z f\nd 9 ! =m ( globules (     
v>i\s sizes4--,page #i4        #c4      
,cry/als ( *ole/]9e4--,page #i4         
#d4 ,cry/als ( pure tyros9e4--,page #fc4
        #e4 ,spiculat$ balls ( tyros9e1 
f ! ur9e ( a case ( acute               
atrophy ( ! liv]4--,page #fd4        #f4
 ,globules ( leuc9e4--,page #ff4        
#g4 ,*ole/]9e cry/als4--,page #hb4      
#h4 7a7 ,cry/als ( cy/9e4          7b7  
,hepatic cells1 %[+ entire abs5ce ( fat 

globules4          7c7 ,caudate or      
sp9dle-%ap$ cells1 f epi!lial l9+       
( hepatic ducts4--,page #hf4      #a    
,,jaundice3 ,,its ,,pa?ology ,,&        
,,treatm5t4          ,,introduction4    
,hav+ entitl$ ?is monograph ,jaundice1  
its ,pa?ology & ,treatm5t1  x may1      
p]haps1 be necess>y = me to /ate at !   
beg9n+ t by  s do+ x is n to be suppos$ 
t ,i reg>d jaundice z a disease  p] se4 
,on ! contr>y1 ,i look ^u x 9 ! same    
light z ,i d  album9uria1 :i* is n (    
itself a disease1 b only ! mo/  prom95t 
symptom ( sev]al widely-diff]+          
pa?ological conditions4  ,s also !      
peculi> /ate ( body *>act]is$ by yell[  
sk91  saffron-col\r$ ur9e1 & pipe-clay  
/ools1 is itself b a symptom  ( morbid  
action4 ,x may be ask$1 ,!n :y d y treat
 ( jaundice  z if x 7 a disease8 ,to ?is
 ,i reply1 ,because1 al?\gh #b !        
condition call$ jaundice be m]ely a     
manife/ation ( morbid action1  & "o1    
too1 requir+ nei!r skill nor exp]i5ce to
 detect1 !  prop] compreh5sion ( its    

true me*anism is ( mu* practical        
importance to ! physician1 = )\t ?is k x
 is  impossible = him to treat x ) any  
*ance ( success4 ,nay1 ev5  ! rem$ies = 
jaundice become dang]\s weapons1 if     
unskilfully  appli$4 ,9 fact1 x is almo/
 unnecess>y to apologise = treat+  (    
jaundice z a disease p] se2 =1 not)/&+  
all t has  be5 writt5 ^u ! subject1 x is
 univ]sally admitt$ t !  simplicity (   
its diagnosis is only equall$ by !      
obscurity ( its  pa?ology1 & ! unc]ta9ty
 ( its treatm5t2 & no "o at all         
conv]sant ) ! lit]ature ( jaundice c be 
9 ! lea/ degree  surpris$ at ?is        
/atem5t4 ,on ! contr>y1 on glanc+ at !  
imm5se v>iety ( morbid /ates1 & kn[n    
pa?ological conditions  ) :i* x is      
associat$1 he _c fail to admit its tru?4
    ,"s ( ! pa?ological conditions are  
closely alli$2 o!rs are  widely         
sep>at$--s widely1 inde$1 t at fir/     
sight x is  impossible to discov] f :5ce
 emanates ! common symptom4 ,we f9d     
jaundice connect$ ) diseases ( ! liv]1 (

 ! neighb\r+  organs1 & ( ! g5]al sy/em4
 ,9 "s diseas$ conditions1 #c  jaundice 
pres5ts itself :5 lea/ expect$4 ,at o!r 
times x is  abs5t :51 app>5tly1 x ought 
to be pres5t4 ,on ! o!r h&1  aga91 !re  
are cases 9 :i* jaundice is evid5tly    
m]ely a symptom1  & o!rs 9 :i* x seems  
to be 9 itself ! disease4 ,we h         
tempor>y jaundice f transi5t d]angem5ts1
 & we h p]man5t  jaundice f /ation>y    
causes4 ,!re are cases 9 :i* ! cause (  
jaundice is visible aft] dea? to ! nak$ 
eye4 ,!re are o!rs  :]e ! m9ute/ rese>* 
is baffl$ 9 asc]ta9+ ! cause4 ,t  ?is is
 no exagg]at$ view ( ! case ! foll[+    
table w  %[3--                          
,,jaundice ,,is ,,met ,,)1      ,fir/ly1
 ,,9 ,,diseases ,,affect+ ,,! ,,liv]--  
7a7 ,canc]4    7b7 ,tub]cle4    7c7     
,cirrhosis4    7d7 ,inflammation4    7e7
 ,atrophy4    7f7 ,amyloid1 &    7g7    
,fatty deg5]ation4        ,secondly1 ,,9
 ,,diseases ,,( ,,! ,,bile-,,ducts--    
7a7 ,cong5ital defici5cy4    7b7        
,accid5tal ob/ruction4 ,! latt] aris+ f 

gall-/ones1            hydatids1 =eign  
bodies #d 7su* z *]ry-/ones &           
entozoa7 ent]+ f ! inte/9es4    7c7     
,ulc] ( ! duod5um4    7d7 ,tum\rs ( !   
pancreas4        ,?irdly1 ,,9           
,,affections ,,( ,,o!r ,,organs ,,( ,,! 
,,body ,,ex]t+ ,,an      ,,influ5ce ,,on
 ,,! ,,bili>y ,,secretion--    7a7      
,diseases ( ! n]v\s sy/em4    7b7       
,diseases ( ! lungs4    7c7 ,diseases ( 
! he>t4    7d7 ,imp]fect e/abli%m5t ( ! 
extra-ut]9e circulation                 
7infantile jaundice74    7e7 ,dyspepsia4
    7f7 ,torpidity ( ! b[els1 &         
consequ5t accumulation ( fces           
9 transv]se colon4    7g7 ,pregnancy4   
,f\r?ly1 ,,9 ,a ,,v>iety ,,( ,,zymotic  
,,diseases--    7a7 ,typhus4    7b7     
,yell[ fev]4    7c7 ,ague4    7d7       
,pymia4    7e7 ,epidemic jaundice4      
,fif?ly1 ,,z ,a ,,result ,,( ,,!        
,,injuri\s ,,effects ,,( ,,c]ta9        
,,poisons--    7a7 ,snake bites4 #e     
7b7 ,alcohol4    7c7 ,*lor(orm1 etc4    
,c x be wond]$1 !n1 t a /ate s easily   

diagnos$ is  nev]!less s difficult to   
compreh5d8    ,not)/&+ ! app>5t         
incongruity ( ! diseases ) :i* !  "o    
common symptom ( jaundice is associat$1 
,i tru/ to be able to  reconcile ^!     
discrepancies1 & prove t ! seem+ discord
 is  b h>mony n und]/ood4    ,all       
physicians1 ,i ?9k1 admit t ! peculi>   
/ate ( ! sy/em to  :i* ! "n ( jaundice  
has be5 appli$1 is ess5tially due to "s 
d]angem5t ( ! bili>y function1 ! exact  
nature ( !  d]angem5t be+ alone ! po9t (
 cont5tion4 ,i ne$ n1 !re=e1  wa/e ! "t 
( my read]s1 ei!r by giv+ an acc\nt ( ! 
lit]ature or a detail ( ! symptoms (    
jaundice4 ,ev5 9 discuss+  its pa?ology1
 ,i %all /rictly limit myself to !      
consid]ation (  ! op9ions at pres5t held
 by ! m advanc$ ( our pa?ologi/s2  !    
object ( ?is monograph be+1 n to p\rtray
 ! views (  o!rs1 b to give a brief     
expos ( my own1 & to po9t out h[  mod]n 
physiology1 & *emi/ry h n only ?r[n a   
new light on  its pa?ology1 b h also    
giv5 u a clue to its successful         

treatm5t4    #f ,fr]i*s1 ! mo/ rec5t    
writ] on ?is subject1 9 8 elaborate     
treatise on diseases ( ! liv]1 says t   
jaundice may result f  "o ( ! ?ree      
foll[+ conditions3--                    
,fir/ly1--,ob/ruction to ! escape (     
bile4    ,secondly1--,dim9i%$           
circulation ( blood 9 ! liv]1 &         
consequ5t  abnormal diffusion2 bo? ( ^! 
conditions giv+ rise to an  increas$    
imbibition ( bile into ! blood1 & 9 bo? 
cases !  liv] be+ m or less directly    
implicat$4    ,?irdly1--,ob/ruct$       
metamorphosis1 or a dim9i%$ consumption 
( bile  9 ! blood4#a    ,footnote #a3   
,fr]i*s' ,cl9ical ,treatises on         
,diseases ( ! ,liv]4  ,new ,syd5ham     
,society's ,translation1 vol4 i4 p4 #ic4
    ,f ?is x is se51 t ! pa?ology (     
jaundice1 accord+ to  ,fr]i*s1 is v     
diff]5t f :at we 7 =m]ly taught4 ,=     
:ile he has entirely laid aside ! !ory (
 jaundice z a result (  suppress$       
secretion1 he has introduc$ two p]fectly
 new  elem5ts--namely1 abnormal         

diffusion1 & dim9i%$ consumption4 ,!    
latt] !ory1 be+1 ( c\rse1 f\nd$ on !    
supposition t bile1  aft] play+ its "p 9
 ! dige/ive process1 is re-absorb$ into 
! circulation1 aga9 to p]=m ano!r       
function 9 ! animal  economy1 be=e its  
f9al excretion f ! organism z effete    
matt]4  ,! !ory ( jaundice1 hi!rto mo/  
fav\r$ 9 ,engl&1 & :i*  f\nd #g su* an  
able expon5t 9 ,dr4 ,budd1 is1 t !      
disease may  arise 9 two ways--fir/ly1  
by a me*anical ob/ruction to ! passage  
( bile into ! inte/9es1 & ! consequ5t   
re-absorption ( !  deta9$ fluid into !  
blood2 & secondly1 by a suppression ( ! 
bili>y secretion aris+ f "s morbid      
condition ( ! liv]  itself1 :]eby !     
bili>y +r$i5ts accumulate 9 !           
circulation4  ,n[1 al?\gh ,i am n prep>$
 to admit ! ju/ice ( ! views held       
reg>d+ ! orig9 & function ( bile1 on :i*
 ^! op9ions are  bas$1 ,i nev]!less     
believe t 9 ! foll[+ pages ,i %all be   
able1 by ! aid ( mod]n m$ical sci5ce1 to
 prove ! correctness (  ! conclusions   

!mselves4 ,9 ord] to d ?is1 h[ev]1 x w  
be  necess>y = me to beg9 by mak+ a few 
rem>ks on ! nature (  bile1 & !         
physiology ( its secretion4      ,,on   
,,! ,,nature ,,( ,,bile4    ,9 a few    
words1 bile may be said to be compos$ ( 
! foll[+  sub/ances3--                  
,fir/ly1--,biliv]d9e1 a gre5 nitrog5iz$1
 non-cry/allizable  col\r+ matt]1       
analog\s to ! gre5 col\r+ matt] (       
plants1  & l x1 leav+ on inc9]ation a   
di/9ctly f]rug9\s a%4 ,?is  col\r+ matt]
 appe>s1 l #h urohmat9e1 & all o!r      
animal  pigm5ts1 to be a direct         
d]ivative ( ! col\r+ matt] ( !  blood4#b
    ,footnote #b3 ,vide pap]s by ! au?or
 on ! col\r+ matt] ( !  ur9e1 ,ph>m4    
,j\rn41 ,novemb]1 #aheb4 ,urohmat9e1 &  
its comb9ation  ) animal res94 ,v]h4 d4 
,phys4-,m$4 ,gesells*aft zu ,wurzburg1  
,bd4  ,v4 #ahed4    ,illu/ration3 ,,fig4
 #a4 ,cry/als ( ,glyco*olate ( soda1 a  
beautiful  pol>iscopic object4 7a7 ,f9e 
ne$le-%ap$ cry/als1 sep>at$ f  a        
rosette-%ap$ gr\p4 7b7 ,small rosette ( 

cry/als4 7c7  ,fan-%ap$ gr\ps ( cry/als1
 :i* are m]ely portions ( l>ge  rosettes
 t h become brok5 up4 7d7 ,a fragm5t ( a
 bundle (  ne$le-%ap$ cry/als4 ,mag4 #ij
 diam4    ,secondly1--,two peculi>      
sub/ances1 nam$ respectively1           
glyco*olic1  & tauro*olic acid--! =m]   
yield+1 :5 9 comb9ation )  soda1 a      
cry/allizable1 ! latt] a                
non-cry/allizable salt4  ,tauro*olic    
diff]s /ill fur!r f glyco*olic acid1 9  
conta9+  a l>ge p]c5tage ( sulphur1 #i &
 be+1 "u ! influ5ce (  hydro*loric acid1
 conv]tible into taur9e1 a beautiful    
:ite  cry/all9e sub/ance4               
,illu/ration3 ,,fig4 #b4 ,tauro*olate ( 
soda is f\nd 9 ! =m (  fatty-look+      
globules ( v>i\s sizes4 ,!y diff] f fat 
& oil  globules1 h[ev]1 9 be+ soluble 9 
wat]1 & insoluble 9 alcohol  & e!r4     
,?irdly1--,*ole/]9e1 a cry/all9e1 fatty 
matt]1 n1 h[ev]1  peculi> to bile1 b    
f\nd 9 v>i\s tissues1 & secretions ( !  
body4    ,illu/ration3 ,,fig4 #c4       
,*ole/]9e cry/als appe> 9 ! =m ( f9e    

transp>5t f\r-sid$ plates ( v>i\s sizes 
& %apes4 ,! cry/als  are freely soluble 
9 hot alcohol1 f :i* !y are re-deposit$ 
on  cool+4    #aj ,f\r?ly1--,a br[n     
res9\s sub/ance resembl+1 9 appe>ance  &
 consi/5ce1 %oemak]'s wax4              
,fif?ly1--,among ! con/itu5ts ( ! bile1 
,i may m5tion sug>1 =  bo? 9 ! normal   
bile ( man1 & ( ! l[] animals1 ! ox1 &  
! dog1 ,i h detect$ t sub/ance4 ,on "o  
occasion1 ,i ev5 f\nd  torul 9 ! bile   
tw5ty-f\r h\rs aft] its removal f !     
gall-bladd] ( a heal?y dog4    ,six?ly1 
& la/ly1--a quantity ( inorganic matt]1 
consi/+  *iefly ( soda1 pota%1 & iron4  
,! specific gravity ( bile fluctuates1 (
 c\rse1 ) ! p]c5tage  ( solid matt] x   
conta9s4 ,f my own obs]vations1 ,i      
consid] t  heal?y human bile has an     
av]age specific gravity ( #ajbj1 &      
conta9s ab\t six p] c5t4 ( solid matt]1 
five p] c5t4 ( :i*  is organic1 & "o p] 
c5t4 inorganic sub/ance4 ,:5 fre%1 bile 
is  almo/ neutral2 b x rapidly und]goes 
decomposition1 & becomes  alkal9e4    ,9

 col\r1 human bile is usually ( a br[ni%
 yell[ hue2 ! col\r1  h[ev]1 v>ies ) its
 degree ( conc5tration1 ! k9d ( food    
tak51 & ! /ate ( ! sy/em4 ,z reg>ds !   
effect ( food1 if  we may be all[$ to =m
 an op9ion f exp]im5ts on dogs1 x may   
be said t1 z a #aa rule1 animal food    
t5ds to give bile a yell[1  vegetable   
food a gre51 t9t4    ,next1 z reg>ds !  
mann] 9 :i* bile is secret$4 ,= a long  
"t  x 0 ?\ght1 &1 inde$1 "s p /ill ?9k1 
t bile exi/s  pre-=m$ 9 ! blood1 & t !  
liv] only excretes x1 z !  kidneys      
excrete ! ur9>y +r$i5ts4 ,ano!r class1  
runn+ to !  opposite extreme1 believe t 
! liv] is n m]ely ! excretive1  b also !
 =mative organ ( ! bile4 ,x appe>s to   
me1 h[ev]1  t nei!r ( ^! extreme views  
is correct1 & t ! tru? lies  betwe5 !   
two4    ,x is1 9 fact1 n at all         
difficult to prove t ! liv]             
manufactures c]ta9 bili>y con/itu5ts1   
:ile x m]ely excretes  o!rs4 ,?us1 =    
example1 ! two sub/ances glyco*olic &   
tauro*olic acids are nev] to be f\nd    

ei!r 9 ! blood1 tissues1  or fluids ( ! 
heal?y organism1 ) ! s+le exception ( ^?
  ( ! liv] & gall-bladd]2 & aft]        
extirpation ( ! liv]  nei!r acid is to  
be f\nd 9 ! body at all4 ,on ! o!r h&1  
su*  sub/ances z *ole/]9e & biliv]d9e1  
are n peculi> to !  liv] or its         
secretion1 b are ! products ( sev]al    
organs1 & are  always to be detect$ 9 ! 
blood1 indep5d5tly ( ! pres5ce or       
abs5ce ( ! liv]4 ,^! facts1 !re=e1      
cle>ly %[ t !  liv] #ab is bo? a =mative
 & excretive organ to "s1 & an          
excretive only to o!rs1 ( ! bili>y      
con/itu5ts4    ,la/ly1 ! g5]al op9ion is
 t ! secretion int]mits1 &1 l  ! ga/ric1
 & pancreatic juices1 bile is only =m$  
dur+  dige/ion4 ,7 x s1 h[ev]1 :]e w\ld 
be ! necessity = a  gall-bladd]8 ,is x n
 to /ore up ! secretion =m$ 9 !         
int]vals ( dige/ion1 & to reta9 x until 
x is requir$8 ,no d\bt  !re are sev]al  
animals1 su* z ! horse1 & ! de]1 t      
possess no gall-bladd]s2 b !re is       
und\bt$ly 9 !m "s special  arrangem5t ( 

! dige/ive app>atus1 r5d]+ ! pres5ce ( a
  gall-bladd] unnecess>y4 ,9 fact1 x is 
easily %[n t ! bili>y  secretion 9      
ord9>y cases is cont9u\s2 = if 9 an     
animal  possess+ a gall-bladd] a bili>y 
fi/ula be e/abli%$1 & !  secretion (    
bile c>efully wat*$1 x w be f\nd t at no
 p]iod  ( ! day does x entirely int]mit1
 al?\gh x is m active at "o  "t ?an at  
ano!r1 ! m9imum ( its activity be+ dur+ 
sleep--! maximum dur+ active dige/ion4  
,! absolute quantity (  bile secret$ 9 !
 tw5ty-f\r h\rs is tol]ably uni=m1      
al?\gh  ! daily am\nt is slightly       
influ5c$ by ! k9d ( food4#c    ,footnote
 #c3 ,arnold f\nd t dogs secret$ m bile 
on a bread1 ?an  on an animal diet4 ,zur
 ,physiologie d] ,galle1 ,mannheim1     
#ahed4      #ac ,,is ,,bile ,,ess5tial  
,,to ,,life8    ,sev]al physiologi/s h  
giv5 x z _! op9ion t bile is n  ess5tial
 to life1 = animals h liv$ = _m mon?s   
aft] !  artificial e/abli%m5t ( a bili>y
 fi/ula1 ?r\gh :i* ! bile  0 all[$ to   
fl[ away1 & be lo/ to ! animal4 ,n[1    

al?\gh ?is  is p]fectly true1 yet x is  
at ! same "t evid5t t ! uses (  ! bile  
_c altoge!r be disp5s$ )1 = all !       
animals )  a bili>y fi/ula lose fle%1   
become emaciat$1 & weak2 ! hair has  a  
t5d5cy to fall (f1 ! b[els to become    
irregul>2 & a great &  an almo/ con/ant 
dis*>ge ( f\l-smell+ gases takes place f
  ! inte/9al canal4 ,at l5g?1 aft] a    
%ort] or long] p]iod1 !  animal s9ks1 & 
dies4 ,! fatal t]m9ation c1 h[ev]1 be   
ret>d$  by all[+ him an additional      
quantity ( n\ri%+ food1 = dea?  f want (
 bile1 z is too (t5 se5 9 ! human       
subject1 is  no?+ else ?an dea? f sl[   
/>vation4 ,! fact j relat$  reg>d+ !    
b5eficial effects ( an additional       
quantity ( food 9  prolong+ life1 %\ld  
nev] be lo/ sight ( 9 ! treatm5t (      
cases ( ob/ruction ( ! gall-ducts1 =1 by
 att5d+ to ?is  circum/ance1 x is (t5 9 
! p[] ( ! m$ical man to keep 8  pati5t  
alive = a consid]able l5g? ( "t4    #ad 
,x may p]haps n be out ( place if ,i "h 
briefly enum]ate !  *ief uses ( bile 9 !

 animal economy4 ,9 ord] to live1 n only
  mu/ ! individual p>ticles ( our frames
 die1 b !y mu/ be  cont9ually replac$ by
 new mat]ials ( a simil> k9d2 & = !     
accompli%m5t ( ?is important end1 nature
 has end[$ animals ) a  dige/ive        
app>atus 9 :i* _! food und]goes ! v>i\s 
physical1  & *emical *anges necess>y to 
its absorption1 & assimilation4 ,9  !   
animal laboratory or dige/ive app>atus  
!re are five important  ag5ts con/antly 
at "w--saliva1 ga/ric juice1 bile1      
pancreatic  fluid1 & inte/9al secretion1
 & ea* ( ^! ag5ts has a special  &      
def9ite (fice to p]=m 9 ! elaboration ( 
! food4#d ,at  pres5t1 h[ev]1 ,i mu/    
limit myself entirely to ! consid]ation 
(  bile4    ,footnote #d3 ,= an         
explanation ( ^! (fices1 see ! au?or's  
article on ,! ,*emi/ry ( ,dige/ion1 9 ! 
,briti% & ,=eign  ,qu>t]ly ,review1     
,janu>y1 #ahfj4    ,bile is ! fir/      
dige/ive ag5t ) :i* ! food comes 9      
contact  on leav+ ! /oma* & ent]+ !     
inte/9es1 & imm$iately on  ! acid *yme  

mix+ ) ! alkal9e bile1 a :ite floccul5t 
emulsion is =m$1 :i* emulsion has be5   
describ$ by _m writ]s  z a precipitation
 ( ! album9ose 7dige/$ album574 ,lat]   
#ae  rese>*es by myself & o!rs h1 h[ev]1
 %[n t x is n !  bile :i* precipitates !
 album9ose1 b ! acid ( ! *yme1  :i* 9   
reality sets free c]ta9 +r$i5ts ( !     
alkal9e bile4 ,9  ! majority ( cases !re
 is n ev5 a true precipitation1 = on    
?r[+ ! milky-look+ mixture ^u a filt]1  
,i f\nd t almo/  no?+ rema9$ beh9d1 & ! 
filtrate 0 ne>ly z :ite z !  orig9al    
liquid4 ,fur!r1 if ! album9ose be       
sep>at$ f !  *yme1 & ! *yme !n br\ght   
into contact ) ! bile1 ! same           
floccul5t-look+ milk9ess /ill appe>s4   
,nay1 m1 on add+ equal  p>ts ( %eep's   
bile 7fre%7 to ga/ric juice drawn f a   
dog's  /oma* 9 full dige/ion1 ! app>5t  
floccul5t precipitate /ill  appe>$1     
al?\gh ! acidity ( ! ga/ric juice rema9$
  unneutraliz$2 & on ?r[+ ! :ole into a 
filt]1 ,i f\nd t  ! liquid t dra9$ ?r\gh
 0 z milky & floccul5t-look+ z  !       

orig9al4 ,! (fice ( bile 9 ! dige/ive   
process is nei!r to  act on ! album9\s#e
 nor amylace\s portions #af ( our food2 
its  *ief action be+ to assi/ 9 !       
absorption ( fats4 ,:5 bile is  mix$ )  
neutral fat1 little *ange is obs]v$1 b  
:5 br\ght 9  contact ) ! fatty acids1 an
 imm$iate emulsion takes place4 ,l5z  & 
,m>cet#f po9t$ out h[ ! neutral fats (  
our food are  trans=m$ into fatty acids 
dur+ _! soj\rn 9 ! /oma*2 &  ,bidd] &   
,s*midt#g illu/rat$ by exp]im5ts on dogs
 ! important  "p play$ by ! bile 9 _!   
absorption4 ,a dog1 :i* 9 its normal    
condition absorb$ on an av]age #g gra9s 
( fat = e #b p\nds (  its weight1       
absorb$ only #c1 or ev5 z little z #a   
gra91 aft] !  bile 0 prev5t$ ent]+ !    
inte/9es1 9 consequ5ce ( a  ligature be+
 appli$ to ! gall-duct4    ,footnote #e3
 ,9 speak+ ( ! prop]ties ( ! bile1 ,i   
may m5tion  t1 al?\gh bile has no       
dige/ive p[] 7prop]ly speak+7 ov]       
album9\s sub/ances1 yet1 :5 inject$ into
 ! subcutane\s  cellul> tissue ( a      

heal?y animal1 x eats its way out ?r\gh 
!  sk91 j z ga/ric juice or lactic acid 
does "u simil>  circum/ances4 ,ev5 !    
muscles ) :i* x comes 9 contact appe>   
to be eat5 away4    ,footnote #f3 ,vide 
a ,disc\rse on ! ,*emi/ry ( ,dige/ion1  
by ,dr4  ,m>cet4 ,j\rn4 ( ! ,*em4 ,soc41
 ,oct4 #ahfb4    ,footnote #g3 ,die     
,v]dauungssaefte und d] ,/(fwe*sel4     
,leipzig1  #aheb4    ,fur!r1 ^! la/-nam$
 obs]v]s f\nd t1 :ile ! *yle 9 !        
?oracic duct ( a heal?y dog conta9s #cb 
p>ts ( fat p] ?\s&1  t 9 ! ?oracic duct 
( a dog ) a ligatur$ gall-duct1 conta9s 
only #b p>ts p] ?\s&4 ,^! facts cle>ly  
prove t bile plays an  important "p 9 ! 
absorption ( ! fatty portion ( our food4
 ,next  comes ! "q1 ,9 :at mann] does   
bile aid 9 ! absorption (  fatty matt]8 
#ag ,z is well kn[n1 fats or oils h no  
t5d5cy to  mix ) wat]1 & h5ce diosmose  
betwe5 an aque\s & an oily fluid  is    
next to impossible4 ,matteucci has1     
h[ev]1 %[n t if an animal  membrane be  
moi/5$ on bo? sides ) a weak solution ( 

pota%1 x  all[s oil to pass ?r\gh x4 ,x 
has also be5 obs]v$1 t :5 !  inte/9e is 
moi/5$ ) bile1 x all[s oil to pass      
?r\gh1 :i*  w\ld n o!rwise be ! case4   
,to illu/rate ?is prop]ty ( bile1 ,i    
p]=m$ ! foll[+ exp]im5ts3--             
,fir/ly1--,a clean piece ( duod5um 0    
fill$ ) oil1 ligatur$ at  bo? ends1 &   
susp5d$ 9 wat]1 hold+ 9 solution a small
 quantity  ( album54 7,! album5 0 add$  
to ! wat] m]ely to imitate  slightly !  
album9\s blood47 ,on exam9ation1        
tw5ty-f\r h\rs  lat]1 no oil 0 f\nd to h
 escap$ ?r\gh ! inte/9al walls4         
,secondly1--,a second portion ( inte/9e 
_h its int]nal surface  moi/5$ ) %eep's 
bile be=e ! introduction ( ! oil4 ,x 0  
!n treat$ 9 ! same mann] z ! prec$+1 &  
on be+ exam9$  aft] ! lapse ( tw5ty-f\r 
h\rs1 a small quantity ( ! oil 0  f\nd  
to h p5etrat$ ?r\gh ! inte/9e4          
,?irdly1--,into a ?ird portion ( inte/9e
 0 p\r$ equal p>ts (  %eep's bile1 &    
*yme obta9$ f a dog 9 full dige/ion1    
?r\gh  a #ah fi/ul\s op5+ into its      

/oma*4 ,aft] be+ treat$ = !  same l5g? (
 "t1 & 9 precisely ! same mann] z !     
o!rs1  evid5t signs ( ! oily matt]s ( ! 
*yme hav+ pass$ ?r\gh  ! walls ( !      
inte/9e 7 obta9$1 = !y 7 se5 z a scum   
float+ on ! surface ( ! album9\s wat]4  
,moreov]1 ! fatty  matt]s 7 n 9 ! =m (  
pure oil1 b ( a soapy sub/ance4    ,!   
bile is ?us se5 to possess "o ( ! m     
rem>kable prop]ties  ( ! pancreatic     
juice4 ,!re is ?is important diff]5ce   
betwe5 !  action ( ^! two secretions on 
fats1 h[ev]1 t :ile bile m]ely          
emulsions & saponifies t portion ( our  
food :i* ent]s !  duod5um 9 ! =m ( fatty
 acids1 pancreatic juice1 on ! o!r  h&1 
possesses ! p[]1 n only ( emulsion+ &   
saponify+ !  fatty acids1 b also !      
neutral fats2 inde$1 its p[] seems      
*iefly  to be ex]t$ ^u ! latt]4 ,h5ce x 
appe>s t bo? secretions  are 9 a measure
 necess>y to ! complete dige/ion &      
absorption (  ! oleag9\s con/itu5ts (   
our food4    ,on "o occasion1 :ile      
exp]im5t+ ) bile at ,univ]sity ,college1

 ,i  0 surpris$ to he> ,m9ton1 ! s]vant 
:o 0 assi/+ me1 say1  t :ile he 0       
travell+ ) ,sir ,&rew ,smi? 9 ,s\?      
,africa1 he  _h (t5times se5 ! #ai      
,caffres dr9k bile direct f !           
gall-bladd]s ( ! animals kill$ by !     
,european p>ty1 & t1  :ile pass+ !      
gall-bladd] r\nd to ea* o!r1 !y w\ld rub
  _! /oma*s & say1--,moo-ka-kolla1      
signify+ !reby1 t x  0 v good4 ,x       
c]ta9ly seems v extraord9>y t any human 
be+ %\ld n only dr9k1 b dr9k ) pleasure1
 a liquid s  bitt] & nauseat+ z bile4   
,p]haps ! poor ,caffres1 h[ev]1 drank  !
 sick5+ ta/$ bile = ! same reasons z !  
cattle 9  ,caffrel&1 at c]ta9 p]iods ( !
 ye>1 g ?\s&s ( miles to  dr9k at !     
salt-spr+s4 ,!re be+ sc>cely any *loride
 ( sodium  9 ! e>?1 !re is insuffici5t =
 ! animal requirem5ts 9 !  h]bage on :i*
 !y fe$1 & !y are =c$ to supply !       
defici5cy by artificial means4 ,bile    
conta9s a l>ge p]c5tage (  soda1 &      
p]haps ! ,caffres dr9k x 9 ord] to obta9
 t  sub/ance1 j z ! animals dr9k !      

bracki% wat] ( ! salt  licks1 feel+ t x 
agrees ) !m1 )\t kn[+ :y4      ,,!      
,,me*anism ,,( ,,jaundice4    ,z said 9 
! beg9n+ ( ?is pap]1 ,i believe1 !      
pa?ology (  jaundice may be embodi$ "u !
 two heads1 jaundice f suppression  #bj 
( ! bili>y functions1 & jaundice f      
re-absorption ( !  secret$ b reta9$     
bile4 ,^! are at be/1 h[ev]1 b vague    
t]ms1 & 9 ord] to make ! pa?ology (     
jaundice some:at m  def9ite x w be      
necess>y = me to subdivide ^! two great 
classes 9 ! foll[+ mann]3--             
7,,class ,a47--,,jaundice ,,f           
,,suppression4                ,aris+    
f3--      7#a7 ,en]vation4      7#b7    
,disord]$ hepatic circulation4      7#c7
 ,abs5ce ( secret+ sub/ance4            
7,,class ,b47--,,jaundice ,,f           
,,re-,,absorption4                ,aris+
 f3--      7#a7 ,cong5ital defici5cy (  
bile-ducts4      7#b7 ,accid5tal        
ob/ruction ( bile-ducts4    ,i %all n[  
try to po9t out ! pa?ology ( ^! diff]5t 
/ates1  & see h[ f> !y are able to      

expla9 ! occurr5ce ( jaundice  "u !     
v>i\s conditions already allud$ to4     
,,jaundice ,,f ,,suppression4    ,al?\gh
 !re c be no misund]/&+ ! mean+ ( ! t]m 
jaundice f suppression1 !re may1        
nev]!less1 be "s  difficulty 9          
compreh5d+ h[ ! sk9 becomes yell[1 & !  
ur9e  high col\r$1 :5 ! secretion #ba ( 
bile is arre/$4 ,9 ord] to  expla9 h[   
?is occurs1 x w be necess>y to recall to
 m9d :at  0 said reg>d+ ! nature ( !    
bili>y secretion4 ,x w be  rememb]$ t ,i
 began by say+1 t :ile "s ( ! con/itu5ts
  ( ! bile are g5]at$ 9 ! liv] itself1  
!re are o!rs t  exi/1 pre-=m$ 9 ! blood4
    ,if ?is view ( ! physiology ( !     
bili>y secretion be correct1 x  is      
p]fectly evid5t t :5 ! secretion ( bile 
is arre/$1 ^?  sub/ances :i* ! liv]     
g5]ates w be entirely want+1 :ile  ^?   
:i* x m]ely excretes f ! blood w        
accumulate !re z  soon z _! excretion is
 prev5t$2 j z urea accumulates 9 !      
circulation :5 its elim9ation by !      
kidneys is /opp$4 ,h5ce x is  t1 z soon 

z ! bili>y secretion is 9 abeyance1     
biliv]d9e  accumulates 9 ! blood 7until 
! s]um is z x 7 completely  saturat$ ) !
 pigm5t71 f :i* x exudes & /a9s !       
tissues1 & produces ! col\r we t]m      
jaundice4 ,at ! same "t1 or  ev5 be=e ! 
sk9 becomes yell[1 ! ur9e assumes a     
saffron t9t  9 consequ5ce ( ! elim9ation
 ( ! col\r+ matt] by !  kidneys4#h ,f   
?is x w be se5 t ,i reg>d #bb ! yell[   
sk9 & high-col\r$ ur9e ( jaundice z     
simply due to ! d]ang$  secretion (     
biliv]d9e1 q indep5d5t ( ! pres5ce or   
abs5ce  ( ! o!r con/itu5ts ( ! bile1 !  
effects produc$ by :i*  w be ref]r$ to  
else:]e4 ,mean:ile we %all sep>ately    
consid]  ! fur!r pa?ology ( ! ?ree      
subdivisions ( jaundice aris+  f        
suppression4    ,footnote #h3 ,! true   
ord] ( ! occurr5ce ( ^! *anges is3--,on 
! second day ! ur9e becomes high-col\r$2
 9 a day or two lat]  ! sk9 assumes a   
yell[ t9t2 &1 9 v sev]e cases1 )9 !     
fir/ week or two1 ! sweat1 ! milk1 !    
te>s1 ! sputa1 & !  s]um 9 ! ?oracic &  

abdom9al cavities1 become ( a m or less 
decid$ yell[ hue4      ,,jaundice ,,z ,a
 ,,result ,,( ,,en]vation4    ,x is n[ a
 well-e/abli%$ fact t all secretions are
 "u !  direct influ5ce ( ! n]v\s sy/em4 
,/imulate a n]ve supply+ a  gl&1 &      
secretion is accel]at$2 /op ! n]v\s     
action1 &  secretion is z in/antane\sly 
arre/$4 ,aga91 j 9 ! same way  z        
volition c produce or susp5d muscul>    
movem5t1 m5tal influ5ce  c ha/5 or ret>d
 gl&ul> secretion4 ,z an illu/ration (  
?is  fact1 ,i ne$ only call to m9d !    
influ5ce ! m]e sight ( food has  9      
excit+ ! saliv>y secretion1 & ! effect (
 bad news 9  arre/+ x4 ,exactly ! same  
influ5ce z is "h allud$ to1 is  ex]t$ by
 ! m9d ov] ! bili>y function4 ,if1 =    
example1 #bc z  ,b]n>d fir/ obs]v$1 a   
dog ) a bili>y fi/ula be c>ess$1 !      
secretion ( bile is actively cont9u$2   
if1 on ! o!r h&1 !  animal be sudd5ly   
ill-us$1 ! secretion ( bile is in/antly 
arre/$4 ,if he be aga9 c>ess$1 !        
secretion is re-e/abli%$1 &  ! bile fl[s

 drop by drop f ! end ( ! cannula4 ,"h !
  influ5ce is entirely produc$ ?r\gh !  
int]v5tion ( ! n]v\s  sy/em2 & if su*   
effects z are above describ$ occur 9 !  
dog1 we  c surely h little difficulty 9 
und]/&+ h[ ! bili>y  secretion c be     
influ5c$ 9 ! highly-develop$            
organization ( !  human be+4 ,inde$1 e  
"o mu/ h felt h[ quickly sad tid+s      
receiv$ dur+ a meal n only de/roy !     
appetite & ret>d  dige/ion1 b           
occasionally alt] ! complexion4 ,?is    
effect1 t all  ( u mu/ h exp]i5c$ 9 a   
slight degree 9 our own p]sons1  sev]al 
may h obs]v$ to a great] ext5t 9 !      
p]sons ( o!rs1  ev5 to ! production (   
well-m>k$ jaundice4 ,at ?is v "t ,i  h  
"u my c>e a "y m>ri$ lady1 :o dur+ ! la/
 two ye>s  has twice suff]$ f an attack 
( jaundice induc$ by witness+ h]  *ild 9
 convulsions1 & ?is ,i reg>d z an       
example ( jaundice f  en]vation4    ,"o 
( ! reasons1 no d\bt1 :y jaundice does n
 m frequ5tly  foll[ ^u m5tal emotion is 
#bd simply on acc\nt ( a c]ta9  am\nt ( 

pigm5t be+ requir$ 9 ord] to produce a  
visible t++  ( ! body1 & x seldom happ5s
 t ! emotional effect on !  bili>y      
secretion is suffici5tly p]man5t to     
p]mit ( ! requisite  am\nt ( pigm5t     
accumulat+ 9 ! blood4 ,! reason1 too1 :y
  m5tal emotion is m apt to cause       
jaundice imm$iately aft] a meal  is1 z w
 aft]w>ds be bett] und]/ood1 on acc\nt (
 !  conge/$ /ate ( ! liv] at t "t fav\r+
 ! /oppage ( !  secretion4 ,a bl[ on !  
head1 :i* is n[ & !n obs]v$ to be       
sudd5ly foll[$ by jaundice1 acts1 ,i    
believe1 9 ! same way z  fright1 namely1
 by p>alyz+ ! n]ve =ce requir$ = !      
cont9uance ( ! bili>y secretion4    ,i  
n[ pass on to ! consid]ation ( !        
pa?ology ( ! second k9d  ( jaundice f   
suppression1 namely1 jaundice result+ f 
hepatic  conge/ion4      ,,jaundice     
,,aris+ ,,f ,,hepatic ,,conge/ion4      
,?is is "o ( ! mo/ common causes ( !    
disease2 b z !re are  two k9ds ( hepatic
 conge/ion--active & passive--x w be    
necess>y = me to make a fur!r           

subdivision1 & consid] ea* (  ^!        
sep>ately4      #be ,jaundice ! ,result 
( ,active ,conge/ion4    ,! me*anism (  
jaundice result+ f active conge/ion ( ! 
liv]  is readily expla9$ on             
physiological gr\nds4    ,! conge/$     
condition ( any gl& is unfav\rable to   
secretion4 ,we  all "k1 = example1 t    
conge/ion ( ! kidney is accompani$ by  a
 suppression ( ! ur9>y secretion1 & t ! 
secretion is  re-e/abli%$ z ! conge/$   
condition ( ! organ dim9i%es4 ,!        
suppression ( ! r5al secretion is no    
d\bt due to ! engorg$  capill>ies press+
 ^u ! secret+ /ructure1 & ultimate      
ramifications ( ! ur9e tubes1 & !reby   
annull+ _!  functions4 ,a simil>        
explanation is equally applicable to !  
bili>y  secretion2 & j z x happ5s 9 !   
case ( ! kidney1 t x is  exce$+ly r>e = 
a total suppression ( its functions to  
take  place1 s ) ! liv] x seldom happ5s 
t ! conge/ion is  suffici5tly sev]e to  
induce complete arre/ ( ! bili>y        
secretion4  ,we f9d1 !re=e1 t al?\gh !re

 may be yell[ness ( ! sk9  & high-col\r$
 ur9e 9 su* cases1 pipe-clay /ools are  
frequ5tly  abs5t1 suffici5t bile to t+e 
! fces /ill f9d+ its way into  !        
inte/9es4    ,und\bt$ly x mu/ h occurr$ 
to _m ( my read]s1 t jaundice  is       
frequ5tly abs5t 9 #bf cases ( acute     
inflammation ( ! liv]1  ev5 runn+ on to 
suppuration1 & t ! =ego+ !ory ( !       
pa?ology ( su* cases is !re=e           
insuffici5t4 ,at "o "t ,i 0  puzzl$ to  
expla9 ?is app>5t anomaly1 b on         
subsequ5t  inve/igation ! true cause    
became app>5t1 & in/ead ( ! above  fact 
detract+ f1 x t5d$ r to /r5g!n ! !ory4  
,if1  = example1 we closely exam9e cases
 ( acute hepatitis )\t  jaundice1 we f9d
 !y are ^? 9 :i* only a portion ( ! liv]
  is affect$4 ,x matt]s n :e!r x be "o  
lobe or two1 ! surface  or ! c5tre ( !  
organ1 ! disease is inv>iably           
circumscrib$2  & !re is en\gh hepatic   
tissue left 9 a suffici5tly normal      
condition to prev5t ! con/itu5ts ( !    
bile accumulat+ 9 !  blood1 & produc+   

jaundice4 ,?is may ev5 occur1 z ,i h    
myself  obs]v$1 :5 ! disease has run on 
to suppuration4    ,! mo/ typical       
example ( jaundice z ! result ( active  
conge/ion1 is to be f\nd 9 ^? cases :]e 
x sup]v5es on an  attack ( hepatitis1   
su* z is met ) 9 hot climates1 :]e      
indol5t habits & high liv+ fav\r portal 
conge/ion4 ,x is  occasionally met ) 9  
,engl&1 h[ev]1 & is frequ5tly associat$ 
) ga/ric d]angem5t4    ,i _h occasion to
 witness a good example ( #bg ?is =m (  
disease  9 ! p]son ( a ,fr5* g5tleman1  
:o 0 br\ght to me sev5 days  aft] 8     
arrival 9 ,engl&1 on acc\nt ( 8 sk9 hav+
 assum$ a  mo/ int5se yell[ hue4 ,x     
appe>$ t he _h come to ,engl& on a      
visit to "s ( 8 fri5ds1 & r enjoy+ !    
novelty ( an  ,engli% table1 indulg$ too
 freely 9 a quantity & quality ( food to
  :i* he _h hi!rto be5 a /rang]4 ,!     
consequ5ce 01 t )9  ?ree days aft] 8    
arrival he began to suff] f hepatic     
t5d]ness1 & dyspeptic symptoms2 ! sk9 at
 ! same "t assum$ a  dusky hue1 :i* soon

 m]g$ into a decid$ yell[ness4 ,^!      
symptoms  7 accompani$ by pipe-clay     
/ools & saffron-col\r$ ur9e2 on !  latt]
 be+ te/$ x gave a di/9ct bile pigm5t1 b
 no bile acid  reaction--a po9t :i* ,i  
%all aft]w>ds h occasion to %[1 is (  a 
c]ta9 diagno/ic value 9 obscure cases ( 
jaundice4 ,?is  g5tleman1 "u ! influ5ce 
( b5zoic acid1 p]fectly recov]$ 8       
normal complexion 9 ! %ort space ( a    
week4    ,!re is ano!r =m ( jaundice f  
active conge/ion1 viz41 t  due to !     
pres5ce ( zymotic disease1 su* z ague1  
typhus1 & o!r  fev]s4 ,z an illu/ration 
( ?is k9d ( affection1 ,i %all cite "o  
aris+ f ! fir/ ( ^! causes1 namely1     
ague4 ,& ! be/  example ,i #bh c give is
 "o t has rec5tly fall5 "u my  notice1 &
 :i* occurr$ 9 ! p]son ( a memb] ( our  
own  pr(ession4 ,! g5tleman 0 = sev]al  
ye>s surgeon to "o ( our  l>ge colonial 
hospitals1 b 9 consequ5ce ( repeat$     
attacks (  int]mitt5t fev]1 0 =c$ to    
resign ! appo9tm5t1 z well z a          
lucrative practice1 & return to ,engl&4 

,he has n[ be5 at home =  two ye>s1 &   
al?\gh 8 g5]al heal? has mu* improv$1   
/ill  suff]s f occasional attacks ( 8   
old enemy4 ,on consult+ me  reg>d+ 8    
case sev]al mon?s ago1 he m5tion$1 t    
:ile  suff]+ f ! above-nam$ attacks1 he 
occasionally sudd5ly pass$  five or six 
ounces ( ur9e z d>k z *ocolate1 & ?is   
w\ld recur  p]haps once 9 tw5ty-f\r     
h\rs1 dur+ two or ?ree days1 & !n  z    
sudd5ly disappe>4 ,?is ur9>y symptom be+
 an unusual "o1 ,i  reque/$ him to s5d  
me on ! next occasion a specim5 ( !     
fluid4  ,9 ! beg9n+ ( la/ ,novemb]#i ,i 
receiv$ ?ree samples ( ur9e1  "o pass$  
at eight ,a4,m41 :i* 0 cle>1 pale1 ( a  
specific gravity  ( #ajbe1 ( an acid    
reaction1 deposit$ no li?ates1 & conta9$
 no  album51 be+ 9 fact normal 9 e      
respect2 ano!r quantity pass$  at two   
,p4,m41 ( #bi a *ocolate br[n col\r1    
opaque1 turbid1 hav+ a  specific gravity
 ( #ajcb1 ( an acid reaction1 deposit+  
li?ates1  conta9+ album51#aj "s sug>1 & 
a l>ge excess ( urea 7#cf p]  c5t47 &   

urohmat9e2 a ?ird sample pass$ at night1
 ( a specific  gravity ( #ajba1 also )  
an acid reaction1 deposit+ li?ates 9    
small quantity1 b conta9+ no album54 ,! 
p]c5tage ( urea 9  ?is ur9e 0 exactly   
"o-half 7namely1 #ah7 ( :at x 0 9 !     
prec$+ specim5 pass$ at two ,p4,m4      
,footnote #i3 ,?is 0 writt5 la/ ye>1 &  
!re=e ref]s to  ,novemb]1 #ahfa4        
,footnote #aj3 ,:5 exam9$ ) !           
microscope1 ?is specim5 ( ur9e  0 f\nd  
to conta9 a l>ge quantity ( nucleat$    
epi!lium1 &  granul> cells2 free        
granules ( a hmat9e col\r1 granul>      
tube-ca/s1 & a quantity ( mucus2 :ile ! 
morn+ & ev5+  ur9es 7 p]fectly free (   
any su* sub/ances4    ,! v>y+ conditions
 ( ^! ?ree ur9es cle>ly po9t$ to int5se 
conge/ion ( ! *ylopoietic visc]a1 ( a   
transi5t & p]iodic  "*4 ,suit+ !        
practice to ! !ory1 m]curials 7 tak5 by 
?is g5tleman 9 ord] to remove !         
conge/ion ( ! *ylopoietic  visc]a1 & ) !
 mo/ fav\rable results1 =1 z ,i aft]w>ds
  le>n$1 ! jaundice & o!r disagreeable  

symptoms soon disappe>$4      ,jaundice 
! ,result ( ,passive ,conge/ion ( !     
,liv]4    ,9 ?is case ! conge/ion1      
in/ead ( aris+ f an increas$ fl[  (     
blood to ! liv]1 z #cj 9 ! prec$+1 is ! 
result ( "s  cause imp$+ ! outw>d fl[ ( 
blood f ! liv]4 ,?us =  example1 passive
 hepatic conge/ion may arise f valvul>  
disease (  ! he>t1 or f any pulmon>y    
affection ob/ruct+ ! circulation  (     
blood ?r\gh ! lungs 7pneumonia1 c474    
,jaundice f ! passive  =m ( hepatic     
conge/ion1 is n s common z jaundice f ! 
active =m1 9 consequ5ce ( ! =m] be+1 z a
 rule1 mu*  slight] ?an ! latt]4 ,its   
pa?ology is1 h[ev]1 ,i believe1 exactly 
! same1 viz4 ! result ( ! engorg$       
hepatic capill>ies  compress+ ! secret+ 
cells & tubes1 & !reby annull+ _!       
functions4 ,su* be+ ! case1 x is        
unnecess>y = me to d m  ?an m]ely allude
 to ?is cause ( jaundice4    ,x may1    
p]haps1 be ask$--,if ! =ego+ /atem5ts   
reg>d+ !  pa?ology ( jaundice f         
conge/ion be correct1 h[ does x happ5  t

 x is n pres5t 9 e sev]e case ( ga/ric  
d]angem5t1  fev]1 he>t-disease1 c48 ,?is
 "q is easily answ]$1 = z  ,dr4 ,budd   
has cle>ly put x1 :ile speak+ ( ! action
 ( m$ic9es  ^u ! liv]--,9 mo/ p]sons1   
p]haps1 a portion ( ! liv] may  wa/e or 
become less active )\t s5sible d]angem5t
 ( heal?1  !y h m liv]1 z !y h m lung1  
?an is absolutely  necess>y4 ,9 o!rs1 on
 ! #ca contr>y1 ! liv]1 f natural       
con=mation1 seems j capable ( effect+   
its purpose "u  fav\rable circum/ances4 
,p]sons inh]it+ ?is feebl5ess ( liv]1   
or 9 :om1 9 consequ5ce ( disease1 a     
portion ( ! liv] has  atrophi$1 or !    
secret+ elem5t ( ! liv] has be5 damag$1 
may  suff] little inconv5i5ce z long z  
!y are plac$ 9 fav\rable  circum/ances1 
& obs]ve ^? rules :i* su* a condition   
requires2 b z soon z ! balance ( _!     
hepatic circulation is  di/urb$ by      
causes l ^? above m5tion$1 jaundice     
makes its  appe>ance2 su* pati5ts be+1 z
 ,dr4 ,budd says1 born ) a  t5d5cy to   
bili\s d]angem5ts4#aa    ,footnote #aa3 

,diseases ( ! ,liv]1 p4 #ee4            
,,jaundice ,,z ,a ,,result ,,(          
,,suppression ,,consequ5t ,,^u ,,abs5ce 
,,( ,,!  ,,secret+ ,,sub/ance4    ,!    
pa?ology ( ?is /ate is self-evid5t1 =   
:]ev] secret+  sub/ance is want+1       
secretion _c take place4 ,if !n1 !      
tissue  :i* secretes bile be de/roy$ or 
trans=m$ by disease1 ! bili>y  function 
mu/ be susp5d$1 & ! +r$i5ts :i* x is !  
(fice  ( su* /ructure to sep>ate f !    
blood1 w accumulate 9 !  circulation1 & 
give rise to ! #cb usual *a9 ( results  
foll[+  suppression ( ! bili>y          
secretion4    ,9 canc]1 tub]cle1 fatty &
 amyloid deg5]ation ( ! liv]1  jaundice 
arises f ! above-nam$ cause4 ,9 ^!      
diseases x is  n1 h[ev]1 a con/ant      
symptom1 & ?is is simply on acc\nt (    
!re be+ usually suffici5t heal?y tissue 
left to enable !  bili>y secretion to be
 c>ri$ on4 ,if ! canc]1 or o!r morbid   
product1 occupi$ ! :ole place ( !       
secret+ tissue1 ! bili>y  function c\ld 
no m be c>ri$ on by su* product1 ?an by 

! same  product occupy+ ano!r organ ( ! 
body4 ,9 cases ( jaundice  aris+ f      
abs5ce ( ! secret+ sub/ance1 ! am\nt ( !
  jaundice dep5ds on ano!r cause besides
 ! m]e ext5t ( ! morbid  deposit4 ,?is  
is its situation4 ,a l>ge am\nt (       
diseas$ tissue may  exi/ 9 c]ta9        
portions ( ! liv]1 & yet fail to produce
  jaundice1 :ile a mu* small] am\nt ( ! 
same diseas$ tissue1  plac$ 9 ano!r     
situation1 may induce x4 ,%\ld ! morbid 
deposit1  = example1 be s plac$ z       
readily to int]rupt ! fl[ ( !  secret$  
bile1 jaundice may rapidly occur1 & be  
due z mu* to !  re-absorption ( !       
secret$ bile1 z to ! suppression ( !    
bili>y secretion4 ,?is is1 inde$1 ! true
 explanation ( ! fact1  t diseases      
affect+ ! #cc concave1 are mu* m        
frequ5tly  accompani$ ) jaundice1 ?an ^?
 attack+ ! convex surface (  ! liv]4 ,i 
might h *os5 :at at fir/ sight appe>s a 
m  typical example ( abs5ce ( secret+   
/ructure1 namely1 a case (  acute       
atrophy ( ! liv]2 = 9 su* cases !       

hepatic tissues  sometimes dw9dle d[n 9 
! c\rse ( a few days to less ?an a      
qu>t] ( _! orig9al bulk1 & give rise to 
int5se jaundice4 ,b  9 su* cases !re    
does n appe> to be a total arre/ ( !    
secretion1 until ! v la/ /age ( !       
disease1 if x ev5 occurs  !n2 & besides1
 if ,i d>e =m an op9ion f "o case1 ,i   
%\ld  say t1 9 consequ5ce ( ! rapid     
disorganization ( ! p>5*yma  ( ! liv]1 !
 circulation 9 ! organ becomes mu*      
di/urb$1 &  gives rise to :at ,fr]i*s   
t]ms disord]$ diffusion4 ,s t 9  cases (
 acute atrophy ( ! liv]1 ! jaundice1    
al?\gh *iefly due  to suppression1 is   
complicat$ ) re-absorption ( ! bile1 z 0
  prov$ 9 a case ,i exam9$1 by f9d+ 9 ! 
ur9e1 n only ^?  products :i* are m]ely 
excret$ f ! blood1 b also "s (  ^? :i*  
are g5]at$ 9 ! liv] itself4 ,x w be     
necess>y =  me1 !re=e1 to g m fully into
 ?is =m ( jaundice ?an ,i h  done 9 any 
( ! prec$+ =ms ( ! disease4      #cd    
,,jaundice ,,aris+ ,,f ,,acute ,,atrophy
 ,,( ,,! ,,liv]4    ,acute1 or yell[    

atrophy ( ! liv]1 is "o ( ! mo/ =midable
 (  human diseases4 ,x is sudd5 9 its   
onset1 rapid 9 its c\rse1 fatal  9 its  
t]m9ation4 ,x is m common 9 wom5 ?an 9  
m52 seldom  attacks ^? above ?irty ye>s 
( age1 & occurs mo/ frequ5tly 9  ! e>li]
 mon?s ( pregnancy4 ,! imm$iate excit+  
cause ( ?is  /range disease appe>s to   
be1 9 ! majority ( cases1 m5tal         
depression4 ,! symptoms usually obs]v$  
are jaundice1 rapidly  foll[$ by        
sickness1 & vomit+2 by febrile          
excitem5t1 & c]ebral  di/urbance4    ,z 
! disease advances1 ! hepatic dulness   
dim9i%es2 ! ur9e  becomes scanty1 &     
high-col\r$2 ! b[els conf9$4            
,extravasations  ( blood take place "u !
 sk92 & hmorrhages f ! nose1  vag9a1 or 
b[els are frequ5tly obs]v$4 ,la/ly1     
delirium1 or coma1  g5]ally closes !    
sc5e1 )9 a week aft] ! comm5cem5t ( !   
viol5t symptoms1 & )9 a mon? aft] !     
appe>ance ( simple  jaundice4 ,fr]i*s1  
:o has s well describ$ ^! cases1 ev5    
says1  t 9 ! sev]e/ =ms1 ! disease may  

run its c\rse1 & end  fatally )9        
tw5ty-f\r h\rs4#ab    ,footnote #ab3    
,cl9ical ,treatises on ,diseases ( !    
,liv]1 vol4 i4 p4  #aig4    #ce ,all    
cases ( acute atrophy ( ! liv] are1     
=tunately1 n  necess>ily fatal4 ,9 "s ! 
viol5t symptoms gradually disappe>1  &  
recov]y takes place aft] free evacuation
 ( ! b[els4    ,9 e case ( suspect$     
acute atrophy ( ! liv]1 ! ur9e ought  to
 be c>efully exam9$ = tyros9e1 & leuc9e1
 two abnormal  products1 :i*1 accord+ to
 ,fr]i*s1 are nev] abs5t4 ,"s rem>ks  on
 ! diagno/ic value ( ^! sub/ances w be  
f\nd at page #fb4    ,?r\gh ! k9dness ( 
,dr4 ,wilks1 ,i _h ! opportunity (      
exam9+  ! liv]1 & analys+ ! ur9e1 9 a   
typical case ( acute atrophy1  :i* he   
report$ 9 ! ,pa?ological ,society's     
,transactions1 vol4  xiii4 p4 #ajg4 ,!  
brief hi/ory ( ! case is z foll[s3--,e4 
,k41 ag$  sev5te51 a m>ri$ woman1 9 !   
?ird mon? ( pregnancy1 0 seiz$  ) a     
bili\s attack1 & jaundice1 aft] hav+ a  
viol5t qu>rel  ) h] husb&1 :o accus$ h] 

) infidelity4 ,! pati5t 0  fir/ "u ! c>e
 ( ,mr4 ,bis%opp1 ( ,s\? ,lambe?1 :o    
f\nd h]  suff]+ f jaundice1 accompani$  
by "s febrile symptoms1 &  vomit+4 ,9   
two days %e became deliri\s1 _h viol5t  
scream+1 &  convulsive fits1 :i* 7      
rapidly foll[$ by unconsci\sness4 ,next 
day ! pati5t 0 se5 by ,dr4 ,wilks2 %e 0 
!n q ins5sible1  ) slight /]tor\s       
brea?+1 #cf & foam on ! lips4 ,! pupils 
7 mod]ately dilat$1 & s5sible to light4 
,! pulse #abj4 ,!  hepatic dulness r$uc$
 to a n>r[ b& ov] ! l[] ribs4 ,no ur9e  
_h pass$ = tw5ty-f\r h\rs2 a ca!t] 0    
!re=e introduc$1  & twelve ounces ( cle>
 bili\s-look+ fluid 7 drawn (f4 ,?is    
ur9e ,i _h ! opportunity ( analys+ a few
 days aft]w>ds4 ,x 0  !n ( a yell[-o*re 
col\r1 & conta9$ a consid]able deposit4 
,! analysis gave3    ,specific gravity 4
 4 4 4 4 4 4 4 4 4 4 4 4    #ajbh       
,reaction 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4    acid 787                ,,9 #ajjj
 ,,p>ts4      ,wat]  4 4 4 4 4 4 4 4 4 4
 4 4 #idhhfj      ,solids 7organic1     

inorganic7  4  #eaach                   
,urea 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4  #cjjjj    ,uric acid  4 4 4 4 4 4 4
 4 4 4 4 4 4 4 4 4   #jcge    ,res9 &   
mucus  4 4 4 4 4 4 4 4 4     ,bile1     
col\r+ matt]1 & acids      ,urohmat9e  4
 4 4 4 4 4 4 4 4 4 4  4 4 4  #adege     
,leuc9e1 & tyros9e  4 4 4 4 4 4         
,inorganic salts  4 4 4 4 4 4 4 4 4 4 4 
4 4   #fahh                             
,! bili>y acids 7contr>y to :at ,fr]i*s 
f\nd 9 "s ( 8  cases7 7 pres5t 9 ?is    
ur9e 9 fair quantity4 ,) ,pett5k(]'s    
te/ 7sulphuric acid & sug>7 a decid$    
purple col\r 0 obta9$4    #cg ,:5 a     
portion ( ! ur9e 0 conc5trat$1 & all[$  
to  cry/allize sl[ly1 beautiful cry/als 
( bo? tyros9e1 & leuc9e  7 detect$ 9 x  
by means ( ! microscope4 ,! purifi$ ur9e
 also  %[$ ! pres5ce ( sug> 9 small     
quantity4 ,:5 ! organic solids  7 burn$1
 !y _h a /rong od\r1 & gave (f a smoky  
flame1  !reby %[+ t ! ur9e conta9$ a    
consid]able quantity (  fatty res94     
,z calculat+ ! con/itu5ts ( ! ur9e by   

p]c5tage is a v  unsatisfactory me?od = 
sci5tific purposes1 x may be useful = me
  to give ! analysis ( ! same ur9e z    
calculat$ = tw5ty-f\r  h\rs1 viz41      
twelve ounces1 ! am\nt drawn f ! bladd] 
%ortly  be=e dea?4 ,9 t case ! analysis 
gives3                 #bd ,,h\rs'      
,,ur9e4    ,quantity 4 4 4 4 4 4 4 4 4 4
 4 4 4  #cgbjj c4c4    ,specific gravity
 4 4 4 4 4 4 4 4 4    #ajbh    ,reaction
 4 4 4 4 4 4 4 4 4 4 4 4 4    acid 787  
,solids 7total7 4 4 4 4 4 4 4 4 4 4     
#aijch grammes4    ,urea 4 4 4 4 4 4 4 4
 4 4 4 4 4 4 4  #aaafj        ,uric acid
  4 4 4 4 4 4 4 4 4 4 4 4   #jaci       
,res91 & mucus 4 4 4 4 4 4     ,bile    
pigm5t1 & acids  4 4     ,urohmat9e  4 4
 4 4 4 4 4 4  4 4   #edda               
,tyros9e1 & leuc9e  4 4 4     ,inorganic
 salts  4 4 4 4 4 4 4 4 4   #bbih       
,dur+ ! night be=e h] dea?1 ! pati5t #ch
 abort$1 & lo/ a  consid]able quantity (
 blood by ! vag9a4 ,! :ole duration ( ! 
disease 0 m]ely six days1 & ! m urg5t   
symptoms only  manife/$ !mselves two    

days be=e ! fatal t]m9ation4    ,aft]   
dea? ! liv] 0 f\nd to be v small 9 size1
 n  exce$+1 z 0 suppos$1 #a p\nd 9      
weight4 ,x 0 deeply /a9$  yell[1 & its  
cells 7 f\nd to be small1 & brok5 up2 n 
an  entire cell c\ld be detect$ by ei!r 
,dr4 ,wilks or myself--no?+1  inde$1 b a
 quantity ( dbris ( hepatic tissue1 &   
fat4 ,!  gall-bladd] 0 contract$1 &     
conta9$ only a little mucus2 !          
ur9>y-bladd] 0 empty4    ,al?\gh        
jaundice ! result ( acute atrophy ( !   
liv]1 might be  ?\ght to be a typical   
example ( jaundice aris+ f a suppression
  ( ! bili>y function--! dim9ution 9    
secret+ sub/ance  naturally induc+ a    
dim9ution 9 secret+ p[]--,i h1 z 0  be=e
 said1 be5 l$ to view x diff]5tly2      
because1 al?\gh less  bile ?an usual is 
secret$1 !re is nev]!less no?+ l an     
entire suppression ( ! bili>y function1 
z is prov$1--    ,fir/ly1--,by ! abs5ce 
( pipe-clay /ools4    ,secondly1--,by ! 
deep /a9+ ( ! hepatic tissue ) bile     
pigm5t1 j z occurs 9 jaundice ! result (

 ob/ruction4    #ci ,?irdly1--,by !     
pres5ce ( ! bili>y acids 9 ! ur9e4      
,f\r?ly1--& la/ly1 ! viol5t symptoms (  
bile-poison+ lead to  ! same conclusion1
 = x is n bile pigm5t1 b ! bile acids1  
t induce ! fatal symptoms (             
bile-poison+4#ac    ,footnote #ac3 ,six 
gra9s ( pure glyco*olate ( soda kill$ a 
small  dog1 into ^: femoral ve9 ,i      
inject$ x1 9 ! c\rse ( two h\rs4  ,9    
exp]im5t+ on animals1 ,i h made ! curi\s
 obs]vation1 t  al?\gh bile has !       
prop]ty ( ret>d+ or arre/+ putrefaction1
  bo? 9 ! inte/9al canal1 & out ( !     
body1 yet1 :5 inject$  into !           
subcutane\s cellul> tissue ( a heal?y   
animal1 x causes  ! surr\nd+ tissues to 
decompose1 & become foetid1 & an        
artificial disease is !reby set up1 ^:  
mo/ peculi> feature is  ! eng5d]+ ( a   
rapid putrefaction ( ! body aft] dea?4  
,,class ,b4    ,,! ,,me*anism ,,(       
,,jaundice ,,aris+ ,,f ,,!              
,,re-,,absorption ,,( ,,!  ,,secret$1   
,,b ,,reta9$ ,,bile4    ,9 cases ( ?is  

k9d1 ! ob/ruction is n usually to be    
f\nd  )9 ! liv] itself1 b 9 ! ducts aft]
 _! exit f !  hepatic organ4 ,! seat ( !
 ob/ruction1 too1 is mu* m  frequ5tly   
f\nd ne> to1 or at ! t]m9ation ( !      
common duct1  ?an close to ! liv]4 ,!   
ob/ruction may be ( ?ree k9ds3--    #dj 
,fir/ly1--,a cong5ital defici5cy ( !    
bile-ducts4    ,secondly1--,an accid5tal
 ob/ruction 9 ! c\rse ( ! ducts1 z  f   
gall-/ones1 hydatids1 or ! entrance (   
=eign bodies f !  inte/9es4             
,?irdly1--,f closure ( ! outlet ( !     
common duct1 z1 =  example1 f ! pressure
 ( ! pregnant ut]us1 or di/5d$          
transv]se colon1 or f organic disease ( 
! pancreas1 or  neighb\r+ organs4       
,fir/1 z reg>ds cases ( jaundice f      
cong5ital defici5cy ( !  ducts4 ,cases (
 ?is k9d are r>e4 ,! be/ ) :i* ,i am    
acqua9t$  is ! "o t 0 br\ght be=e !     
,pa?ological ,society la/ ye>1  by ,dr4 
,wilks4 ,! *ild _h nev] pass$ any       
meconium1 ! motions  always be+ ( a :ite
 col\r4 ,:5 a =tnight old1 jaundice came

 on1  & cont9u$ until dea?1 at ! age (  
six weeks4 ,aft] dea?1 !  liv] 0 f\nd ( 
a d>k gre5 col\r1 &1 app>5tly1 !        
gall-bladd] 0 abs5t4 ,on fur!r          
exam9ation1 h[ev]1 ! cellul>  tissue1   
:i* appe>$ to occupy its place1 0 f\nd  
to be occupi$ by  a small canal1 j l>ge 
en\gh to conta9 a bri/le2 to ?is1       
h[ev]1 no outlet c\ld be f\nd1 & on     
endeav\r+ to discov] !  hepatic ducts1  
^!1 9 l mann]1 c\ld n be made #da out4  
,!  op5+ ( ! common duct 9 ! duod5um 0  
natural1 b no hepatic  duct c\ld be f\nd
 jo9+ ! pancreatic4 ,x appe>$1 !re=e1 z 
if ! l>g] ducts _h become %runk5 &      
oblit]at$4#ad    ,footnote #ad3 ,m$ical 
,times & ,gazette1 #bi? ,m>*1 #ahfb4    
,?r\gh ! k9dness ( ,dr4 ,wilks1 ,i _h ! 
opportunity ( mak+ a  microscopical     
exam9ation ( ! liv]4 ,! hepatic cells 7 
v  small 9 size1 mu* brok5 up2 v few    
possess$ nuclei1 & all 7  deeply t+$ )  
br[ni% yell[ col\r+ matt]4 ,scatt]$     
?r\gh\t ! hepatic tissue1 ,i f\nd numb]s
 ( well-=m$  *ole/]9e cry/als1 l ^?     

repres5t$ 9 ,fig4 #c4    ,i mu/ "h      
m5tion1 t jaundice does n necess>ily    
foll[ ^u  abs5ce ( ! gall-bladd]2 j z 9 
! horse1 ! de]1 ! rat1  & o!r animals t 
possess no gall-bladd]s1 ! bili>y       
function  is p]fectly well c>ri$ on1 s x
 may be 9 ! human subject1  lab\r+ "u a 
cong5ital or accid5tal defici5cy ( !    
gall-bladd]4 ,9 su* cases1 ! hepatic    
ducts are p]vi\s1 &  consequ5tly !      
secret$ bile f9ds no difficulty 9 rea*+ 
!  inte/9es4 ,9 ! ,ed9burgh ,m$ical     
,j\rnal 7,may1 #ahfa1 p4 #ajde17  ,dr4  
,alex&] ,simpson reports a case ( #db   
?is k9d occurr+ 9 a  *ild1 :i* di$ :5   
only a few weeks old4 ,!re 0 no trace ( 
!  exi/5ce ( a gall-bladd]2 b on lay+   
op5 ! duod5um1 !  orifice ( ! bile-duct 
0 at once se5 9 its ord9>y situation1  &
 a drop ( pale bile 0 express$ f x4 ,on 
trac+ ! duct to  ! liv]1 x 0 f\nd to    
pass up undivid$ into ! horizontal      
fissure1 :]e x at once broke up & bran*$
 into ! hepatic tissue  ( ! "r1 & left  
lobes4    ,i %all delay ent]+ into an   

explanation ( ! me*anism ( jaundice  f  
ob/ruction1 until ,i come to !          
consid]ation ( :at may be  t]m$ ,p]man5t
 ,jaundice1 z 9 t case "o explanation w 
d  = all4      ,,jaundice ,,z ,a        
,,result ,,( ,,! ,,accid5tal            
,,ob/ruction ,,( ,,! ,,bile-,,ducts4    
,! second class ( cases1 namely1 ^? 9   
:i* ! ob/ruction is 9  ! c\rse ( !      
ducts1 are ( frequ5t occurr5ce1 & 9 !m !
  jaundic$ /ate is usually m]ely        
transi5t1 = no soon] has !  ob/ruction  
be5 remov$1 ?an ! jaundice beg9s to     
disappe>4 ,!  mo/ common cases ( ?is k9d
 are ^? aris+ f gall-/ones4 ,z  e "o is 
famili> ) _! hi/ory1 ,i may m]ely       
m5tion1 t we  may h gall-/ones1 & ev5   
all ! mo/ pa9ful #dc symptoms (         
gall-/ones1 )\t ! slighte/ trace (      
jaundice4 ,?is1 ,i believe1  arises 9 ! 
foll[+ mann]3--    ,fir/ly1--,! majority
 ( gall-/ones are =m$ 9 ! gall-bladd]2  
_! =mation be+ due to ! accid5tal       
deposition ( ! less  soluble p>ts ( !   
bile1 ei!r z a consequ5ce ( ^! +r$i5ts  

be+ pres5t 9 excess1 or 9 consequ5ce ( !
 solv5t1 ^: duty  x is to reta9 !m 9    
solution1 be+ 9 r$uc$ quantity4 ,!      
deposition or =mation ( gall-/ones      
foll[s exactly ! same law z  !          
deposition or =mation ( /one 9 ! bladd]4
    ,secondly1--,9 "s cases ! gall-/one1
 or /ones--= !re may be  _m1 ev5        
hundr$s1 rema9 9 ! gall-bladd] dur+ !   
:ole life  ( ! individual1 )\t giv+ rise
 to any disagreeable results1  ei!r z   
reg>ds pa91 or jaundice4 ,9 o!r cases1 !
  gall-/ones--& ?is usually happ5s :5 !y
 are small--get into !  cy/ic duct1 &   
become lodg$ !re2 & 9 su* a case1 al?\gh
 !  pati5t may suff] int5se pa91 !re is 
/ill no jaundice4 ,moreov]1  x is n     
until ! /one or /ones h pass$ d[n into !
 common  bile-duct1 t jaundice is at all
 likely to be induc$ by !m4 ,=  :ile a  
/one rema9s 9 ! cy/ic duct1 al?\gh x may
 completely  block x up1 & effectually  
prev5t ! bile ei!r #dd ent]+ into  or   
escap+ f ! gall-bladd]1 yet1 z 9 ?is    
situation x _c  (f] any ob/acle to !    

direct fl[ ( ! bili>y secretion f !     
hepatic tissue into ! inte/9es1 !re is  
no ret5tion1 &  consequ5t absorption (  
bile4 ,9 fact1 ! pres5ce ( ! /one 9  ?is
 position1 9 z f> z ! bili>y function is
 conc]n$1 only  r$uces ! pati5t to !    
/ate ( a p]son 9 :om ! gall-bladd]  is  
accid5tally abs5t2 or to t ( a horse1 or
 o!r animal1 9  :i* ! abs5ce ( !        
gall-bladd] is a normal condition4      
,?irdly1--,!re are yet o!r ways 9 :i*   
gall-/ones may give rise  to great      
discom=t1 & ev5 imp]il life1 )\t induc+ 
jaundice4  ,= example1 a calculus may   
rema9 9 ! gall-bladd] until x atta9s  a 
v l>ge size1 & !n ulc]ate its way into !
 /oma*1  inte/9es1#ae p]itoneal cavity1 
or ev5 out ( ! body ?r\gh an  op5+ 9 !  
abdom9al p>ietes4#af    ,footnote #ae3  
,vide a case ( ?is k9d publi%$ by !     
au?or 9 !  ,pa?ological ,society's      
,transactions = #aheg1 p4 #bce4         
,footnote #af3 ,vide a case publi%$ by  
,mr4 ,h9ton 9 ! ,brit4 ,m$4  ,j\rn4 (   
,augu/ #d?1 #ahfj1 p4 #fjc1 & "o by ,mr4

 ,sympson 9 ! same  ,j\rnal ( ! #g?     
,febru>y1 #ahfc1 p4 #aci4    ,9 fact1   
jaundice only appe>s z a complication ( 
gall-/ones :5  !y *ance to block up !   
common duct1 & !reby prev5t ! bile      
ent]+ ! inte/9al canal4 ,h5ce1 also1 !  
reason #de :y  jaundice1 z a result (   
gall-/ones1 is m frequ5tly transi5t ?an 
p]man5t4 ,if x *ances to become p]man5t1
 x soon] or lat] leads  to a fatal      
t]m9ation--usually )9 eighte5 mon?s aft]
 complete  ob/ruction4 ,la/ly1 x may be 
m5tion$ t1 al?\gh gall-/ones are  liable
 to =m 9 almo/ e con/itution1 yet x is  
g5]ally  consid]$ t !y are mo/ frequ5t 9
 p]sons ( ! tub]cul>1  canc]\s1 & g\ty  
dia!sis1 ei!r h]$it>y or acquir$4       
,!re are o!r sub/ances besides          
gall-/ones :i*1 by _!  accid5tal pres5ce
 9 ! bile-ducts1 may give rise to       
jaundice4 ,?us1  = example1 =eign       
bodies1 su* z *]ry-/ones1 h f\nd _!  way
 f ! inte/9e into ! bile-duct1 & giv5   
rise to jaundice4  ,inte/9al worms h be5
 obs]v$ to d ! same ?+1 & rec5tly  an   

int]e/+ case ( jaundice1 occurr+ 9 a    
girl ag$ #af1 :o di$  aft] a few weeks' 
illness1 has be5 report$1 :i* result$ f 
!  pres5ce ( hydatids 9 ! ductus        
hepaticus1 & ductus communis            
*ol$o*us4#ag ,hydatids ( ! liv] itself  
seldom give rise to  jaundice1 _!       
position be+ usually su* z n to int]f]e 
)  ! bili>y function4    ,footnote #ag3 
,dr4 ,dick9son has report$ ?is case 9 ! 
,pa?ological  ,society's ,transactions1 
p4 #ajd1 vol4 xiii4 #ahfb4    ,!re are  
/ill o!r cases :]e we f9d #df transi5t  
jaundice  aris+ f accid5tal ob/ruction (
 ! bile-ducts2 b 9 !m1  in/ead ( !      
closure ( ! ducts result+ f plugg+ f    
)91 x arises f ! application ( pressure 
f )\t4 ,?us1  = example1 transi5t       
jaundice is met ) z ! result ( closure (
  ! common bile-duct1 by pressure ex]t$ 
^u x by ! pregnant  ut]us1 or by impact$
 fces 9 ! transv]se colon4 ,c]ta9       
p]man5t  abdom9al tum\rs may also lead  
to ! same result1 b ^! w )  great]      
propriety be consid]$ "u ! next head4   

,,p]man5t ,,jaundice ,,f ,,ob/ruction4  
,9 ord] to give z cle> a view z possible
 ( ! pa?ology (  p]man5t jaundice f     
ob/ruction1 x w be necess>y = me to     
give ! hi/ory ( a case ( closure ( !    
outlet ( ! common  bile-duct 9          
consequ5ce ( organic disease--su*1 =    
example1 z  canc] ( ! head ( ! pancreas4
 ,a case ( ?is k9d has ! fur!r          
advantage ( at ! same "t furni%+ u ) a  
typical example (  jaundice aris+ f !   
re-absorption ( ! secret$1 b reta9$     
bile4    ,:5 canc] ( ! head ( ! pancreas
 involves ! orifice ( !  common         
bile-duct1 z ! tum\r gr[s1 ! duct sl[ly1
 & gradually  becomes imp]vi\s to !     
passage ( bile into ! #dg inte/9es1     
until at l5g? ! fl[ is completely       
arre/$4 ,z ?is gradual  process (       
occlusion ( ! outlet goes on1 ! duct    
itself becomes  m & m di/5d$ by ! reta9$
 bile1 till x at l5g? atta9s  an enorm\s
 size4 ,! gall-bladd] be+ equally       
prev5t$ f  empty+ itself1 likewise      
becomes /ret*$ & dilat$1 until x may  at

 la/ become n only palpable to ! t\*1 b 
ev5 app>5t to !  eye ?r\gh ! abdom9al   
walls4 ,?is 0 ! case 9 ! pati5t ^:      
liv]1 & occlud$ ducts are repres5t$ 9   
,plate ,i4    ,! di/5tion ( ! bile-ducts
 is n limit$ to ^? situat$  ext]nal to !
 liv]1 b also affects ^? 9 ! sub/ance ( 
!  organ2 & to su* an ext5t may ?is be !
 case1 t1 on mak+ a  section ( a liv] t 
has long _h its common duct ob/ruct$1 a 
numb] ( l>ge excavations are obs]v$ all 
ov] its surface1 :i*  excavations are   
no?+ m ?an ! op5 m\?s ( ! transv]se     
sections ( ! dilat$ ducts4 ,su* a /ate (
 matt]s is tol]ably  well repres5t$ 9 ! 
section ( ! liv] 9 ,plate ,i4 ,fur!r1 ! 
effect ( ?is ob/ruction to ! exit1 &    
consequ5t accumulation (  ! bili>y      
secretion1 is n conf9$ to ! m]e di/5tion
 ( !  ducts1 b causes v>i\s *anges to   
occur 9 ! p>5*yma ( !  liv] itself4 ,!  
fir/ ( ^! is an increase #dh 9 ! size ( 
!  organ1 aris+ p>tly f ! accumulation (
 ! bile1 & p>tly  f ! conge/ion caus$ by
 ! pressure ex]t$ on ! vessels by  !    

di/5d$ ducts4 ,9 ! second place1        
gradually z ! /ate (  matt]s "h describ$
 progresses1 ! p>5*yma ( ! organ becomes
  itself affect$1 p>tly f ! direct      
pressure ex]cis$ ^u x1 &  p>tly f !     
d]angem5t ( its nutrition1 produc$ by ! 
int]ruption to ! hepatic circulation2 s 
t1 aft] a "t1 !  enl>g$ liv] sl[ly1 & by
 degrees dim9i%es1 until x at l5g?      
rega9s its natural size1 !reby r5d]+1 at
 ?is p]iod ( !  disease1 ! diagnosis ( !
 case extremely difficult4 ,?is /ate (  
matt]s is n1 h[ev]1 ( long duration2 =1 
9 consequ5ce ( !  cont9u$ compression ( 
! blood-vessels & p>5*yma1 !  nutrition 
( ! liv] is s disord]$1 z to lead to a  
gradual  %r9k+ ( ! entire sub/ance1 or1 
9 o!r words1 to a g5]al  atrophy ( !    
organ4    ,x is ?us se5 h[ 9 p]man5t    
occlusion ( ! common gall-duct  ! liv]  
may be f\nd hyp]trophi$ 9 ! fir/1 (     
normal  dim5sions 9 ! second1 & atrophi$
 9 ! ?ird & la/  /age ( ! disease4    ,9
 cases ( ! k9d "h describ$1 x is n at   
all unlikely t !  enl>gem5t ( ! liv] 9 !

 e>li]1 z well z its atrophy 9 !  lat]  
#di /ages ( ob/ruction1 may be mi/ak5 = 
! cause ( !  jaundice1 in/ead ( ! result
 ( ! arre/ ( ! fl[ ( bile1 &  !reby lead
 to a grave error 9 treatm5t4 ,! hi/ory 
( ! case1  toge!r ) a k ( ! above facts1
 w1 h[ev]1 t5d to  facilitate !         
diagnosis4 ,?us1 x mu/ be asc]ta9$3--   
,fir/ly1--,if ! jaundice prec$$ !       
alt]ation 9 size ( ! organ4             
,secondly1--,if !re is an abs5ce ( any  
hi/ory ( hepatitis2 &1    ,?irdly1--,if 
!re is no evid5ce ( any pulmon>y or     
c>diac mis*ief  likely to lead to       
passive conge/ion ( ! hepatic tissue4   
,ev5 ) a k ( all ^! facts1 h[ev]1 x (t5 
baffles !  skill1 & acum5 ( ! able/     
physicians to discov] ! cause (         
jaundice4 ,e n[ & !n cases are met )1   
:]e ! pati5t  tells u t ! jaundice has  
gradually come on )\t any assignable    
cause1 & :]e1 aft] ! mo/ c>eful         
exam9ation ( 8 hi/ory1 z  well z ( 8    
physical condition1 we fail to detect a 
clue to !  diagnosis4 ,cases ( ?is k9d  

are f> f uncommon1 & ?is is !  m to be  
regrett$1 see+ t unless we h a cle>     
appreciation  ( ! cause1 x is n only    
difficult1 b ev5 dang]\s to treat !     
symptom4 ,! injudici\s adm9i/ration (   
#ej a rem$y "h1 may  ha/5 ! t]m9ation we
 mo/ desire to ret>d4 ,! tru? ( ?is     
rem>k w1 h[ev]1 be bett] appreciat$ :5  
,i come to consid] !  rationale ( !     
treatm5t ( jaundice4 ,mean:ile1 x may be
 advisable  to po9t out a me?od capable 
( yield+ mo/ important in=mation1  :5   
all ! ord9>y means ( diagnosis fail4 ,i 
allude to !  *emi/ry ( ! excretions4    
,al?\gh ! pa?ological *emi/ry ( !       
excretions is z yet 9 its infancy1 x has
 already giv5 !  sci5tific physician a  
key to ! detection ( sev]al diseases1 & 
,i  tru/ to be able to %[1 t ev5 9 !    
obscure cases ( jaundice  above allud$  
to1 x n only gives u a clue to _! cause1
 b  pres5ts u ) a guide to _! treatm5t4 
,9 jaundice aris+ f ob/ruction1 !       
pipe-clay /ools are1 z 9  ! case (      
jaundice f suppression1 entirely due to 

! abs5ce (  bile f ! inte/9al canal4 ,! 
yell[ness ( ! sk9 is 9 l  mann] caus$ by
 ! accumulation ( ! bile pigm5t 9 !     
blood1  f :5ce x exudes1 & /a9s !       
tissues2 &1 la/ly1 !  saffron-col\r$    
ur9e results 9 a simil> way f !         
elim9ation (  ! pigm5t f ! blood by !   
kidneys4 ,in/ead1 h[ev]1 ( ^!  ?ree     
conditions aris+1 z 9 ! case ( jaundice 
f suppression1  f ! arre/ ( ! bili>y    
functions #ea all[+ c]ta9 ( !           
con/itu5ts ( ! bile to accumulate 9 !   
circulation1 !y are1 9  ! fir/ place1 ! 
result ( ! re-absorption ( ! secret$    
bile  f ! di/5d$ ducts1 & gall-bladd]4  
,s t :ile 9 jaundice  f suppression1    
only ^? bili>y products :i* exi/ pre-=m$
 9  ! blood accumulate 9 ! circulation1 
9 cases ( jaundice f  ob/ruction1 !     
bili>y products :i* are manufactur$ 9 ! 
liv]1  equally ) ^? :i* are pre-=m$ 9 ! 
blood1 f9d _! way  back into !          
circulation1 to be f !nce elim9at$ ) !  
excretions4 ,if !n1 we c\ld asc]ta9 !   
pres5ce or abs5ce (  ^! products 9 !    

excretions1 we %\ld be enabl$ to di/+ui%
  betwe5 jaundice result+ f suppression1
 & jaundice aris+ f  ob/ruction4 ,let u 
n[ see :at ! *emi/ry ( ! excretions     
tea*es u2 & to beg91 we %all take !     
inte/9al excretion4      ,,analysis ,,( 
,,! ,,inte/9al ,,excretion ,,z ,,an     
,,aid ,,to ,,! ,,diagnosis ,,(          
,,obscure ,,cases ,,( ,,jaundice4    ,! 
inte/9al excretion1 9 ! natural /ate1   
consi/s1 fir/ly1--(  ^? portions ( our  
food :i* h resi/$ ! action ( !  dige/ive
 juices2 secondly1--( ! excess ( !      
modifi$ food  rema9+ unabsorb$2 &1      
?irdly1--( ! excess1 #eb z well z (  !  
effete portions ( ! dige/ive secretions 
!mselves4  ,consequ5tly1 if f any cause 
! dige/ive secretions d n act  prop]ly1 
! evacuation imm$iately becomes         
abnormal1 & we c  discov] by analysis   
:i* ( ! secretions is at fault4 ,?us1 = 
example1 we "k t ! saliva acts ^u ! />*y
 matt]s ( our  food1 ! ga/ric juice on !
 album9\s1 ! pancreatic on ! fatty1  & t
 ! bili>y secretion s modifies ! *yme z 

to all[ ( its  rapid absorption by !    
lacteal1 & portal vessels4 ,if !n1 f any
  cause ! elaboration1 or excretion (   
any ( ^! dige/ive juices be  int]f]$ )1 
m ( ! p>ticul> k9d or k9ds ( food on :i*
  x acts1 passes un*ang$ ?r\gh !        
inte/9es4 ,?us1 if ! saliv>y  secretion 
be affect$1 an unusual am\nt ( unmodifi$
 />* is f\nd  9 ! /ool4 ,if ! ga/ric    
juice is defective1 m album5 ?an is     
normal passes away un*ang$1 & s on ) !  
o!rs4    ,x is cle> !n1 t an exam9ation 
( ! /ools mu/ af=d u  important         
in=mation reg>d+ ! pres5ce1 or abs5ce ( 
! normal  secretions4 ,a simple         
inspection ( ! /ool w sometimes at once 
tell u :e!r or n bile is pres5t4 ,if x  
be pres5t1 ! /ool  v>ies f a pale yell[1
 to a d>k olive-gre5 hue1 accord+ to !  
k9d1 & quantity ( bili>y col\r+ matt]   
pres5t1 & #ec !  nature ( ! food4 ,x mu/
 n be =gott5 h[ev]1 t unless c>e  be    
tak51 ! col\r d$ucible f highly-col\r$  
food may be  mi/ak5 = an excess ( bile4 
,?is rem>k is /ill m applicable to      

m$ic9es1 = m]cury1 bismu?1 iron1 & "s   
o!r m9]al rem$ies1  give rise to d>k    
evacuations s closely resembl+ bili\s   
/ools 9  appe>ance1 t ! only way to     
di/+ui% !m1 is by *emical  analysis2 :51
 ! pres5ce ( ! m9]al1 toge!r ) ! abs5ce 
( ! bile pigm5t1 & ! bili>y acids 7:i*  
are always to be  f\nd 9 normal         
evacuations71 w at once reveal ! true   
nature (  ! case4 ,i h se5 a mi/ake (   
?is k9d happ51 & t too1  :]e a pati5t   
lab\r+ "u jaundice f ob/ruction1 0 ?\ght
  to be pass+ ! usual am\nt ( bile 9 8  
/ools1 :5 9 reality  n a p>ticle ( bile 
pigm5t 0 pres5t4 ,! col\r 0 9 ?is case  
entirely due to ! food1 & f]rug9\s      
rem$ies4 ,blood f !  /oma* or b[els1 is 
also apt to be mi/ak5 = bili>y matt]1 m 
especially :5 act$ on by ! ga/ric juice1
 :i* has ! prop]ty  ( turn+ r$ blood    
br[n4 ,) ^! exceptions1 ! abs5ce ( bile 
f ! /ool1 is usually v easily asc]ta9$4 
,= if ! pati5t  be tak+ no highly-col\r$
 food1 or any ( ! m$ic9es above         
indicat$1 ! /ools are ( a #ed dirty     

pipe-clay col\r4 ,?is is n  due to !    
pres5ce ( any new or =eign matt]1 b     
solely to !  abs5ce ( bile pigm5t4 ,9 ^!
 cases ! evacuations1 besides be+  :ite1
 are usually ( a mo/ (f5sive od\r1 =1   
among o!r ?+s1  bile *ecks inte/9al     
putrefaction1 & ! developm5t ( (f5sive  
gases4    ,9 addition to ! col\r1 & od\r
 ( ! fces1 9 cases (  jaundice1 ano!r   
important indication is to be f\nd 9 !  
pres5ce  ( fat4 ,! pres5ce ( fat 9 !    
/ools 0 at "o "t look$ ^u  z evid5ce (  
pancreatic1 at ano!r "t ( hepatic       
disease2 n[1  h[ev]1 exp]im5tal         
physiology has taught u1 t x 9 "s       
measure  dep5ds ^u bo?4 ,= :ile1 on ! "o
 h&1 ! pancreatic secretion  emulsions !
 fatty "p ( our diet1 & !reby r5d]s x   
capable (  absorption1 rec5t rese>*es1 z
 has be5 already po9t$ out1 h  e/abli%$ 
! fact t ! bili>y secretion also plays  
an important  "p 9 ! absorption ( !     
oleag9\s con/itu5ts ( our food4  ,bidd] 
& ,s*midt1 z 0 be=e said1 h %[n t a dog1
 aft]  ligature ( ! gall-duct1 absorbs  

less ?an half ! av]age normal  quantity 
( fat2 & by exp]im5t x has be5 f\nd t   
?is arises  f ! circum/ance t bile      
emulsions only ! acid fats1 :ile        
pancreatic juice trans=ms ! neutral z   
well z ! acid #ee  oleag9\s matt]s4 ,!  
pres5ce ( fat 9 ! /ools may be due1     
!re=e1 p>tly to hepatic1 p>tly to       
pancreatic d]angem5t2 & ,i  %all        
imm$iately po9t out h[ we c turn ?is    
fact to acc\nt 9  diagnosis1 & discov] 9
 cases ( jaundice f ob/ruction1 :e!r  ! 
seat ( ! ob/ruction be at ! outlet or 9 
! c\rse ( !  duct4      ,,exam9ation ,,(
 ,,! ,,r5al ,,secretion4    ,! ur9e     
af=ds u important in=mation 9 all cases 
( jaundice4 ,9  fact1 an exam9ation ( x 
alone w\ld 9 _m cases enable u to       
discov] ! pres5ce or abs5ce ( ?is       
affection4      ,diagno/ic ,value ( !   
,col\r ( ! ,ur9e4    ,! ur9e ( jaundice 
has inv>iably a peculi> t9t1 rang+ f a  
saffron-yell[ to a d>k olive-gre51 or   
almo/ black hue4 ,x mu/ n  be =gott5 t !
 col\r ( normal ur9e v>ies ) ! degree ( 

conc5tration4 ,:]e little is pass$1 be+ 
( a high1 :]e mu* is  pass$1 ( a pale   
col\r2 ! dep? ( col\r dep5d+ on ! degree
  ( dilution ( ! urohmat9e4 ,aga91 x mu/
 also be rememb]$ t  !re are _m         
diseases1 :i* *ange ! col\r ( ur9e v    
mat]ially1 "s only deep5+1 o!rs actually
 *ang+ ! t9t4  ,foods1 & m$ic9es also1  
#ef alt] ! col\r ( ! r5al  secretion4   
,rhub>b1 & santon9e give to x a saffron 
hue1 ars5i\s  acid gas a black col\r4   
,be>+ 9 m9d ^! facts1 "o w\ld  hesitate 
be=e giv+ a decid$ op9ion z to ! pres5ce
 or abs5ce  ( ict]us f a m]e inspection 
( ! ur9e4 ,= ?is reason1 x is  g5]ally  
recomm5d$ 9 cases ( jaundice to p\r a   
little ( !  ur9e on a :ite plate1 & wat*
 ! play ( col\rs produc$ by  /rong      
nitric acid4 ,?is me?od1 h[ev]1 is n    
always satisfactory1  = ! play ( col\rs 
dep5ds on ! diff]5t /ages ( oxidation   
?r\gh :i* ! pigm5t passes1 & o!r animal 
pigm5ts1 besides  biliv]d9e1 un=tunately
 act 9 a some:at simil> mann]4    ,a v  
simple1 & m conv5i5t way ( te/+ ! pigm5t

 )\t  *ang+ its physical *>act]s1 is to 
sep>ate x 9 comb9ation )  uric acid4    
,?is is readily done by simply acidulat+
 ! ur9e ) a  few drops ( hydro*loric    
acid1 & sett+ x aside = tw5ty-f\r  h\rs 
to cry/allize4 ,! :ite uric acid 9      
cry/alliz+ takes up !  col\r+ matt]1 &  
assumes ! hue ( ! pigm5t pres5t 9 !     
ur9e4 ,i h ?us obta9$ cry/als ( all !   
diff]5t hues f a  bright gold5 yell[ t9t
 ?r\gh ! int]v5+ %ades ( r$1 br[n1      
blue1 olive1 to a d>k1 almo/ black      
col\r4 ,?is exp]im5t #eg has  ano!r     
advantage1 = if we take a measur$       
quantity ( ur9e1 &  collect1 dry1 &     
weigh ! uric acid obta9$ f x1 we c      
readily  calculate ! total quantity     
pass$ 9 ! tw5ty-f\r h\rs1 &  !reby assi/
 9 diagnos+ ! pres5ce or abs5ce (       
malignant  disease ( ! liv]1 z ,i %all  
aft]w>ds h occasion to po9t out4    ,!  
ur9e ( jaundice is g5]ally describ$ z   
be+ ( a saffron  col\r2 b if ,i may be  
all[$ to =m an op9ion f my own          
obs]vations1 :i* are tol]ably num]\s1 ,i

 %\ld say t x1 9  col\r1 mu* m frequ5tly
 resembles old ale ?an any?+ else )  :i*
 ,i am acqua9t$4 ,on /&+1 ! col\r *anges
 v  consid]ably1 9 consequ5ce ( ! pigm5t
 becom+ sl[ly oxidiz$ by  its exposure  
to ! air4 ,:5 !re is a v great excess ( 
bile  pigm5t pres5t 9 ! blood1 ! kidneys
 h "s difficulty 9  elim9at+ x4         
,occasionally ev51 x *okes up ! r5al    
capill>ies1  & !reby complicates !      
jaundice by induc+ second>y disease 9  !
 kidney4 ,9 su* cases ! ext]nal surface 
( ! kidney1 aft] !  removal ( ! capsule1
 looks z if x _h be5 spr9kl$ ov] )  ink4
 ,! black specks v>y 9 size f ! m9ute/  
visible po9t to  t ( a p9-head4 ,!      
accompany+ *romo-li?ograph 7,plate      
,,ii47  repres5ts a kidney 9 ?is        
condition4 #eh ,x w also be obs]v$  t x 
is /udd$ ov] ) a numb] ( small          
abscesses2 b :e!r  ^! result$ f !       
block+-up ( ! capill>ies j allud$ to  or
 n1 x is impossible to say4 ,9 ! case 9 
"q no album5 0  detect$ 9 ! ur9e dur+   
life1 & x 0 only on c>eful analysis1    

aft] ! po/-mortem _h reveal$ ! above    
/ate ( matt]s1 t a  small quantity 0    
discov]$2 & ev5 !n1 _h n ! exp]im5t  be5
 c>efully p]=m$1 ! pres5ce ( album5     
might h be5  ov]look$4    ,illu/ration3 
,plate ,,ii4 ,kidney f a ,case (        
,p]man5t ,jaundice4      ,diagno/ic     
,value ( ! pres5ce ( ! ,bile-,acids 9 ! 
,ur9e4    ,all acqua9t$ ) ! rec5t       
lit]ature ( jaundice "k h[ h>d a  battle
 is be+ f\ght betwe5 two sets ( obs]v]s 
9 ,g]many1  reg>d+ ! pres5ce (          
bile-acids 9 ur9e4 ,"o class1 ) ,fr]i*s 
& ,/dl] at _! head1 believe t ! bili>y  
acids are  decompos$ 9 ! blood1 & are   
consequ5tly nev] to be detect$ 9  !     
ur9e4 ,! o!r class1 head$ by ,khne1 /ate
 z positively t  !y h detect$ ^!        
sub/ances 9 ! ur9e4 ,inde$1 ,khne /ates 
t by adopt+ ,hoppe's me?od1#ah he nev]  
fails to #ei detect !  pres5ce ( !      
bili>y acids 9 ! ur9e ( pati5ts lab\r+  
"u  ict]us1 z well z 9 ! ur9e ( dogs ) !
 bile-duct ligatur$4  ,:5 fir/ /udy+ ?is
 "q1 ,i 0 v mu* p]plex$ by ^!           

contradictory /atem5ts1 = nei!r !       
judgm5t1 nor ! p[] (  obs]vation ( ei!r 
( ! au?orities c\ld = a mom5t be call$  
9 "q2 & on exp]im5t+ = myself1 s        
unsatisfactory 7  ! results obta9$1 t ,i
 almo/ ?rew ! "q aside 9  despair4 ,on  
"o occasion1 h[ev]1 ,i at l5g? met ) su*
  unmi/akeable evid5ce ( ! pres5ce (    
bile-acids 9 ! ur9e1 t  ,i c\ld no long]
 d\bt ! fact ( _! exi/5ce1 & 0 =c$ to   
se>* = an explanation ( ! previ\s       
contradictory results4  ,=tunately1 x 0 
n v long be=e a solution to ! difficulty
  0 obta9$1 &1 :at 0 ( /ill great]      
importance1 l$ to !  obs]vation t !     
contradictory results arose f a         
circum/ance  :i* might be turn$ to      
acc\nt1 z a means ( diff]5tial          
diagnosis4  ,! discov]y 01 t 9 c]ta9    
cases ( jaundice n a trace ( !  bili>y  
acids is to be detect$ 9 ! ur9e1 al?\gh 
! #fj bile  pigm5t is pres5t 9          
abundance2 :ile 9 c]ta9 o!r cases bo?   
bili>y acids1 & bile pigm5t occur 9     
notable quantity4 ,:at1 !n1  is ! cause 

( ?is diff]5ce8 ,simply ?is4 ,9 jaundice
 f  suppression ! liv] does n secrete   
bile2 consequ5tly no bile-acids  be+    
=m$1 none c ent] ! circulation1 & !y are
 !re=e  n to be detect$ 9 ! ur9e4 ,9    
jaundice f ob/ruction1 on !  o!r h&1    
bile is secret$1 & absorb$ into ! blood2
 & !  bile-acids n be+ all trans=m$ 9 ! 
circulation1 z ,fr]i*s  suppos$1 are    
elim9at$ by ! kidneys1 & appe> 9 ! ur9e1
 :]e  !y c be detect$ by ,hoppe's me?od1
 or ev51 ) prop]  precautions1 by simply
 add+ sulphuric acid & sug>4 ,"h1 h[ev]1
  "s skill & exp]i5ce are requisite1 9  
ord] n to conf\nd !  col\r produc$ by ! 
action ( ! reag5ts on o!r sub/ances )  !
 f9e purple produc$ by ! bili>y acids4  
,z ! majority ( cases  ( jaundice result
 f suppression ( ! hepatic function1 & z
  _m ( ! cases ( ob/ruction ultimately  
m]ge into ! =m]1 x  is easily und]/ood  
h[ ! exi/5ce ( ! bili>y acids 9 !  ur9e 
has be5 s frequ5tly d5i$4 ,i h myself   
se51 9 a case (  ob/ruction ( ! common  
duct1 ! bili>y acids sl[ly & gradually  

dim9i%$ 9 ! ur9e1 until !y at l5g? almo/
 entirely #fa  disappe>$ z ! case       
approa*$ a fatal t]m9ation4 ,"h !       
disappe>ance ( ! bili>y acids w5t on /ep
 = /ep ) !  impairm5t ( ! secret+ p[]s (
 ! liv]1 9 consequ5ce ( !  pressure     
ex]cis$ on its p>5*yma by ! reta9$ bile4
    ,footnote #ah3 ,pr(essor ,hoppe te/s
 = bile-acids 9 ! foll[+  mann]3--,!    
ur9e is boil$ ) an excess ( milk ( lime 
= ab\t  half an h\r1 & filt]$ to free x 
f ! precipitate ?us =m$4  ,! filtrate is
 evaporat$ to dryness1 decompos$ )      
hydro*loric  acid1 wa%$ ) wat]1 & !n    
extract$ ) alcohol4 ,! alcoholic        
extract conta9s ! bile-acids1 :i* are   
recognis$ by ,pett5k(]'s  te/4    ,!    
readie/ mode by :i* ! bili>y acids may  
be detect$ is !  foll[+3 ,to a c\ple (  
dra*ms ( ! suspect$ ur9e add a small    
fragm5t ( loaf-sug>1 & aft]w>ds p\r     
sl[ly into ! te/-tube  ab\t a dra*m (   
/rong sulphuric acid4 ,?is %\ld be done 
s z n  to mix ! two liquids4 ,if bili>y 
acids be pres5t1 !re w be  obs]v$ at !  

l9e ( contact ( ! acid1 & ur9e--aft] /&+
  = a few m9utes--a deep purple hue4#ai 
,?is result may be tak5 z a  sure       
indication t ! jaundice is due to       
ob/ruct$ bile-ducts4 ,on  ! o!r h&1 !   
abs5ce ( ?is ph5om5on1 & ! occurr5ce (  
m]ely a br[n in/ead ( a purple t9t1     
al?\gh1 9 ! e>li]  /ages ( jaundice1    
equally indicative ( suppression1 is (  
c\rse1  = ! reasons already giv51 no    
indication ( ! cause ( !  suppression4  
,t mu/ be glean$ f o!r circum/ances4    
,footnote #ai3 ,! imm$iate =mation ( a  
r$di% col\r$ l9e is due  to ! acid sett+
 free urohmat9e1 ! normal col\r+ matt] (
  ! ur9e4    ,x is se5 t ,i h tak5 no   
notice ( #fb ,fr]i*s' !ory  reg>d+ !    
bile-acids be+ *ang$ into bile pigm5t4  
,i h done  s advis$ly1 feel+ z ,i d1 t  
:5 t obs]v] inve/igates !  subject m    
fully1 he w himself ab&on su* an        
unt5able doctr9e1  f\nd$ z x is1 on an  
errone\s view reg>d+ ! nature ( bile    
pigm5t4 ,! col\r induc$ by sulphuric    
acid on ! acids ( ! bile1  is z diff]5t 

9 its *emical nature f animal pigm5t1 z 
any two  sub/ances c possibly be4       
,inde$1 !y h no bond ( connection       
:atev]1 except ! m]e t9t4 ,all animal   
pigm5ts1 :e!r !y be  gre51 l bile-col\r+
 matt]1 or r$1 l hmat9e1 spr+ f  ! same 
s\rce1 & conta9 iron4 ,besides ?is1 !   
m]e fact ( an  increase ( animal pigm5t 
be+ f\nd 9 ! ur9e aft] !  bile-acids h  
be5 inject$ into ! circulation1 to :i*  
,fr]i*s  atta*es su* importance1 9      
reality proves no?+ m1 z ,khne  po9t$   
out1 ?an t an increas$ de/ruction (     
blood corpuscles has  tak5 place4 ,i h  
f\nd ! ur9e ( dogs load$ ) d>k col\r+   
matt] aft] inject+ *lor(orm1 & o!r      
/imulants into _!  portal ve9s1 9 ord]  
to e/abli% artificial diabetes2 &1      
assur$ly1 9 ^! cases ! pres5ce or abs5ce
 ( bile-acids 9 !  blood _h no?+ to d ) 
! result4      #fc ,diagno/ic ,value ( !
 pres5ce ( ,tyros9e1 & ,leuc9e 9  ,ur9e4
    ,!re are two o!r abnormal products  
occasionally met ) 9 !  ur9e ( jaundice1
 namely1 tyros9e1 & leuc9e4 ,^!         

sub/ances1  al?\gh = _m ye>s kn[n to    
*emi/s1 attract$ comp>atively  little   
att5tion until ,fr]i*s discov]$ _!      
diagno/ic value 9  hepatic disease4     
,illu/ration3 ,,fig4 #d4--;,cry/als (   
pure tyros9e1 obta9$ f !  ur9e ( a case 
( *ronic atrophy ( ! liv]1 foll[+ ^u    
ob/ruction ( ! bile-duct4 7a7 ,l>ge     
cry/als4 7b7 ,! m  common =m ( ! /ellate
 gr\ps ( ne$le-%ap$ cry/als4 7c7 ,a  few
 sep>ate fragm5ts ( ne$le-%ap$ cry/als4 
,9 t peculi> =m ( compla9t1 describ$ z  
acute or yell[  atrophy ( ! liv]1 ! #fd 
ur9e is said inv>iably to conta9        
tyros9e1 & leuc9e4 ,! pres5ce ( ^!      
sub/ances may !re=e  assi/ u 9 diagnos+ 
! case4 ,:5 tyros9e1 & leuc9e are       
pres5t 9 quantity1 !y are v readily     
detect$1 all t is  requir$ be+ sl[ly to 
evaporate an ounce ( ur9e1 to !         
consi/5cy ( syrup1 put x aside dur+ a   
few h\rs to cry/allize1  & !n exam9e x )
 ! microscope4 ,! tyros9e is recognis$  
by  be+ 9 f9e /ellate gr\ps ( ne$le-l   
cry/als1 z repres5t$  9 fig4 #d1 or     

spiculat$ balls n unlike a roll$-up     
h$gehog1 )  ! bri/les /ick+ out 9 all   
directions4    ,illu/ration3 ,,fig4 #e4 
,spiculat$ balls ( tyros9e1 f ! ur9e (  
a case ( acute atrophy ( ! liv]4 ,:5 ^! 
7 re-dissolv$1  purifi$1 &              
re-cry/alliz$1 !y assum$ ! =m repres5t$ 
9  ,fig4 #d 7b74    #fe ,tyros9e may be 
obta9$ 9 a pure /ate by add+ to f\r     
ounces  ( ur9e a solution ( acetate (   
lead1 till a precipitate ceases to  =m1 
filt]+1 & free+ ! liquid f ! excess (   
lead by a  curr5t ( sulphurett$ hydrog51
 aga9 filt]+1 & evaporat+ !  cle>       
solution4 ,! tyros9e is n[ col\rless1 & 
cry/allizes )  ! microscopic *>act]s    
above allud$ to1 b /ill bett] m>k$4     
,tyros9e may be fur!r recognis$ by putt+
 a few cry/als on a  plat9um spatula1   
add+ a drop or two ( nitric acid1 &     
evaporat+  to dryness4 ,if pres5t1 !    
yell[ residue ?us obta9$ assumes a      
pumpk9 hue on ! addition ( pota%1 &     
leaves on inc9]ation a  d>k greasy /a94 
,fr]i*s recomm5ds ano!r te/1 namely1 !  

foll[+3--,put ! suspect$ sub/ance into a
 wat*-glass1 along )  "s sulphuric acid1
 & aft] !y h be5 9 contact ab\t half an 
h\r1 dilute ! mixture ) wat]4 ,next     
boil1 & !n neutralize  ) c>bonate (     
lime4 ,filt]1 & to ! clean filtrate add 
a few  drops ( p]*loride ( iron1 devoid 
( free acid4 ,! =mation ( a  d>k violet 
blue col\r indicates ! pres5ce (        
tyros9e4    ,leuc9e is kn[n by its flat1
 circul>1 oily-look+ discs1 )\t any     
cry/all9e /ructure4 ,at ! fir/ glance1 a
 globule ( leuc9e might  be mi/ak5 =    
oil1 n only on acc\nt ( its #ff         
microscopical  *>act]s1 b also on acc\nt
 ( its be+ light] ?an wat]4 ,!  globules
 ( leuc9e are di/+ui%$ f ^? ( oil by _! 
be+  soluble 9 wat]1 & boil+ alcohol1 & 
insoluble 9 e!r4 ,besides  ?is1 ! discs 
are occasionally opaque & lam9at$ l !   
granules  ( potato />*4 ,!y are !n n at 
all unlike microscopic cry/als  ( !     
c>bonate ( lime2 b ! c>bonate ( lime    
cry/als s9k 9  wat]4    ,illu/ration3   
,,fig4 #f4 ,d>k globules ( leuc9e (     

v>i\s sizes1  resembl+ 9 appe>ance      
globules ( c>bonate ( lime4    ,bo?     
tyros9e1 & leuc9e are usually deeply    
impregnat$ ) !  col\r+ matt] ( ! ur9e4  
,s9ce ,fr]i*s' views 7 fir/ publi%$ ,i h
 f\nd tyros9e1 &  leuc9e 9 ! ur9e (     
cases ( *ronic1 z well z ( acute atrophy
  ( ! liv]4 ,_! pres5ce may !re=e aid 9 
diagnos+ ! latt]  z well z ! =m]        
condition ( ! hepatic organ4    #fg ,i h
 little d\bt t future rese>* w discov]  
o!r  conditions ( ! liv]1 besides ^? j  
m5tion$1 9 :i*  tyros9e1 & leuc9e1 may  
appe> 9 ! ur9e2 =1 z w be  subsequ5tly  
po9t$ out at page #if1 ,i h be5         
successful 9  produc+ !m artificially 9 
! ur9e ( animals 9 :i* !re 0  no evid5ce
 ei!r ( acute or *ronic atrophy ( ! liv]
 hav+  tak5 place4 ,9 ! cases cit$1     
inde$1 x w be se5 t !  jaundice 0 !     
result ( suppression1 consequ5t ^u      
conge/ion (  ! liv]1 produc$ by blood   
poison+4    ,x may be add$ t s9ce ^!    
obs]vations 7 made ,i h f\nd 9  !       
artificially conc5trat$ ur9e ( a case ( 

jaundice f  ob/ruction consequ5t ^u     
impact$ gall-/one1 a few balls closely  
resembl+ leuc9e 9 %ape1 & size1 b diff]+
 f x 9 be+  excessively d>k 9 col\r4 ,no
 tyros9e cry/als 7 obs]v$1 &            
un=tunately !re 0 n suffici5t ( !       
leuc9e-l sub/ance  pres5t 9 ! ur9e to   
admit ( its be+ *emically te/$4 ,i h    
?\ght x my duty to record ?is fact = !  
b5efit ( o!r  obs]v]s1 z !re c be little
 d\bt t we are gradually v]g+  t[>ds "s 
important discov]y 9 a diagno/ic po9t ( 
view4      #fh ,melan9e 9 ! ,ur9e4      
,f\r ye>s ago 7#aheh71 ,dr4 ,eiselt (   
,prague call$ att5tion to !  fact t 9   
cases ( melanotic canc] ( ! liv]1       
melan9e appe>s  9 ! r5al secretion4#bj  
,:5 ! ur9e is pass$ x is usually  q     
cle>2 b aft] /&+ x becomes ( a d>k      
col\r1 ev5 z  d>k z port]1 )\t1 h[ev]1  
los+ its transp>5cy4 ,?is  deep5+ ( !   
col\r is no d\bt due to ! oxidation ( ! 
melanotic pigm5t1 z ! employm5t ( an    
oxidiz+ ag5t1 su* z  nitric or *romic   
acid1 causes ! same *ange to occur      

in/antly4    ,footnote #bj3 ,dr4 ,eiselt
 /ates t he also f\nd melan9e 9 !  ur9e 
9 a case ( melanotic canc] ( ! eyeball4 
,9 addition to ! cases relat$ by ,dr4   
,eiselt1 ,i am able to add "o (         
consid]able importance1 z x n only (f]s 
a /rik+ illu/ration  ( ! correctness ( 8
 views1 b has ! d\ble advantage ( be+   
an unbiass$ record ( facts1 9 consequ5ce
 ( its hav+ be5  obs]v$1 & record$ long 
be=e ,dr4 ,eiselt's views 7 publi%$1  & 
!re=e at a "t :5 ! au?or _h no idea (   
its  significance4 ,! case occurr$ ab\t 
?irte5 ye>s ago1 9 ! w>ds  ( ! ,royal   
,infirm>y ( ,ed9burgh4 ,! hi/ory ( !    
case ,i extract  f my private note-book4
 ,x is briefly z #fi foll[s3--,9 ! mon? 
( ,may a sailor 0 admitt$ into ! cl9ical
 w>ds ( ! ,royal  ,infirm>y ) symptoms (
 jaundice f enl>g$ liv]4 ,he /at$ t  he 
_h be5 a great deal abroad1 9 hot       
climates1 & admitt$ t he  _h be5 a h>d  
dr9k]4 ,on admission 8 sk9 0 ( a dusky  
yell[  col\r1 & _h be5 s s9ce ! mon? (  
,febru>y4 ,! liv] 0  consid]ably enl>g$1

 & he compla9$ ( sudd5 viol5t pa9s 9 !  
neighb\rhood ( ! umbilicus4 ,! pa9 0    
usually mo/ sev]e dur+  ! night4 ,! ur9e
 0 ( a d>k col\r1 & on ! addition (     
nitric acid1 became ne>ly q black4 ,x   
conta9$ no album54 ,!  pati5t di$ t5    
days aft] admission4 ,on po/-mortem     
exam9ation1 !  hepatic duct 0 f\nd      
block$ up ) malignant deposit1 & ! liv] 
( a d>k gre5 col\r4 ,!re 0 also a       
consid]able am\nt (  malignant deposit 9
 ! mes5t]y4 ,?is pati5t1 z frequ5tly    
happ5s  9 su* cases1 became deliri\s    
be=e dea?4    ,9 jaundice aris+ f       
melanotic canc] ( ! liv]1 ! recognition 
( ! pres5ce ( melan9e 9 ! ur9e w\ld be  
an important aid to  ! diagnosis4 ,c>e  
mu/ be tak5 n to conf\nd ! d>k          
olive-gre5  ur9e occasionally met ) 9   
o!r =ms ( jaundice1 ) !  melanotic ur9e 
j describ$1 or bo? #gj pati5t & doctor  
may  become unnecess>ily al>m$4#ba      
,footnote #ba3 ,:ile ,i 0 ,resid5t      
,physician 9 ! ,royal ,infirm>y (       
,ed9burgh1 9 #ahej1 a woman1 ag$ #bh1 0 

admitt$ ) a univ]sal &  bright jaundice 
( ?ree weeks' /&+4 ,h] ur9e 0 high      
col\r$1  & ( a specific gravity ( #ajbb4
 ,x conta9$ a small quantity (  album51 
& became p]fectly black on be+ boil$ )  
nitric acid4  ,9 ?is case !re 0 no      
reason to suspect malignant disease ( ! 
liv]2 ! col\r ( ! ur9e 01 !re=e1 mo/    
probably due to !  bile pigm5t be+ m ?an
 usually oxidiz$4 ,aft] a six weeks' /ay
  9 ! hospital1 ,i dismiss$ ! pati5t z  
cur$4      ,urea1 ,uric ,acid1 & ,sug>4 
,! pres5ce1 & quantity ( c]ta9 o!r      
sub/ances met ) 9 !  ur9e ( jaundice1   
al?\gh n peculi> to t condition1        
nev]!less af=d u important in=mation1 n 
only z to its cause1  b also z to its   
probable mode ( t]m9ation4    ,fir/ly1 a
 correct k ( ! quantity ( urea1 & ( uric
 acid  pass$ 9 ! tw5ty-f\r h\rs is (    
great value2 &1 secondly1 !  pres5ce1 or
 abs5ce ( sug> is a fact :i* ought nev] 
to be lo/  sight (4 ,! value ( ?is      
/atem5t1 z well z ( sev]al ( !  prec$+1 
w1 ,i ?9k1 be bett] appreciat$ by giv+ a

 %ort  acc\nt ( a case ( obscure disease
 7:]e a correct diagnosis1 &  prognosis 
c\ld n h be5 arriv$ at )\t ! application
 ( !  *emical k ref]r$ to71 ?an by any  
m]e ab/ract #ga  treatm5t ( ! "q4 ,i    
%all1 !re=e1 at once proce$ to  relate !
 brief hi/ory ( ! case4    ,a g5tleman1 
ag$ fifty1 :o _h be5 a rem>kably heal?y 
man1  obs]v$1 )9 eighte5 mon?s ( 8 dea?1
 t 8 sk9 gradually  assum$ a m & m      
jaundic$ t9t )\t any assignable cause4  
,! /ools 7 clay-col\r$1 ! ur9e load$ )  
bile pigm5t4 ,soon  aft]w>ds1 ! pati5t  
began to lose fle%4 ,! liv] became      
enl>g$1  & some:at t5d] to ! t\*2 !     
gall-bladd] be+ at ! same  "t s di/5d$ t
 x c\ld be se51 z well z felt1 project+ 
f "u ! false ribs4 ,z ! case resi/$ !   
usual rem$ies1 !  pati5t 0 recomm5d$ to 
try *ange ( air4 ,dur+ 8 abs5ce f  t[n1 
he sudd5ly pass$ a l>ge quantity ( yell[
 matt] by /ool  7suppos$ to be bile71 & 
imm$iately aft]w>ds ! fulness 9 !       
abdom5 disappe>$4 ,on ! pati5t's return 
to t[n1 ! gall-bladd]  c\ld no long] be 

se5 or felt1 & x 0 naturally suppos$ t x
  _h empti$ itself on ! occasion ref]r$ 
to4 ,z1 not)/&+  ?is1 ! jaundice        
cont9u$1 & ! heal? & /r5g? gradually    
decl9$1 ,dr4 ,prance1 "u ^: c>e ! pati5t
 01 s\ght !  assi/ance ( a physician (  
di/+ui%$ reputation 9 ^!  affections4   
,at ?is p]iod1 #gb h[ev]1 ! entire      
abs5ce (  physical signs beyond !       
clay-col\r$ /ools1 & ^? directly        
ref]rable to ! jaundice1 r5d]$ x        
impossible = any decid$  op9ion to be   
arriv$ at4 ,! liv] _h n[ resum$ its     
natural size1  & ! only ?+ detectable 0 
slight t5d]ness on pressure1 ) a        
d\btful fulness 9 ! pancreatic region4  
,^! signs1 associat$ z  !y 7 ) gradually
 increas+ emaciation & debility1 l$ to !
  suspicion ( malignant disease1 ei!r 9 
! c\rse ( ! bile-ducts1  or at ! head ( 
! pancreas4 ,ab\t ?is "t x 0 discov]$ t 
! pati5t occasionally pass$ a           
consid]able am\nt ( a  fatty-look+ matt]
 by /ool--n mix$ ) ! motion1 b sep>ate1 
?\gh ^u x4 ,aft] ! passage ( ?is matt]1 

!re 9 g5]al  appe>$ to be a slight      
improvem5t 9 ! pati5t's condition4 ,!   
sub/ance 9 "q1 on cool+1 solidifi$ into 
a firm pale-br[n  matt]1 resembl+       
,w9dsor soap1 & n at all unlike "s ( !  
bili>y products4 ,?is l$ to ! idea t x  
might be compos$ ( !  fatty acids ( !   
bile4 ,on "o occasion a portion ( x 0   
=w>d$  to me = analysis1 & on subject+ x
 to *emical exam9ation x  prov$ to be1  
/rangely modifi$ fi%-oil1 ! ole9e ( :i* 
_h  entirely disappe>$4 ,9 fact1 x 0    
no?+ b ! sp>+ly soluble  fatty acids (  
cod-liv] oil1 :i* _h #gc be5 trans=m$ 9 
!  /oma*1 & f :i* all ! liquid pr9ciples
 _h be5 absorb$4  ,?is 0 consid]$ an    
important discov]y1 z x n only negativ$ 
! idea ( ! bile /ill rea*+ ! inte/9es1 b
 also prov$  t ! pancreas1 z well z !   
liv]1 0 affect$4 ,hav+ ?us  le>n$ t !   
pancreatic juice1 z well z ! bile1 fail$
 to rea*  ! inte/9es1 an ef=t 0 made to 
c\nt]act ! p]nici\s effect  on ! sy/em  
caus$ by ! abs5ce ( ! =m] secretion1 by 
giv+  #a gra9s ( pancreat9e 9 ! =m (    

pill ?ree times a day4 ,dur+  ! p]iod t 
! pati5t 0 tak+ ?is m$ic9e1 ! quantity (
  fat pass$ by /ool 0 suppos$ to dim9i%4
 ,no decid$ improvem5t 9  ! pati5t's    
condition took place1 h[ev]1 & on ! #bnd
 ( ,novemb]  ! g5tleman 0 br\ght to me  
by 8 m$ical att5dant4 ,at ?is "t  !     
pati5t 0 mu* 9 ! /ate already           
describ$1#bb & aft] a  c>eful physical  
exam9ation1 ,i fail$ to elicit any new  
fact (  importance4 ,! hepatic dulness 0
 p]fectly natural2 !re 0 no  t5d]ness to
 speak (1 no hi/ory ( gall-/ones1 & #gd 
no evid5ce  ( any tum\r beyond ! d\btful
 fulness 9 ! pancreatic region4 ,!      
dige/ive1 & o!r functions ( ! body1     
except ^? already  m5tion$1 seem$       
unimpair$1 & yet ! pati5t's /r5g? daily 
decl9$4 ,z physical z well z            
symptomatical diagnosis prov$           
inadequate to unravel ! my/]y ( ?is     
obscure case1 & z *emical  means _h     
already1 9 z f> z x _h be5 tri$1 be5 (  
advantage1  x 0 resolv$ to subject !    
excretions to a rigid *emical           

exam9ation4 ,! pati5t 0 accord+ly desir$
 to collect all !  ur9e he pass$ dur+   
tw5ty-f\r h\rs1 & :ile ,i analys$ x1    
,dr4  ,prance exam9$ ! /ools1 9 ord] to 
asc]ta9 _!  composition--especially z   
reg>d$ ! am\nt ( fatty & album9\s       
matt]s conta9$ 9 !m4 ,! ur9e yield$ on  
analysis ! foll[+  result3--            
#bd ,,h\rs' ,,ur9e4    ,quantity 7#ee   
oz47 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
  #agje c4c4    ,reaction  4 4 4 4 4 4 4
 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4  ,acid4  
,specific gravity  4 4 4 4 4 4 4 4 4 4 4
 4 4 4 4 4 4 4  #ajah4    ,col\r  4 4 4 
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4   
,gre5i% yell[4    ,urea  4 4 4 4 4 4 4 4
 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4  #bgbh 
grammes4    ,uric acid 7cry/als l>ge1 & 
( a d>k-gre5 col\r7  #jeaa       ,bile  
acids#bc  4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 
4 4 4 4  ,abundant4 #ge    ,bile        
pigm5t#bd  4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
 4 4 4  ,abundant4    ,album5 4 4 4 4 4 
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4     
,none4    ,sug> 4 4 4 4 4 4 4 4 4 4 4 4 

4 4 4 4 4 4 4 4 4 4 4 4  ,none4         
,footnote #bb3 ,i not$ 8 /ate to be z   
foll[s3--,sk9 ( a black  jaundic$ t9t   
7d>k gre574 ,eyes deeply /a9$4 ,lips    
anmic4  ,consid]able emaciation &       
debility4 ,extreme languor4 ,appetite   
good4  ,tongue1 & pulse n rem>kable4    
,slight pa9 on pressure ov] !           
gall-bladd]4 ,indi/9ct fulness 9        
pancreatic region1 & to ! left  ( middle
 l9e4    ,footnote #bc3 ,on ! addition (
 sulphuric acid1 & :ite sug> to !  ur9e1
 a v m>k$1 & beautiful purple hue 0     
obta9$4    ,footnote #bd3 ,nitric acid  
at fir/ turn$ ! ur9e gre51 b on !       
application ( heat x became r$1 & aft]  
prolong$ boil+1 ( a  pale /raw col\r4   
,hydro*loric acid *ang$ ! col\r ( ! ur9e
  imm$iately to a deep olive-gre5 t9t4  
,! facts "h elicit$ 7 int]pret$ z       
foll[s3--    #a/1--,! quantity ( urea   
:i* might be said to be normal1 0       
consid]$ a fav\rable sign1 z x indicat$ 
t ! /oma*al  dige/ion 0 unimpair$4      
#bnd1--,! quantity ( uric acid be+ bel[ 

! av]age1 0 likewise  reg>d$ z          
fav\rable1 t5d+ z x did to negative !   
idea (  canc]\s disease ( ! liv]2 ! uric
 acid be+ 9 su* cases  usually increas$4
    #crdly1 & la/ly1 ! pres5ce ( !      
bili>y acids1 z well z !  bile pigm5t1 9
 ! ur9e1 %[$ t bile 0 /ill be+ secret$1 
b re-absorb$1 & ?is l$ at once to !     
diagnosis t ! case  0 "o ( jaundice f   
ob/ruction4    ,"h1 !n1 0 an important  
/ep ga9$4 ,! next po9t 01 if  possible1 
to asc]ta9 ! cause ( ! ob/ruction4 ,tak+
 into  acc\nt ! abs5ce ( any tum\r1 &   
any hi/ory ( gall-/ones1  toge!r ) !    
fact ( ! sudd5 disappe>ance ( ! enl>g$  
gall-bladd]1 my #gf fir/ idea 0 t x     
might be a case (  hydatids block+ up ! 
common gall-duct1 & t on "o occasion1   
"s l>ge cy/ _h ruptur$1 & dis*>g$ itself
 ?r\gh !  inte/9es4 ,on talk+ ! case ov]
 ) ,dr4 ,prance1 h[ev]1 t  idea 0       
ab&on$1 & we 7 =c$ to cont5t ourselves )
 !  simple fact t ! case 0 "o ( jaundice
 f ob/ruction ( !  common bile-duct1    
complicat$ ) occlusion ( ! pancreatic   

duct1  :i* fact _h be5 previ\sly        
asc]ta9$ by ! discov]y ( !  fatty acids 
9 ! fces4 ,ab\t ?is "t ! pati5t took    
?ree gra9s  ( b5zoic acid1 9 ! =m ( pill
 ?rice a day1 & x 0 ?\ght1  ) !         
advantage ( slightly dim9i%+ ! jaundic$ 
/ate ( !  sk94 ,b no p]man5t b5efit 0   
obta9$1 & aft] a "t ?is  rem$ial ag5t _h
 to be discont9u$1 9 consequ5ce ( its   
hav+  induc$ slight dyspepsia4 ,9 !     
lett] ,i receiv$ in=m+ me ( ?is  fact1 x
 0 also not$ t !re 0 mu* less bo? ( !   
oily  matt]1 & album5 9 ! /ools4 ,!re 01
 at ! same "t1 a  consid]able deposit ( 
urates 9 ! ur9e4 ,! specific gravity    
cont9u$ to be ab\t #ajah4 ,! quantity 9 
tw5ty-f\r h\rs ab\t  =ty ounces4 ,on !  
#bi? ( ,novemb]1 ! pati5t 0 aga9 br\ght 
to  me1 & we made a c>eful exam9ation ( 
! size1 %ape1 & exact  position ( ! #gg 
hepatic organ4 ,! measurem5ts 7 f\nd to 
be #e  in*es at ! extreme "r1 #d in*es  
at a l9e drawn p]p5dicul>ly  to !       
nipple1 & #b in*es midway betwe5 nipple 
& /]num4 ,beyond  ! c5tre ( ! /]num !   

liv] did n rea*4 ,z reg>ds ! size  ( !  
liv] !n1 !re 0 /ill no?+ v rem>kable4   
,on ?is occasion x 0 obs]v$1 t !        
pati5t's memory 0 n s  good z =m]ly1 & t
 !re 0 a c]ta9 am\nt ( m5tal z well  z  
bodily languor4 ,8 he>+ 0 likewise      
sluggi%1 ! words hav+  occasionally to  
be repeat$ be=e !y made an impression on
 !  c]ebral organ4 ,?is1 no d\bt1 arose 
f ! poison\s effects ( !  bile circulat+
 9 8 blood4    ,x may be "h m5tion$1 t 9
 cases ( jaundice f suppression we      
seldom or nev] meet ) ^? extreme        
symptoms ( c]ebral  di/urbance :i* are s
 common 9 cases ( jaundice f ob/ruction4
  ,i believe ! reason ( ?is diff]5ce 9 !
 two =ms ( jaundice  arises f !         
circum/ance t ! really poison\s p>ts ( !
  bile are ! bili>y acids1 & t !y1 l    
urea1 are p[]ful  n>cotic poisons4 ,!   
results ( ! exp]im5ts on artificial     
jaundice  7page #ie7 l$ me to ?is       
conclusion4    ,z nei!r ! symptoms nor  
physical signs ?rew any additional light
  on ?is int]e/+ case1 #gh x 0 det]m9$  

once m to br+  *emi/ry & ! microscope to
 be> ^u x1 ) ! view (1 if  possible1    
ext5d+ ! in=mation ^! me?ods (          
inve/igation _h  already yield$4        
,accord+ly1 a specim5 ( ! ur9e 0 aga9   
obta9$ = analysis1 & x yield$ ! foll[+  
results3--                  #bd ,,h\rs' 
,,ur9e4    ,quantity1 7#dc oz47 4 4 4 4 
#accc c4c4    ,specific gravity 4 4 4 4 
4  #ajaf4    ,reaction 4 4 4 4 4 4 4 4 4
  ,acid4    ,urea 4 4 4 4 4 4 4 4 4 4 4 
#bciid grammes4    ,uric acid  4 4 4 4 4
 4 4 4   #jbff        ,bile pigm5t 4 4 4
 4 4 4 4  ,abundant4    ,bile acids 4 4 
4 4 4 4 4 4  ,small quantity4    ,sug>  
4 4 4 4 4 4 4 4 4 4  ,a little4         
,solids 7total7 4 4  #daihi    ,organic 
matt] 4 4 4 4 4 4  #caiib    ,inorganic 
4 4 4 4 4 4 4 4   #iiig    ,a m>k$ *ange
 is "h se5 to h occurr$ 9 ! con/itution 
(  ! r5al secretion4 ,fir/--! quantity (
 urea has notably dim9i%$  7f #bgbh to  
#bcii grammes1 or 9 o!r words1 f #dbchd 
to #cgj  gra9s47 ,! am\nt ( uric acid   
has also fall5 7f #jeaa to #jbff        

grammes1 or 9 o!r words1 f #h to #d     
gra9s72 :ile at ! same "t  ! bili>y     
acids h consid]ably decreas$4 ,^! *anges
 are also  se5 to be accompani$ by      
ano!r1 :i* ,i at once reg>d$ #gi z a    
mo/ unfav\rable sign1--namely1 !        
appe>ance ( sug> 9 ! ur9e4  ,al?\gh !   
quantity ( sug> 0 z yet small1 & x 0    
associat$  ) a dim9ution 9 ! bile acids1
 x nev]!less made me look  =w>d ) gloomy
 =ebod+s1 = z f> z my exp]i5ce goes1 :5 
! ur9e becomes sac*>9e 9 ! c\rse ( a    
*ronic1 & exhau/+  disease1 x has       
g5]ally be5 ! =]unn] ( a fatal          
t]m9ation4  ,?is case1 ,i am sorry to   
say1 prov$ no exception to ! rule4 ,!re 
01 inde$1 b "o consolatory fact 9 !     
analysis1 & t 0 !  dim9ution ( ! uric   
acid1 :i*1 z ,i be=e rem>k$1 t5d$ to    
negative ! idea ( malignant disease ( ! 
liv]1 & ?is 0 a  great s\rce (          
satisfaction to ! pati5t4    ,eight days
 lat]1 #ab? ,novemb]1 a qualitative1 &  
quantative analysis  ( ! ur9e 0 aga9    
made1 ) ! foll[+ result3--              

#bd ,,h\rs' ,,ur9e4    ,quantity 7#cc   
oz47 4 4 4 4 4 4 4  #ajbc c4c4          
,reaction  4 4 4 4 4 4 4 4 4 4 4  ,acid4
    ,specific gravity  4 4 4 4 4 4 4    
#ajag4    ,urea  4 4 4 4 4 4 4 4 4 4 4 4
 4  #aecde grammes4    ,uric acid 4 4 4 
4 4 4 4 4 4 4 4  8    ,bile acids  4 4 4
 4 4 4 4 4 4 4  ,none4    ,bile pigm5t  
4 4 4 4 4 4 4 4 4  ,abundant4    ,sug> 4
 4 4 4 4 4 4 4 4 4 4 4 4  ,increas$4 #hj
    ,tyros9e1 & leuc9e#be 4 4 4  ,9     
small quantity4      ,solids 7total7  4 
4 4 4  #bcdbf    ,organic matt]  4 4 4 4
 4 4 4 4  #agfih    ,inorganic 4 4 4 4 4
 4 4 4 4 4 4   #egbh    ,footnote #be3  
,on precipitat+ ! ur9e ) ! acetate (    
lead1  filt]+1 & free+ ! cle> liquid f !
 excess ( t reag5t  by means (          
sulphurett$ hydrog51 & aga9 filt]+1 !   
liquid1 on  evaporation1 0 f\nd to      
deposit small cry/als ( tyros9e1 & to  h
 float+ 9 x1 & on its surface1 r\nd     
balls ( leuc9e4    ,"h1 is n[ to be     
obs]v$1 ! rapid d[nw>d progress ( !     
case4  ,/oma*al dige/ion1 z indicat$ by 

! am\nt ( urea1 is mu*  impair$4 ,!     
g5]al heal?1 z indicat$ by ! sug>1 is   
sadly  affect$1 &1 to cr[n all1 tyros9e1
 & leuc9e1 ! indicators (  atrophy ( !  
liv]1 h made _! appe>ance4 ,s           
unfav\rable 0  ! result ( ?is analysis  
consid]$1 t ,dr4 ,prance felt himself   
b\nd to fulfil a promise he _h made to !
 family "s "t  previ\sly1 ( w>n+ !m (   
approa*+ dang]1 :5 we _h no  long] any  
hope ( ! pati5t's recov]y4    ,"s "t    
aft]w>ds1 9 ! beg9n+ ( ,decemb]1 we aga9
 saw !  pati5t toge!r1 & made a physical
 exam9ation ( ! hepatic organ1  ! result
 ( :i* only confirm$ our suspicions4 ,! 
liv] 0  decid$ly small]4 ,! epiga/ric   
t5d]ness 0 increas$4 ,! #ha  jaundic$   
t9t deep]4 ,pete*ial spots _h n[ appe>$ 
on ! trunk1  & arms4 ,! l[] extremities 
7 o$emat\s1 & ! abdom5  two-?irds fill$ 
) fluid4    ,on ! #ca/ ,decemb]1 ,i     
receiv$ a sample ( ur9e1 & a note say+  
t ! pati5t _h slightly ralli$4 ,b on    
exam9+ ! ur9e1 x  0 f\nd to h a neutral 
reaction--x _h previ\sly always be5     

acid--to be ( a specific gravity (      
#ajai1 & on /&+1 to deposit  a copi\s   
s$im5t ( li?ates1 col\r$ int5sely yell[ 
) ! bile  pigm5t4 ,curi\sly en\gh1 !    
bile-acids _h reappe>$2 b only 9        
quantity suffici5t to admit ( _! be+    
detect$4 ,9 spite ( ^!  trifl+ *anges = 
! bett]1 ! om9\s "o ( an increas$ am\nt 
( sug> 0 /ill !re4    ,a few days lat]1 
& j be=e 8 dea?1 ! pati5t _h !  b5efit (
 ano!r physician's op9ion1 :i*1 al?\gh x
 diff]$  some:at f ! =ego+1 01          
nev]!less1 equally unfav\rable1  = he   
consid]$ x a case ( malignant disease4  
,! g5tleman hav+ notic$ t 8 case excit$ 
consid]able  int]e/1 & "s diff]5ce (    
op9ion among 8 m$ical att5dants1        
direct$ t 8 body %\ld be exam9$ aft]    
dea?2 & z ?is wi%  0 second$ by 8 wife1 
#hb a lady ( sup]ior m9d &              
accompli%m5ts1 a po/-mortem exam9ation 0
 accord+ly made1 )  ! foll[+ results3-- 
,fir/ly1--,! pancreatic duct1 z _h be5  
suspect$1 0 f\nd  completely occlud$ at 
its outlet1 & s di/5d$ by ! accumulat$  

secretion1 t x readily admitt$ ! po9t ( 
! little f+]4  7,vide ,plate ,i41 g47   
,secondly1--,! orifice ( ! common       
bile-duct 0 9 l mann]  completely       
oblit]at$1 & ! duct itself imm5sely     
di/5d$ )  d>k ?ick t>ry bile1 :i* on    
microscopic exam9ation1 0 f\nd  load$ ) 
beautiful cry/als ( *ole/]9e4 7,fig4    
#g47    ,illu/ration3 ,,fig4 #g4    ,!  
gall-bladd] 0 enl>g$ to ! size ( a      
swan's egg1 &  conta9$ ?ick t>ry fluid2 
b no gall-/ones1 or masses (  inspissat$
 bile4 ,! hepatic duct 0 greatly enl>g$1
 easily  admitt+ #hc ! po9t ( ! f+]4 ,! 
cy/ic duct 0 also  dilat$1 ?\gh 9 a mu* 
less degree4 7,vide ,plate ,i41 c4 d4   
e47    ,?irdly1--,! gall-bladd]1        
duod5um1 abdom9al p>ietes1 & 9 fact  all
 ! abdom9al visc]a1 7 int5sely /a9$1    
almo/ black5$1 by  ! osmos$ bile4       
,f\r?ly1--,! bile1 on analysis1 0 f\nd  
to conta9 9 "o ?\s&  p>ts3--            
,wat] 4 4 4 4  #fidde      ,solids  4 4 
4  #cjeee                     ------    
#ajjjjj                          ,pigm5t

 4 4 4 4     ,bile-acids  4 4  ,organic 
matt]  4  #bhhii    ,*ole/]9e  4        
,soda  4 4 4 4 4     ,pota%  4 4 4 4    
,inorganic salts 4   #afef    ,iron  4 4
 4 4 4     ,:]eas a specim5 ( normal    
bile tak5 f ! gall-bladd] ( a  woman ag$
 sixty-"o1 0 ( a specific gravity (     
#ajbj1 & conta9$  9 #ajjj p>ts3--       
,wat] 4 4 4 4  #iccbg      ,solids  4 4 
4   #ffgc                     ------    
#ajjjjj                      #hd        
,pigm5t 4 4 4 4     ,bile acids  4 4    
,organic matt]  4  #efgc    ,*ole/]9e  4
     ,sug> 4 4 4 4 4       ,soda  4 4 4 
4 4     ,pota%  4 4 4 4  ,inorganic     
salts 4  #ajjj    ,iron  4 4 4 4 4      
,! diff]5ce 9 composition ( ^! two biles
 is v /rik+4 ,!  "o conta9s m ?an f\r   
times z mu* solid matt] z ! o!r2  & if !
 relative am\nt ( organic1 & inorganic  
sub/ances be  comp>$1 ! curi\s fact is  
obs]v$1 t ! diff]5ce 9 !  am\nt ( solids
 9 ! two cases1 is almo/ entirely due to
 ! *ange  9 quantity ( organic matt]4 ,!
 inorganic salts h n ev5 s  mu* z d\bl$ 

!mselves 9 ! abnormal bile4 ,:5ce is    
?is8 ,soda  is ! *ief inorganic sub/ance
 f\nd 9 bile1 & we h se5 t  x occurs 9 !
 =m ( glyco*olate1 & tauro*olate ( soda1
  sub/ances :i*1 z be=e rem>k$1 are     
re-absorb$ f !  di/5d$ ducts1 &         
gall-bladd] into ! circulation1 f :5ce  
!y are con/antly be+ elim9at$ ) ! ur9e2 
& ?is1 no  d\bt1 is "o ( ! causes :y !  
inorganic salts are proportionally  9   
su* small quantity 9 ! abnormal bile (  
jaundice f  ob/ruction4    #he          
,fif?ly1--,9 ! abdom5 0 a consid]able   
quantity ( d>k  /raw-col\r$ s]um1 :i* on
 ! addition ( /rong sulphuric acid      
became ( a f9e em]ald-gre5 col\r1 9     
consequ5ce ( ! pres5ce  ( bile4 ,traces 
( sug> 7 also pres5t 9 ! effus$ liquid4 
,!  s]um _h only collect$ 9 ! latt]     
weeks ( ! pati5t's life1 &  aft] ! %r9k+
 ( ! liv] 0 obs]v$ to h begun4          
,six?ly1--,! liv] 0 small 9 size1       
excessively d5se1 & v  heavy4           
,ext]nally1 x _h a d>k olive hue1 & on  
section pres5t$ a  mo/ curi\s appe>ance4

 ,! section 0 ( an almo/ uni=m          
yell[i%-gre5 col\r1 & /udd$ ov] )       
excavations 7,plate ,i41  b71 f :i* ?ick
 bile /ream$ 9 all directions4 ,! app>5t
  excavations 7 no?+ m or less ?an      
imm5sely di/5d$ ducts4  ,on look+ into !
 ducts1 x 0 obs]v$ t !y pres5t$ !       
appe>ance ( possess+ valves4 ,on        
microscopical exam9ation1 !  hepatic    
cells 7 f\nd small] ?an normal1 z if    
p>tially  atrophi$4 ,! nuclei 7         
unusually well m>k$1 9 consequ5ce ( !   
fat granules be+ almo/ entirely abs5t4  
7,fig4 #h1 b47 ,9 ! field  ( !          
microscope 7 a numb] ( caudate or       
sp9dle-%ap$ cells  7,fig4 #h1 c471 f !  
epi!lial l9+ ( ! ducts4 ,9 ! hepatic    
tissue 7 f\nd "s beautiful #hf /ellate  
cry/als1 z well z a  numb] ( sep>ate    
ne$les ( tyros9e4 ,a few small cry/als (
 cy/9e  7 also f\nd4 7,fig4 #h1 a47     
,illu/ration3 ,,fig4 #h4                
,sev5?ly1--,! kidneys 7 enl>g$1 pale1 & 
fatty-look+2 & all  ov] ! surface ( !   
section1 z well z imm$iately "u !       

capsules1 :i* 7 v loosely atta*$1 7     
small abscesses4 ,!  surface 0 also     
/udd$ ) num]\s m9ute d>k bile-pigm5t    
po9ts1  & x is possible t ! abscesses 7 
! result ( ! block+  up ( ! capill>y    
vessels by ! pigm5t deposit1 z previ\sly
  allud$ to1 page #eg4    ,eigh?ly1--,! 
head ( ! pancreas 0 consid]ably enl>g$1 
& on  cutt+ into x1 a quantity ( pus    
ooz$ out f an abscess 9 its  int]ior4 ,!
 abscess 0 f\nd to communicate ) a l>ge 
ulc]at$  spot 9 ! duod5um4 7,plate ,i41 
f47 ,on microscopical exam9ation1  ! #hg
 tum\r ( ! pancreas 0 f\nd to consi/ (  
an hyp]trophy  ( ! normal gl& tissue1   
be+1 9 fact1 a *ronic inflammatory      
tum\r ( ! gl& sub/ance4    ,9 no portion
 ( ! body 0 a trace ( canc] detect$1 nor
 any  enl>gem5t ( ! mes5t]ic or o!r     
gl&s1 to ju/ify ev5 a  suspicion (      
malignant disease4 ,s ! op9ion arriv$ at
 reg>d+ !  pa?ology ( ?is case is1 t !  
disease orig9at$ 9 an  inflammatory     
affection ( ! pancreas1 dur+ ! progress 
( :i*1  ! op5+s ( ! bile1 & pancreatic  

ducts became block$ up2 !  int]ruption  
to ! excretion ( ! bile giv+ rise to !  
jaundice1  & at ! same "t induc+        
engorgem5t1 & enl>gem5t ( !  liv]4 ,!   
inflammatory affection ( ! pancreas _h  
probably end$ 9  ! =mation ( an abscess1
 :i*1 pu%+ ! enl>g$ liv]  =w>ds1 admitt$
 ( ! di/5d$ gall-bladd] be+ se51 & felt 
?r\gh ! abdom9al p>ietes4 ,at l5g? !    
abscess bur/1 &  sudd5ly empti$ itself  
into ! duod5um2 ! yell[ fluid dis*>g$  f
 ! inte/9es be+ n bile1 z ! pati5t _h   
suppos$1 b  pus4 ,no soon] _h ! abscess 
empti$ itself1 ?an ! liv] return$  to   
its natural position1 & ?us acc\nt$ = ! 
di/5d$  gall-bladd] s sudd5ly ceas+ to  
be se5 or felt4 ,! ulc] 9 !  duod5um    
appe>s #hh to be ! m\? ( ! abscess1 :i* 
has  probably be5 prev5t$ clos+1 p>tly  
on acc\nt ( ! occasional  dra9+ away (  
pus1 :i*1 be+ 9 small quantity1 & mix$ )
  ! /ools1 escap$ detection2 & p>tly to 
! con/ant irritation (  ! passage ( !   
food1 !re be+ no bile or pancreatic     
fluid to  neutralize ! acidity ( ! *yme4

 ,?is might ev5 be suffici5t (  itself  
to delay ! heal+ process4 ,! ultimate   
gradual atrophy (  ! liv] w\ld arise f !
 cont9u$ pressure ( ! di/5d$  bile-ducts
 int]rupt+ ! hepatic circulation1 z     
=m]ly po9t$  out at page #dh4 ,la/ly1   
!re be+ no bile or pancreatic juice     
admitt$ into ! inte/9es1 ! great] "p ( !
 food tak5 pass$  out ( ! body          
unabsorb$1 & ! pati5t1 ?\gh possess+ an 
excell5t appetite1 & tak+ pl5ty ( food1 
actually di$ ( sl[  />vation4    ,my    
object 9 giv+ su* prom95ce to ?is       
int]e/+ case1 is to  %[ h[ valuable an  
adjunct physiological *emi/ry is to !   
o!r  me?ods ( diagnosis 9 obscure       
diseases ( ! abdom9al organs1 &  to     
enc\rage o!rs to foll[ 9 ! same pa?2 = x
 mu/ be  rememb]$ t ! =ego+ 0 no        
dead-h\se diagnosis1 b t  e fact "h /at$
 0 discov]$ & record$ be=e dea?4    #hi 
,hav+ n[ expla9$ ! me*anism ( ! two =ms 
(  jaundice--t aris+ f suppression1 & t 
induc$ by  ob/ruction--x only rema9s =  
me to rem9d my read]s1 t !re is         

frequ5tly a comb9ation ( ! two          
conditions4 ,jaundice f  ob/ruction1 =  
example1 _c long exi/ )\t becom+        
complicat$ ) jaundice f suppression4 ,! 
cont9u$ backw>d  pressure ex]t$ on !    
hepatic p>5*yma by ! ov]-di/5d$         
bile-tubes1 soon] or lat] imp$es !      
circulation 9 ! organ to an  ext5t      
suffici5t to induce an impairm5t1 if n  
an almo/ total  arre/ ( ! bili>y        
secretion4 ,h5ce x is1 t 9 ! la/ /age ( 
jaundice f ob/ruction1 ! bili>y acids   
gradually dim9i%1 & at  la/ f9ally      
disappe> f ! ur9e4 ,we h x1 nev]!less1 9
 our  p[] to di/+ui% betwe5 ! two =ms ( 
disease--= :]eas1 9  jaundice aris+ f   
simple suppression1 !re is only an      
abs5ce (  ! bile-acids2 9 jaundice f    
ob/ruction1 complicat$ )  suppression1 !
 abs5ce ( ! bile-acids is usually       
associat$ )  ! pres5ce ( tyros9e1 &     
leuc9e4 ,= be=e complete suppression    
occurs z a result ( ob/ruction1 !       
hepatic tissue has already _h  its      
nutrition s impair$1 z to admit ( !     

=mation ( ^!  =eign sub/ances4 ,la/ly1 !
 hi/ory ( ! case w ( itself be  an      
important guide4      #ij ,,epidemic    
,,jaundice4    ,x is seldom t jaundice  
attacks p]sons 9 an epidemic =m2 z x    
does s occasionally1 h[ev]1 & t too 9   
almo/ all c\ntries1 x  is necess>y t ,i 
%\ld say a few words on its pa?ology4 ,9
 a  quotation1 9 ! ,m$ical ,times &     
,gazette1 f ! ,recueil de  ,mmoires de  
,mdec9e ,militaire1 vol4 iii4 p4 #cgd1 x
 is /at$ t1  ,m4 ,m>t9 gave an acc\nt ( 
an epidemic ( jaundice :i* he _h !      
opportunity ( obs]v+ among ! artill]y & 
eng9e]s ( !  ,fr5* army /ation$ at      
,pavia dur+ ! ,italian w>4 ,x comm5c$   
dur+ ! great heats ( ,augu/1 & t]m9at$  
by ! end ( ,octob]4  ,!re occurr$ #ga   
cases 9 an effective ( #ajbb m54 ,!     
causes he  consid]s to h be5 ! unusual  
heat1 :i* gave rise to great  conge/ion 
( ! liv]1 ! fatigue ( long m>*es 7!     
m\nt$ m5  suff]+ (t5] 9 proportion ?an !
 unm\nt$71 indulg5ce 9  alcoholic dr9ks1
 & m>% miasmata4 ,great increase 9 !    

size ( !  liv] 9 mo/ ( ! cases1 & ( !   
sple5 9 _m1 0 obs]v$1  & all compla9$ ( 
pa9 9 ! epiga/rium & 9 ! hypo*ondria4   
,9 fact1 ?is la/ 0 ! fir/ symptom ( !   
approa*+ jaundice4  ,none ( ! cases     
prov$ fatal4 ,pr(essor ,san-,galli #ia  
in=m$ ,m4  ,m>t9 t a simil> epidemic    
prevail$ 9 ! t[n ( ,pavia at !  same "t4
    ,t jaundice may also occur 9 an     
epidemic =m among pregnant wom51  has   
be5 %[n by ,dr4 ,sa9t-,vel1 :o relates  
t1 ,9 #aheh ! isl&  ( ,m>t9ique 01 )\t  
appreciable cause1 visit$ by an epidemic
 (  jaundice1 rem>kable = its sev]ity 9 
pregnant wom54 ,x broke out  at ,/4     
,pi]re t[>ds ! middle ( ,april1 atta9$  
its maximum height  9 ,june & ,july1 &  
t]m9at$ t[>ds ! end ( ! ye>4 ,all races 
7 attack$2 ! pati5ts 7 mo/ly adults2 no 
liv]-complication  c\ld be detect$2 nor 
c\ld any resemblance be trac$ betwe5 !  
disease & yell[ fev]4 ,x 0 fatal to     
females only1 especially  dur+          
pregnancy4 ,( ?irty pregnant wom5 :o 7  
attack$ at ,/4  ,pi]re1 t5 only arriv$  

at ! full p]iod ( pregnancy )\t  pres5t+
 any o!r symptoms ?an ^? ( ord9>y       
jaundice4 ,!  o!r tw5ty all _h abortion 
or premature lab\r a =tnight or ?ree    
weeks aft] ! comm5cem5t ( ! attack1 &   
di$ 9 a /ate (  coma1 :i* appe>$ a few  
h\rs be=e or aft] ! expulsion ( !       
foetus4 ,! females :o di$ 7 f ! f\r? to 
! eigh? mon?  advanc$ 9 pregnancy4 ,9 "s
 cases1 slight delirium prec$$ !  coma1 
:i* 0 nev] int]rupt$1 b became m & m #ib
  pr(\nd up to ! "t ( dea?4 ,its longe/ 
duration1 9 two cases1  0 tw5ty-f\r &   
?irty-six h\rs4 ,x 0 n prec$$ by any    
notable modification ( ! g5]al          
s5sibility1 nor ( ! respiration  or     
circulation4 ,hmorrhage 0 abs5t1 except 
9 "o case1 :]e a  female _h x be=e      
deliv]y4 ,:5 dea? 0 delay$ till ?ree or 
f\r days aft] deliv]y1 ! lo*ia 7 heal?y4
 ,almo/ all !  *ildr5 7 /ill-born2 "s   
liv$ a few h\rs2 "o alone surviv$4      
,none ( ! infants _h ! ict]ic col\r2 nor
 0 !re any sign (  jaundice 9 ! t5      
*ildr5 born at ! full t]m4    ,! =ego+  

translation f ! ,gazette des ,hpitaux1  
#bj?  ,novemb] #ahfb1 appe>$ 9 ! ,briti%
 ,m$ical ,j\rnal ( ! #g? (  ,febru>y1   
#ahfc1 p4 #ada4    ,we h x fur!r /at$ 9 
! ,lancet ( ! #ba/ ,febru>y #ahfc1  "u !
 head ( ! ,heal? ( ,ro!rham1 t1 sc>cely 
_h !  late fatal epidemic ( fev] subsid$
 ere ano!r1 less fatal1 b z  widely     
spread1 took its place4 ,9 la/ ,novemb] 
sev]al p]sons 7  attack$ ) jaundice1 &  
n[ n less ?an #aej p]sons are suff]+  f 
x4 ,none ( ^? :o 7 attack$ by ! late    
fev] are  suff]+ f ! pres5t epidemic4   
,:5 we reflect on ! facts "h relat$1 we 
#ic c h little  difficulty 9 =m+ an     
op9ion ( ! pa?ology ( jaundice occurr+  
9 an epidemic =m4 ,its me*anism seems to
 be precisely simil> to  t ( ! isolat$  
cases ( ! disease :i* are e n[ & !n  met
 ) z ! result ( blood-poison+4 ,i h     
rec5tly se5 a case  ( well-m>k$ jaundice
 sup]v5e on an attack ( sc>let fev]1 & z
  x af=ds a tol]ably good illu/ration ( 
! pa?ology ( su*  cases1 x may1 p]haps1 
be briefly giv5 ) advantage4    ,a      

,london cabman1 ag$ #bc1 0 admitt$ "u my
 c>e into ,univ]sity  ,college          
,hospital1 on ! #bnd ,m>* ( ! pres5t    
ye>4 ,he /at$ t  he _h always enjoy$    
good heal?1 b t lately he _h be5 mu* out
  ( spirits1 9 consequ5ce ( ! dea? ( "o 
( 8 relatives4 ,on !  #be? ,febru>y1    
aft] ?ree days' illness1 a sc>lat9al ra%
 appe>$  all ov] 8 *e/1 & extremities1 &
 f\r days lat] 7! day  be=e 8           
admission71 he became jaundic$4 ,m>*    
#crd4 ,8 sk9 is n[  ( a bright yell[    
col\r1 & :5 ! f+] is rapidly drawn      
across  x1 a p9k l9e imm$iately takes ! 
place ( ! yell[ness1 %[+  t !re is /ill 
great subcutane\s vascul>ity4 ,! ?roat  
is sore1  & !re is consid]able          
difficulty 9 swall[+4 ,! conjunctiv are 
int5sely yell[--proportionally m s ?an !
 sk91 9 consequ5ce  ( ! sc>lat9al hue   
be+ /ill #id bl5d$ ) ! t9t ( !  latt]4  
,! ur9e is high col\r$1 has a slight    
deposit ( urates2  conta9s a l>ge am\nt 
( bile pigm5t1 b no bile-acids4 ,! /ools
  h n be5 obs]v$ to be clay-col\r$4 ,!  

liv] is enl>g$  7dulness ext5ds #e in*es
 9 a p]p5dicul> direction71 & t5d] on   
pressure4 ,he compla9s ( pa9 9 ! hepatic
 region on tak+ a deep  inspiration1 & (
 a g5]al uneas9ess at o!r times4 ,has no
  sickness or vomit+4 ,! muc\s membrane 
( ! tongue is r$ &  raw-look+2 flakes ( 
epi!lial fur are readily deta*$ f x4    
,! case 0 at once diagnos$ z "o (       
jaundice f suppression4 ,its  me*anism  
be+ suppos$ to be id5tical to t ( !     
cases discuss$  at pages #be-i "u ! head
 ( jaundice aris+ f active conge/ion  ( 
! liv] induc$ by blood-poison+1 a dose (
 calomel & jalap  0 accord+ly adm9i/]$1 
) ! view ( remov+ ! portal  conge/ion1 &
 ) ! mo/ satisfactory result2 =1 not)/&+
  ! jaundice be+ complicat$ ) sc>lat9a1 
a v decid$  improvem5t 9 ! col\r ( ! sk9
 took place )9 tw5ty-f\r  h\rs1 ! o!r   
symptoms rema9+ z be=e4 ,m>* #aj?4 ,!   
calomel  & jalap 0 repeat$ on ! #d?1 &  
s9ce !n ! sk9 has  gradually become     
pal]4 ,x is n[ sc>cely t+$4    #ie ,to  
return to ! cases ( epidemic jaundice2  

!y1 z ,i h j  h9t$1 are due to a        
precisely simil>                        
cause--blood-poison+--ei!r  ! direct    
result ( miasmata1 or ( contagion4    ,a
 fur!r explanation ( ! reason :y        
jaundice occurs 9 an epidemic  =m1 may  
be f\nd 9 ! circum/ance t 9 all febrile 
/ates (  ! g5]al sy/em "s "o or o!r ( ! 
int]nal organs is liable  to become     
conge/$4 ,= example1 typhus is1 z a     
rule1 complicat$  ) c]ebral conge/ion1  
typhoid ) mes5t]ic1 ague ) spl5ic1      
sc>lat9a ) r5al1 & s on4 ,x is n1 h[ev]1
 necess>y t  ! organs %\ld be affect$ 9 
! same relation to ! disease z is  "h   
giv54 ,on ! contr>y1 9 "o epidemic (    
typhus1 ! bra9 may  be conge/$1 9 ano!r 
! lungs1 & 9 a ?ird ! liv]2 & s  also ) 
o!r fev]s4 ,h5ce we c h little          
difficulty 9  und]/&+ :y epidemics (    
jaundice e n[ & !n occur1  see+ t !y are
 b ! second>y results ( o!r epidemic    
affections1 al?\gh1 z occasionally      
happ5s1 ! jaundice is !  *ief1 if n !   
only well-m>k$ symptom4                 

,,artificial ,,jaundice4    ,:at is !   
s\rce ( ! tyros9e1 & leuc9e f\nd 9 !    
ur9e1 9  cases l ^? previ\sly describ$8 
,be+ well aw>e t !  physiologi/ #if has 
x 9 8 p[] to produce almo/ any          
pa?ological /ate or artificial disease  
at pleasure1 ,i set ab\t  imitat+ on an 
animal ! effects produc$ 9 ! human      
subject by  ob/ruction ( ! bile-ducts4  
,hi!rto1 artificial jaundice has be5    
usually induc$ ei!r by ligatur+ !       
gall-ducts or inject+ bile  into !      
circulation2 b z bo? ( ^! me?ods 7 9 !  
pres5t  in/ance objectionable--! fir/ on
 acc\nt ( ! con/itutional  di/urbance   
liable to be induc$ by ! sev]ity ( !    
op]ation2 !  second f ! bile be+ all at 
once ?r[n into ! circulation1 &  !reby  
produc+ toxic effects1 besides ! dang] (
 its too rapid  elim9ation by ! ur9e--,i
 adopt$ ano!r plan1 :i* came mu*  ne>]  
to ! /ate induc$ by disease 9 man--,i   
took ! bile ( ?ree  heal?y dogs1 &      
inject$ x "u ! sk9 ( a f\r?4 ,9 ?is case
  ! effects ( ! op]ation 7 almo/ nil1 & 

! bile 0 at !  same "t plac$ 9 a        
position fav\rable = its sl[ absorption1
 j  z 9 ! human subject4 ,dur+ ! fir/   
two days ! animal rema9$  comp>atively  
well1 ! ur9e 0 normal 9 appe>ance1 &    
conta9$  nei!r bile-pigm5t1 nor         
bile-acids4 ,b on ! ?ird day ! animal   
became ill1 & on ! f\r? jaundice set 94 
,he di$ on ! fif?4  ,aft] dea? ! ur9e 0 
f\nd to conta9 n only #ig bile-pigm5t1  
& bile-acids1 b also ! diseas$ products1
 leuc9e1 & tyros9e2  & :at 0 m int]e/+  
/ill1 ! ur9e 0 load$ ) sug>1  j z       
occurr$ 9 ! case imitat$4    ,x w be    
rememb]$ t 9 speak+ ( ! bile-acids1 ,i  
m5tion$  t :ile glyco*olic acid is a    
cry/all9e1 tauro*olic is a              
non-cry/all9e sub/ance4 ,tyros9e1 &     
leuc9e /& 9 a simil>  relation to ea*   
o!r2 tyros9e be+ cry/allizable1 leuc9e  
non-cry/allizable4 ,n[1 tak+ ?is fact   
into acc\nt1 toge!r )  ! fact1 t :5 !   
bile-acids are all[$ sl[ly to ent] !    
circulation1 !y reappe> 9 ! ur9e1       
accompani$ ) tyros9e1 &  leuc9e2 & also 

) ! ?ird fact ( ^! latt] sub/ances be+  
f\nd 9 ! liv] :5 ! bili>y function is   
int]f]$ )1 ,i am  incl9$ to look ^u     
tyros9e1 & leuc9e z ! products ei!r (  !
 arre/$1 or ( ! retrograde metamorphosis
 ( glyco*olic1 &  tauro*olic acids4     
,moreov]1 ,i h f\nd 9 "o case1 aft]     
inject+  bile 9 ! way be=e m5tion$1 into
 ! cellul> tissue1 cry/als (  tyros9e   
spontane\sly =m 9 ! bile tak5 f !       
animal's  gall-bladd] aft] dea?1 & m]ely
 all[$ sl[ly to evaporate4 ,?is  result 
/r5g!ns ! =ego+ op9ion4    ,fr]i*s /ates
 t he has nev] detect$ ! bili>y acids 9 
!  blood1 ev5 aft] bile _h #ih be5      
inject$ into ! circulation4 ,9  a       
rem>kable case :]e #a oz4 ( ox-bile     
kill$ a dog 9 less ?an five  m9utes f ! 
"t x began to be sl[ly inject$ into !   
jugul>  ve91 ,i detect$ ! bile-acids 9 a
 cle> extract ( ! blood1 )  facility4   
,?is leads me to m5tion t1 contr>y to ! 
/atem5t (  ,fr]i*s1 & 9 accordance ) t (
 ,khne1 ! injection ( !  pure bile-acids
 into ! blood is v dang]\s1 & t ev5 !   

injection ( pure bile into ! cellul>    
tissue1 (t5 proves fatal 9  ! c\rse (   
tw5ty-f\r h\rs1 !reby %[+ t ! con/itu5ts
  ( ! bile are highly poison\s4    ,9   
illu/ration ( ^! facts ,i may cite !    
foll[+ exp]im5ts3--    ,into ! cellul>  
tissue ( ! back ( a full-gr[n1 &        
heal?y-look+ t]ri] dog1 ,i inject$ !    
bile tak5 f !  gall-bladd]s ( ?ree      
heal?y dogs1 two ( :i* _h j be5 kill$1  
! o!r _h be5 dead a few h\rs4 ,! bile 0 
9 ! fir/ two  cases neutral1 9 ! ?ird   
fa9tly alkal9e4 ,all ! biles seem$      
p]fectly normal4 ,!y conta9$ no cry/als 
( any k9d4 ,eighte5  h\rs aft] !        
op]ation ! animal appe>$ q well1 & took 
8  food he>tily4 ,f\r h\rs lat] a       
rem>kable *ange took place4 ,! dog      
look$ dull & dr[sy1 & c\ld n su/a9      
himself on 8 legs2 :5  left to himself1 
he #ii lay on 8 side1 & made n !        
slighte/  movem5t4 ,he 0 n only p>alyz$1
 b ev5 ! n]ves ( s5sation  _h ceas$ to  
act1 = :5 8 tail1 & feet 7 p9*$1 he 0  q
 ins5sible to pa94 ,! pupils 7 dilat$1 &

 ! body felt  cold4 ,dea? occurr$       
tw5ty-?ree h\rs aft] ! op]ation4 ,ur9e1 
&  fces 7 pass$ 9 small quantity        
imm$iately be=e dea?4 ,! ur9e  0 /rongly
 alkal9e1 & eff]vesc$ on ! addition (   
sulphuric  acid1 !reby %[+ t x conta9$  
alkal9e c>bonates4 ,prismatic           
phosphatic cry/als 7 pres5t 9 ! /ill    
fre% ur9e4    ,:5 te/$ = bile-acids1    
only ! fa9te/ trace 0 obta9$1 aft]  !   
ur9e _h be5 cle>$ ) ! acetate ( lead &  
sulphurett$  hydrog54    ,! tissues ( ! 
abdom5 & ?orax 7 o$emat\s1 b1 )9 an  h\r
 aft] dea?1 _h n ! disagreeable od\r    
f\nd 9 animals  kill$ by inject+ pure   
bile-acid4 7,see foot-note at p4 #ci47  
,?is exp]im5t 0 aga9 repeat$ ) alkal9e  
bile4 ,two ounces (  ox-bile ( a        
specific gravity ( #ajbe 7 inject$ "u ! 
sk9 ( a  l>ge po9t] dog4 ,9 tw5ty-f\r   
h\rs ! animal 0 dead2 !  sub-cutane\s   
tissue all r\nd ! seat ( ! injection1   
r$1  inflam$1 & infiltrat$ ) #ajj blood4
 ,! ur9>y bladd] 0  empty4 ,!           
gall-bladd] conta9$ #a ounces ( d>k bile

 ( a specific  gravity ( #ajdj4 ,:5     
exam9$ ) ! microscope1 ! blood 0 f\nd   
to conta9 a l>ge excess ( :ite          
corpuscles4#bf    ,footnote #bf3 ,x has 
j be5 said t ! blood conta9$ a l>ge     
am\nt ( :ite blood corpuscles4 ,?is     
rem9ds me ( a fact t ,i h  omitt$ to    
m5tion--namely1 t 9 a case ( sev]e      
jaundice f  suppression1 9 consequ5ce ( 
cirrhosis ( ! liv]1 ,i f\nd t !  blood  
possess$ a v treacle-l aspect4 ,! s]um 0
 ( a d+y  yell[ hue1 & felt some:at     
/icky to ! f+]s4 ,"u !  microscope !    
blood corpuscles 7 f\nd to be l>ge1 &   
flabby1 _h  a great t5d5cy to adh]e     
toge!r by ! edges1 & become flatt5$  on 
! sides :5ev] !y came 9 contact4        
,moreov]1 ! corpuscles  look$ z if !y _h
 no di/9ct cell-wall2 "s1 & t too1 9 !  
fre%ly drawn blood1 gave (f buds1 o!rs  
split into two1 ea* half  :5 sep>ate    
look+ l a di/9ct blood corpuscle4 ,9    
fact1 !  blood look$ m z if x _h be5    
act$ ^u by "s p[]ful  *emical ag5t ?an  
any?+ else4 ,i aga9 exam9$ x aft] ! dea?

  ( ! pati5t1 & f\nd x pres5t$ all !    
above *>act]s 9 a  /ill m m>k$ degree4  
,to ! nak$ eye x _h a viscid1 t>ry      
appe>ance4    ,^! results r militate    
aga9/ ! !ory ( ! bile be+  re-absorb$1 9
 an un*ang$ /ate1 into ! circulation1   
aft] !  completion ( ! dige/ive process4
      #aja ,,treatm5t ,,( ,,jaundice4   
,aft] :at has be5 said reg>d+ ! pa?ology
 ( jaundice1 ,i ne$  sc>cely rem>k t !  
treatm5t mu/ v>y accord+ to ! k9d (     
disord] we h to deal )4 ,a l9e (        
treatm5t f\nd to be  b5eficial 9 "o case
 ( jaundice1 might prove v hurtful 9    
ano!r4 ,=1 z has be5 %[n 9 ! =ego+      
pages1 jaundice f  suppression1 &       
jaundice f ob/ruction1 are1 x might be  
said1 two  entirely diff]5t diseases1 ) 
only ! symptoms ( yell[ sk91            
high-col\r$ ur9e1 & pipe-clay /ools 9   
common4 ,! success ( our  treatm5t w    
!re=e dep5d on our p[]s ( diagnosis4    
,! g5]al pr9ciples ^u :i* ! treatm5t (  
jaundice mu/ be  f\nd$ are z foll[s3--  
,! fir/ & great object is1 ( c\rse1 z 9 

! case ( e o!r  disease1 to remove1 if  
possible1 ! excit+ cause4 ,:5 t is      
accompli%$1 we c ) safety turn our      
att5tion to ! removal (  its effects4 ,i
 ne$ n "h detail ! diff]5t excit+ causes
 :i*  x is our duty to remove4 ,i h     
indicat$ !m else:]e1 & ! m]e  m5tion (  
"s ( _! names is suffici5t to d5ote !   
l9e (  treatm5t :i* ought to be adopt$4 
,?us1 = example1 if x be #ajb  asc]ta9$ 
f !re be+ symptoms ( t5d]ness1 c41 9 !  
hepatic region1 t ! jaundice arises f   
active conge/ion ( !  liv]1 ! fir/      
object w\ld ( c\rse be to subdue !      
conge/ion (  t organ by means ( lee*es1 
hot fom5tations1 sal9e purgatives1  c41 
accord+ to ! age1 sex1 & con/itution ( !
 pati5t4 ,on !  o!r h&1 if ! jaundice be
 ! result ( passive conge/ion ( !  liv]1
 we "k well t s long z ! excit+ cause   
exi/s  else:]e1 x w be worse ?an futile 
to attempt ! removal ( !  hepatic       
conge/ion by direct means4 ,9 su* a     
case1 !re=e1 if to  rem$y ! cause is    
beyond our p[]1 our object w be to      

conc5trate  our ef=ts on ! mitigation ( 
its effects4 ,?us ,i might g ?r\gh  !   
:ole li/ ( causes ( jaundice1 & po9t out
 :at appe>s to be  ! mo/ appropriate    
treatm5t ( ea*2 b ,i ?9k ! "t ( my      
read]s & my space1 w be m pr(itably     
employ$1 if1 in/ead (  do+ s1 ,i turn my
 rem>ks *iefly to ! !rapeutical action (
  ^? rem$ies :i* we are con/antly       
employ+ 9 ! treatm5t (  jaundice4 ,!    
fir/ rem$y t m]its special notice is    
m]cury4    ,! b5efit ( m]cury 9 cases ( 
liv] disease _c be d5i$2 b  ! injudici\s
 employm5t ( ?is drug 9 cases (         
jaundice1 has  frequ5tly be5 foll[$ by !
 mo/ disa/r\s results4 #ajc ,!re  0 a "t
 :5 m]cury 0 adm9i/]$ 9 all cases (     
jaundice1  irrespective ( _! cause2 n[1 
h[ev]1 m5 are =tunately becom+  m c>eful
 9 ! employm5t ( ?is drug4 ,b !re is    
/ill a  mi/ak5 notion reg>d+ !          
!rapeutical action ( m]curial           
prep>ations4 ,x 0 at "o "t ?\ght t !y   
/imulat$ ! liv]  to secrete bile1 & n[  
s9ce physiology has %[n t !y possess  no

 su* action1 _m h gone to ! opposite    
extreme1 & decl>$1  t if m]curials d n  
/imulate ! liv] to secrete bile1 _!     
b5efit 9 hepatic disease has be5 a      
delusion2 & ! d>k /ools  foll[+ ^u _!   
employm5t b ! result ( ! sulphuret (    
m]cury =m$ 9 ! inte/9es4 ,i take a v    
diff]5t view ( !  matt]2 = ?\gh believ+ 
t m]cury does n directly /imulate  !    
liv] to secrete bile1 ,i nev]!less op9e 
t x has an  important indirect effect 9 
re9duc+ ! bili>y secretion1 &  !reby    
cur+ c]ta9 cases ( jaundice4    ,!      
action ( m]curials seems to me1 to be   
?is--m]cury is a p[]ful                 
antiphlogi/ic--x r$uces ! volume ( !    
blood by its purgative  prop]ties1 & x  
impov]i%es ! blood by its direct action 
on !  r$ corpuscles4 ,x has be5         
poetically said by ,dr4 ,watson1 t      
m]cury  c blan* ! rosy *eek to ! :ite ( 
! lily2 #ajd & no?+  is m true1 = 9     
exp]im5ts on animals1 ,i h f\nd !       
prolong$  use ( m]cury r$uce ! r$ blood 
corpuscles to a m9imum4 ,f ?is  x is    

easy to und]/& h[ m]cury acts 9         
inflammatory affections2  & z 9 !       
majority ( cases ( jaundice f           
suppression1 !  /oppage ( ! bili>y      
secretion is due to active conge/ion ( !
  liv]1 m]cury proves b5eficial 9 su*   
cases1 n by /imulat+ !  bili>y          
secretion1 b simply by remov+ ! ob/acle 
to its  re-e/abli%m5t1 namely1 ! hepatic
 conge/ion4    ,z a good illu/ration ( !
 correctness ( ?is !ory reg>d+ !  action
 ( m]curials 9 cases ( jaundice aris+ f 
conge/ion1 ,i  may be all[$ to quote !  
foll[+ case1 :i* appe>$ among !         
,hospital ,reports ( ! ,lancet ( ! #g?  
,decemb]1 #ahfa4 ,! case is  head$1     
,int5se ,conge/ion ( ! ,liv]1 simulat+  
an ,abdom9al  ,tum\r3--    ,alex4       
,e----1 ag$ =ty-eight1 0 admitt$ into   
,/4 ,b>?olomew's  ,hospital1 "u ! c>e ( 
,dr4 ,f>re1 on ! #ag? ,octob]1 #ahfa4 ,!
  pati5t _h1 x appe>$1 be5 suff]+ f     
jaundice dur+ six  weeks4 ,he /at$ t !  
tum\r 9 ! epiga/rium began ab\t !  same 
"t z ! yell[ness ( ! sk94    ,on        

exam9ation1 a prom95t swell+ 0 #aje     
notic$ 9 !  epiga/ric region1 possess+  
an indi/9ct feel+ ( fluctuation1 b  x 0 
f\nd to be cont9u\s ) ! liv]4 ,! motions
 7 n  bili\s1 b 7 ( a clay col\r1 & !   
ur9e look$ l pure  bile4 ,?ree gra9s (  
blue pill & two ( ,b>badoes aloes 7     
ord]$  e night4 ,by ! #be? ! hepatic    
tum\r 0 less1 & ! ict]us  0 disappe>+4  
,on ,novemb] #d? ! ur9e 0 cle>] & full (
  li?ates4 ,! conjunctiv 7 ! only p>ts  
obs]v$ ( a yell[  col\r4    ,novemb]    
#aa?4--,al?\gh ! pills _h be5 cont9u$ up
 to ?is date1  ! m\? 0 n sore4 ,! ur9e &
 /ools 7 natural1 & !  pati5t 0         
convalesc5t4 ,a few days aft]w>ds he    
left ! hospital4    ,! result ( ! case  
cle>ly prov$ n only t ! swell+ 0  f a   
highly conge/$ liv]1 b also t ! jaundice
 dep5d$ on  ?is /ate4    ,9 ?is case x  
is evid5t t ! prim>y b5eficial action ( 
!  m]cury 0 to r$uce ! conge/$ /ate ( ! 
hepatic organ1 & no  "o1 ,i ?9k1 w\ld   
v5ture to say t ?is 0 accompli%$ by !   
p[] ! m]cury possess$ ( excit+ ! liv] to

 secrete bile4    ,if1 !n1 ! above view 
( ! !rapeutical action ( m]curials be   
correct1 x is easy to und]/& h[1 9 cases
 ( jaundice f  p]man5t #ajf ob/ruction (
 ! gall-duct1 ! adm9i/ration (  m]cury  
or any o!r l[]+ m$ic9e1 mu/ prove       
detrim5tal by  ha/5+ ! fatal t]m9ation4 
,al?\gh m]cury has n1 !re are "s        
sub/ances :i* h1 !  p[] ( excit+ ! fl[ (
 bile1 j z !re are sub/ances :i*  excite
 ! fl[ ( saliva4 ,among ^! ! m9]al      
acids1 & soluble  alkalies1 hold ! fir/ 
rank4 ,x may seem /range t acids1 &     
alkalies1 %\ld be "h plac$ 9            
juxta-position2 b ! reason (  ?is       
arrangem5t w imm$iately appe>4          
,accord+ to a physiological law1 acid   
sub/ances h ! p[] (  excit+ alkal9e     
secretions1 & alkal9e sub/ances (       
/imulat+  acid secretions4    ,bile be+ 
an alkal9e secretion1 we c !re=e h no   
difficulty  9 und]/&+ h[ ! m9]al acids  
act 9 cases ( jaundice f  suppression1  
induc$1 = example1 by en]vation4 ,!y    
simply /imulate  ! secretion ( bile4    

,x is n s easy1 h[ev]1 to compreh5d !   
action ( alkalies 9  simil> cases4 ,my  
explanation ( _! action is z            
foll[s3--,:5  tak5 aft] food1 & :5 tak5 
on an empty /oma*1 ! action ( an  alkali
 is entirely diff]5t4 ,aft] food1 & dur+
 dige/ion1 !  /oma* conta9s a #ajg      
quantity ( acid ga/ric juice1 & an      
alkali  tak5 !n1 only neutralizes !     
acid4 ,on ! o!r h&1 :5 an  alkal9e      
sub/ance is introduc$ into an empty     
/oma*1 x acts  accord+ to ! g5]al law ( 
excit+ an acid secretion2  consequ5tly1 
an imm$iate fl[ ( ga/ric juice takes    
place4 ,& ,i  believe x is ! excess (   
?is acid ga/ric juice1 :i*1 on rea*+  ! 
duod5um1 /imulates ! secretion1 &       
excites ! fl[ f !  gall-bladd] ( !      
alkal9e bile1 j z ! m9]al acids d "u    
simil> circum/ances4 ,"o rem>k fur!r is1
 h[ev]1 necess>y4 ,!  quantity ( alkali 
employ$ = ! purpose ( /imulat+ !        
secretion1 or ( excit+ ! fl[ ( ! already
 secret$ bile mu/ be  small1 = if mu* be
 us$1 ! great] "p ( ! ga/ric juice w  be

 r5d]$ useless1 9 consequ5ce ( its be+  
neutraliz$ z fa/ z  x is secret$4 ,x may
 be laid d[n z a g5]al rule1 t :5 we    
desire to increase ! fl[ ( bile by means
 ( a m9]al acid1 !  acid mu/ be giv5    
aft] food4 ,:51 on ! o!r h&1 an alkali  
is  select$ = t purpose1 ! alkali mu/ be
 adm9i/]$ be=e  food4    ,= obvi\s      
reasons1 bo? alkalies & acids are       
c\nt]-indicat$ 9  cases ( jaundice      
result+ f active conge/ion ( ! liv]2 & x
  is equally evid5t t !y c be ( no      
direct #ajh s]vice 9  jaundice aris+ f  
occlusion ( ! bile-duct1 :]e our object 
w\ld be r to dim9i% ?an to increase !   
secretion ( bile4    ,alkalies1 or at   
lea/ "s alkalies1 possess c]ta9 o!r     
prop]ties  besides ^? to :i* allusion   
has j be5 made1 :i* may be  usefully    
turn$ to acc\nt 9 ! treatm5t ( hepatic  
diseases4 ,=  example1 we h be5 long    
told t alkal9e c>bonates are valuable   
rem$ies 9 cases ( gall-/ones1 9         
consequ5ce ( _! possess+  ! p[] (       
dissolv+ bili>y calculi4 ,n[1 al?\gh ,i 

am n  suffici5tly en?usia/ic to believe 
t alkalies c h mu* effect  9 dissolv+   
gall-/ones :5 once =m$1 ,i nev]!less    
believe t  !y are ( ! utmo/ advantage 9 
prev5t+ & arre/+ _!  deposition4 ,!     
alkali to :i* ,i give pref]5ce is !     
c>bonate (  soda1 & ! reason :y ,i pref]
 x to ! c>bonate ( pota%1 is 9          
consequ5ce ( my believ+ t ! advantages  
d]iv$ f  adm9i/]+ alkalies 9 cases (    
incipi5t gall-/ones are entirely  due to
 our be+ able !reby to increase ! am\nt 
( glyco*olate1  & tauro*olate ( soda    
pres5t 9 ! bile2 bo? ( :i* sub/ances1   
sep>ately or comb9$1 reta9 *ole/]9e 9 a 
soluble =m2 &1 z  is well kn[n1 by f> ! 
great] numb] ( bili>y calculi are       
compos$ almo/ entirely ( pure *ole/]9e4 
#aji ,! c>bonate ( soda has yet ano!r   
advantage4 ,x 0 long ago  obs]v$ by ,dr4
 ,pr\t t gall-/ones are v common 9      
p]sons ( a  g\ty1 & rheumatic t5d5cy (  
body1 a fact :i* ,i h myself be5  able  
to confirm on sev]al occasions1 by mak+ 
a quantitative analysis  ( ! uric acid 9

 ! tw5ty-f\r h\rs' ur9e1 z recomm5d$ at 
page #ef4 ,9 su* cases ! c>bonat$ alkali
 is ( d\ble s]vice1 =  :ile increas+ !  
solv5t 9 ! bile1 x at ! same "t         
c\nt]acts ! uric acid dia!sis4 ,9 a case
 ( gall-/ones1 9 a  woman ag$ #cf1 :]e  
!re 0 an almo/ daily deposit ( f9e      
cry/all9e uric acid 9 ! ur9e1 x 0 f\nd  
necess>y to cont9ue  ! adm9i/ration ( t5
 gra9s ( soda1 ) five ( rhub>b1 ?ree    
times a-day dur+ two mon?s1 be=e ?is    
t5d5cy to li?ic acid  deposit 0 entirely
 ov]come4    ,rec5tly ,i h prescrib$    
li?ia wat] to p]sons ( ! uric acid      
dia!sis 9 :om ,i _h reason to suspect ! 
exi/5ce ( a  pr$isposition to           
gall-/ones2 & :5 x 0 necess>y to comb9e 
x  ) /imulants1 %]ry has be5 ! w9e      
select$4 ,= "s fur!r  rem>ks on !       
treatm5t ( gall-/ones1 see pages #aad1  
#aai1 & #abc4    ,!re is a rem$y to :i* 
,i wi% to call special att5tion1 namely1
  b5zoic acid4 ,?is sub/ance 0 fir/     
recomm5d$ z a rem$y 9 #aaj  jaundice by 
a ,g]man physician1 ab\t six ye>s ago4  

,s9ce !n1 ,i h  tri$ x sev]al times1 &  
f\nd x ( b5efit 9 jaundice aris+  f     
suppression4 ,9 ^? cases ( ob/ruction1  
on ! o!r h&1 9  :i* ,i tri$ x1 x appe>$ 
to be any?+ b b5eficial4 ,i give x  9 ! 
=m ( pill1 ?ree times a day4 ,dr4 ,gre51
 "o ( my =m]  pupils1 :o has j return$ f
 ,india1 tells me t he act$ on my       
sugge/ion1 & tri$ x 9 a case ( well-m>k$
 jaundice1 foll[+  an attack ( delirium 
trem5s2 & t by ! end ( eight days x     
w\ld h requir$ an exp]i5c$ eye to detect
 ! t++ ( !  conjunctiv4    ,! foll[+ may
 be cit$ z a tol]ably good example ( !  
value (  b5zoic acid 9 cases ( jaundice 
f en]vation3--    ,william ,m----1 ag$  
elev5 ye>s1 lab\r+ "u an acute attack ( 
sev]e jaundice1 came "u my c>e at       
,univ]sity ,college ,hospital on  ! #bnd
 ( ,febru>y4 ,! pati5t appe>$ to be a   
mod]ately develop$1  & v intellig5t boy4
 ,! jaundic$ condition ( ! sk91 8  "m   
said1 0 fir/ notic$ on ! #cj? ( ,janu>y1
 only two days  be=e he came to !       
hospital4 ,x 0 fur!r asc]ta9$ t1  al?\gh

 ! boy _h = "s l5g? ( "t be5 subject to 
mon?ly  attacks ( sev]e heada*e1 &      
bili\s vomit+1 he _h nev] be=e  suff]$ f
 #aaa jaundice4 ,on ! pres5t occasion he
 compla9$ (  heada*e1 b x 0 unaccompani$
 ei!r by sickness or vomit+4 ,on        
exam9ation ! liv] 0 f\nd normal 9 size1 
& n 9 ! lea/  t5d] on pressure4 ,! b[els
 7 mod]ately op51 & ! /ools n           
clay-col\r$4 ,! ur9e 0 ( a deep orange  
t9t1 & ! sk9 ( a  d>k yell[ hue4 ,!re 0 
an abundance ( bile pigm5t1 b n a  trace
 ( bile-acids 9 ! ur9e4    ,z ! jaundice
 appe>$ to be ! result ( en]vation1     
br\ght on by  ov] m5tal ex]tion1 ! boy 0
 ord]$ to be kept f s*ool1 &  n all[$ to
 read any books 78 "m said he 0 always  
read+74  ,at ! same "t ?ree gra9s (     
b5zoic acid 7 ord]$ to be tak5  ?rice   
a-day4    #i? ,febru>y4--,! sk9 0 n[ v  
mu* pal]1 ! yell[ col\r  be+ ne>ly gone4
 ,! conjunctiv 7 /ill yell[1 al?\gh less
 s  ?an at la/ visit4 ,! ur9e rema9$    
un*ang$ 9 col\r4 ,he 0  ord]$ to cont9ue
 ! m$ic9e4    #af? ,febru>y4--,sk9      

p]fectly normal 9 col\r2 if any?+ p]haps
 a  %ade :it] ?an natural4 ,conjunctiv  
no long] yell[4 ,dismiss$  cur$4    ,9  
?is case no m$ic9e :atev]1 except !     
b5zoic acid1 0 giv54    ,z f> z my      
exp]i5ce goes1 b5zoic acid #aab appe>s  
to be mo/  useful 9 jaundice aris+ f    
en]vation or f active conge/ion1  z 9 ! 
case relat$ at page #bg2 b 9 cases ( !  
latt] k9d x  seems to be ( little s]vice
 until ! acute symptoms h  disappe>$4 ,i
 am /ill r d\btful reg>d+ ! mode 9 :i* x
  acts1 al?\gh "o po9t seems cle>1      
namely1 t x ha/5s !  re-absorption f !  
tissues1 & elim9ation f ! body1 ( !     
bile-pigm5t4 ,x ?us appe>s to play ! "p 
( a :itewa%2 =1 z  "o ( my lady pati5ts 
once graphically said1 ! m$ic9e _h      
blea*$ h]4 ,on "o occasion ,i tri$      
b5zoic acid 9 a case (  jaundice foll[+ 
^u an attack ( ague2 b x prov$ ( no     
s]vice4  ,inde$1 qu99e1 comb9$ )        
m]curials1 seem$ 9 t case to be  ! only 
rem$y4    ,!re is ano!r drug :i* proves 
( s]vice 9 jaundice f  suppression1     

namely1 podophyll91 or ,may-apple4 ,?is 
rem$y1 :i* 0  fir/ introduc$ f ,am]ica1 
is suppos$ to possess bo? !  alt]ative &
 purgative prop]ties ( m]cury4 ,z an    
alt]ative1 x is  giv5 9 doses v>y+ f    
#a_/h to  ( a gra91 ?ree times a-day2 z 
a purgative1 f  to #a gra91 z a s+le    
dose4 ,i h giv5 ?is  rem$y a tol]ably   
fair trial1 & al?\gh x seems to be v    
useful  z a purgative 9 hepatic disease1
 & to increase ! fl[ ( bile1 ,i  h f\nd 
x op5 to two objections3 #aac fir/ly1   
its action is  sl[1 & n always c]ta92 &1
 secondly1 9 delicate females x  gives  
rise to a good deal ( grip+4 ,?is latt] 
objection c1  h[ev]1 to a c]ta9 ext5t1  
be c\nt]act$1 by comb9+ ! rem$y  )      
hyoscyamus4 ,on ! :ole1 ,i pref]        
m]curials to podophyll91 &  only adm9i/]
 ! latt] 9 slight cases ( jaundice1 or 9
 ^?  :]e m]curials are c\nt]-indicat$4  
,= example1 9 cases ( feeble liv]1 :]e  
!re is an insuffici5t  secretion ( bile 
f want ( n]v\s p[]1 podophyll9 is       
decid$ly  ( s]vice1 = 9 su* cases m]cury

 is ( c\rse c\nt]-indicat$4  ,moreov]1  
podophyll9 c be advantage\sly comb9$ )  
vegetable  tonics1 &1 :5 giv5 along )   
g5tian or qu99e1 =ms an  admirable      
hepatic /imulant 9 "s ( ! cases usually 
d5om9at$  torpid liv]4    ,i _c refra9 f
 mak+ a few rem>ks on :at ,i consid] !  
injudici\s employm5t ( podophyll94 ,l e 
new rem$y1 x has to  run ! risk ( fall+ 
into disfav\r1 9 consequ5ce ( its too   
ard5t admir]s bl9dly prescrib+ x 9 all  
cases ( hepatic disease2  9 _m ( :i* x  
mu/ ( necessity prove unsuitable1 if n  
ev5  detrim5tal4 ,9 cases ( jaundice1 = 
example1 podophyll9 is at "o1  & ! same 
"t1 ! bane1 & ! antidote4 ,! bane 9 all 
cases  ( #aad jaundice f ob/ruction1 !  
antidote 9 a few cases (  jaundice f    
suppression4 ,hav+ already indicat$ !   
cases 9 :i*  x may be adm9i/]$ )        
advantage1 ,i %all n[ call att5tion to  
"o ( ^? :]e x _c be employ$ )\t injury1 
& "o 9  :i* x is1 nev]!less1 frequ5tly  
giv54 ,! case ,i allude to is  t (      
gall-/ones4 ,:5 once a gall-/one has    

=m$1 & is block+  up ! common bile-duct1
 !reby caus+ jaundice f ob/ruction1 x   
is easy en\gh to und]/& :y a sub/ance l 
podophyll91 :i*  increases ! bili>y     
secretion1 is to be avoid$4 ,x is n1    
h[ev]1  s easy to und]/& :y ! rem$y is  
equally c\nt]-indicat$1  ei!r dur+ !    
=mation or soj\rn ( a gall-/one 9 !     
gall-bladd]4 ,?is1 !re=e1 ,i mu/ expla94
 ,9 speak+ ( ! mode  ( =mation (        
gall-/ones 9 ! gall-bladd] 7page #dc71  
,i h  /at$ t _! =mation is due to !     
deposition ( ! less  soluble p>ts ( !   
bile1 ei!r z a consequ5ce ( ^! +r$i5ts  
be+ 9 excess1 or 9 consequ5ce ( !       
solv5t1 ^: duty x is to  reta9 !m 9     
solution1 be+ 9 r$uc$ quantity4 ,x      
foll[s1 !n1  z a natural result1 t !    
long] bile soj\rns 9 ! gall-bladd]1  & !
 ?ick] x becomes1 ! m likely are its    
con/itu5ts to be  deposit$1 & increase !
 size ( ! already exi/+ concretion1     
#aae or give orig9 to a new =mation4 ,x 
may be fur!r add$1 t  ! great] ! am\nt (
 bile secret$1 ! long] is x likely to   

rema9 9 ! gall-bladd]1 & ! m conc5trat$ 
to become2 =1  z is well kn[n1 !re is a 
con/ant absorption ( ! aque\s  p>ticles 
( ! bile go+ on dur+ ! :ole "t x is /or$
 up 9  its res]voir4 ,if1 !n1 dur+ !    
int]vals ( dige/ion1 ! liv]  secretes   
m]ely suffici5t bile to meet !          
requirem5ts ( !  succe$+ meal1 by ! end 
( ! dige/ive process ! gall-bladd]  w be
 entirely empti$ ( its cont5ts1 & ready 
to receive a fre%  supply4 ,:]eas1 if ! 
liv] secretes m bile dur+ ! int]vals  ( 
dige/ion ?an ! wants ( ! sy/em require2 
aft] ! completion  ( ea* succe$+ meal ! 
excess ( bile w rema9 beh9d 9 !         
gall-bladd]1 &1 :ile becom+ /or$ up ) t 
subsequ5tly  secret$1 ( necessity1 fav\r
 ! increase or excite ! =mation (       
gall-/ones 9 p]sons pr$ispos$ to !m4    
,!re be+ no?+ m  conducive to !         
deposition ( bili>y calculi ?an a       
well-fill$  gall-bladd]4    ,z a w>n+   
aga9/ ! indiscrim9ate use ( podophyll91 
,i may cite  ! foll[+ case1 :i* has come
 "u my notice z ^! %eets are  pass+     

?r\gh ! press4 ,a few weeks ago ,i      
receiv$ a telegram  reque/+ me to visit1
 z #aaf e>ly z possible1 a lady dwell+ 9
  ! neighb\rhood ( ,/4 ,john's ,wood4   
,on my arrival ,i f\nd ! lady  suff]+ f 
a well-m>k$ jaundice1 & consid]ably     
pro/rat$ 9  consequ5ce ( h] hav+ j      
arriv$ f ,brighton1 :]e %e _h  gone = ! 
b5efit ( h] heal?1 b :]e1 in/ead ( gett+
  bett]1 %e got consid]ably worse4 ,!   
hi/ory ( ! case 01 t  ! lady _h be5     
seiz$ ) pa9 9 ! back 7middle ( dorsal   
region7 ab\t ?ree weeks be=e ,i saw h]4 
,t !re _h be5 great  t5d]ness 9 ! region
 ( ! gall-bladd]--s mu* s1 t %e  c\ld   
sc>cely tol]ate ! pressure ( h] /ays2 & 
t %e _h  suff]$ f occasional attacks (  
sickness aft] eat+4    ,on exam9+ !     
pati5t ,i f\nd ! liv] enl>g$1 & t5d] on 
pressure4 ,! gall-bladd] mu* di/5d$1 &  
easily felt4 ,! sk9 (  a yell[ hue4 ,!  
/ools ( a pale t9t4 ,! ur9e v           
d>k-col\r$1  & load$ ) li?ates4 ,i _h1  
consequ5tly1 no difficulty 9  diagnos+ !
 case z "o ( gall-/one impact$ 9 !      

common  bile-duct2 b on communicat+ my  
suspicions to ! pati5t1 ,i 0  in=m$ t   
su* c\ld n possibly be ! case1 = dur+ a 
consid]able "t pa/ %e _h be5 c>efully   
treat$ ) podophyll94  ,inde$1 ,i le>n$  
to my surprise t %e _h tak5 f a qu>t] to
  #aag half a gra9 ( t sub/ance ne>ly e 
day dur+ ! six  previ\s mon?s6    ,?is  
incid5tal piece ( in=mation1 in/ead (   
%ak+ my op9ion1 z  ! pati5t _h app>5tly 
expect$1 only t5d$ to /r5g!n my         
suspicions1 = ! reasons previ\sly giv51 
namely1 t !  podophyll9 mu/ h t5d$ to   
keep ! gall-bladd] con/antly full  (    
bile4 ,i accord+ly prescrib$ = ! case z 
"o ( impact$  gall-/one1 & left         
in/ructions t ! /ools %\ld be c>efully  
exam9$ = its appe>ance4    ,on ! foll[+ 
day ! pati5t felt bett]2 b ! jaundic$   
t9t  0 deep]1 ! /ools pal]1 & ! ur9e    
/ill high-col\r$4 ,!  deposit ( li?ates 
_h1 h[ev]1 slightly dim9i%$4 ,/ill1     
feel+  c]ta9 t ! case 0 "o ( impact$    
gall-/one1 ,i ord]$ !  m$ic9e to be     
repeat$1 & ! /ools to be aga9 c>efully  

exam9$4#bg ,on my arrival at ! pati5t's 
h\se ! next day1 !  maid met me ) an    
expression ( satisfaction :i* c\ld n be 
mis9t]pret$1 & ,i _h sc>cely ent]$ !    
sick *amb] :51 )  an #aah air ( triumph1
 %e %[$ me a gall-/one ab\t ! size ( a  
l>ge g>d5-pea1 or small field-bean4 ,x  
_h be5 pass$ t morn+  ab\t #aa o'clock1 
t is to say ab\t fifte5 h\rs aft] !     
second  dose ( m$ic9e4 ,on analysis !   
/one 0 f\nd to consi/ almo/  entirely ( 
*ole/]9e1 & ,i h n ! smalle/ d\bt 9 my  
own  m9d t to ! con/ant use ( !         
podophyll9 may1 9 a great  measure1 be  
attribut$ its =mation4 ,un=tunately !   
/one _h be5  accid5tally brok5 be=e ,i  
saw x1 & ,i 0 consequ5tly unable to     
asc]ta9 decid$ly :e!r x 0 a solit>y     
calculus1 or "o ( _m4  ,_h x be5 "o (   
sev]al1 x w\ld ( c\rse h possess$       
facets4  ,"o facet w\ld h indicat$ t !  
/one 0 "o ( two2 two  facets t ?ree     
/ones exi/$2 ?ree facets1 t !           
gall-bladd]  _h conta9$ at lea/ f\r     
calculi2 :ile f\r or m facets w\ld      

d5ote t ! /one 0 "o ( _m2 :]eas1 if x 0 
a solit>y  calculus1 no su* m>k+s w\ld  
be pres5t4    ,footnote #bg3 ,we are    
sometimes told to add wat] to ! /ools1 &
  t if gall-/ones are pres5t !y w be    
f\nd float+ on !  surface4 ,i h nev] yet
 be5 able to detect a gall-/one 9 ?is   
way4  ,! plan ,i recomm5d is1 !re=e1 to 
mix ! /ool freely ) wat]1  & ei!r decant
 ! sup]natant fluid1 & !n add fre%      
portions (  wat] till ! :ole ( ! soluble
 matt] is remov$1 or to /ra9 !  mixture 
?r\gh a hair-sieve4 ,! gall-/one 9 ei!r 
case rema9s  beh9d1 & c be readily      
detect$4    ,i may m]ely add1 9         
conclusion1 t f ! "t ! /one pass$1  !   
/ools resum$ _! normal col\r--! fir/ two
 or ?ree 7  mu* d>k] ?an natural1 9     
consequ5ce ( ! sudd5 escape ( !  p5t-up 
bile--! ur9e gradually became pale1 &   
cle>1 & ! sk9  rega9$ its wont$ hue4 ,! 
latt] *ange 0 exp$it$ by #aai !         
adm9i/ration ( b5zoic acid1 & 9 a week f
 my fir/ visit1 a  /rang] w\ld h be5 q  
unable to detect t ! pati5t _h  lab\r$  

"u a rec5t attack ( jaundice4    ,a few 
ye>s ago a mixture ( sulphuric e!r1 &   
turp5t9e 0 v  ext5sively us$1 especially
 9 ,france1 z a solv5t = gall-/ones4    
,?is l9e ( treatm5t 0 adopt$ on acc\nt (
 ! well-kn[n  solubility ( *ole/]9e 9   
sulphuric e!r1 & x 0 ?\ght t  ! rem$y   
w\ld act ^u ! *ole/]9e concretions 9 !  
gall-bladd] 9 ! same mann] z x did out (
 ! body4 ,aft] a  "t1 fai? 9 ! p[]s ( ! 
mixture became %ak51 & x at  l5g?       
gradually ceas$ to be employ$4    ,)9 ! 
la/ ye> or two1 ,dr4 ,b\*ut#bh has      
reviv$ ! same  !ory ) ano!r =m ( rem$y1 
namely1 *lor(orm1 :i* he  adm9i/]s      
int]nally1 ) ! view ( dissolv+ any      
inspissat$  bile or bili>y calculi t may
 be lodg+ 9 ! gall-bladd]4 ,dr4  ,b\*ut 
/ates t he has treat$ "o case (         
gall-/ones 9 ?is  mann] ) success4 ,n[1 
al?\gh ,i h n ! slighte/ desire to  ?r[ 
discr$it on ! /atem5t ( ,dr4 ,b\*ut1 ,i 
mu/ c&idly admit  t ,i am v mu* incl9$  
to d\bt ! accuracy ( 8 obs]vations4  ,9 
! fir/ place1 x is always #abj extremely

 difficult to asc]ta9  ! exi/5ce (      
bili>y concretions s long z !y rema9 9 !
  gall-bladd]1 & x is equally difficult 
to "k1 aft] gall-/ones  h be5 once pass$
 by a pati5t1 :e!r or n all h come away4
  ,if1 !n1 we adm9i/] *lor(orm to a     
pati5t1 ei!r be=e or aft]  a gall-/one  
has actually pass$1 we _c1 ) any?+      
approa*+  to c]ta9ty1 attribute !       
cessation ( 8 symptoms to !  circum/ance
 ( ! *lor(orm hav+ dissolv$ a gall-/one4
 ,9 fact1  on physiological gr\nds1 ,i v
 mu* d\bt ! efficacy ( ei!r  sulphuric  
e!r or *lor(orm z solv5ts ( gall-/ones 9
 ! liv+  body4 ,sulphuric e!r1 &        
*lor(orm w\ld no d\bt dissolve a        
concretion ( *ole/]9e 9 ! gall-bladd] 7 
!y admitt$ into  t viscus 9 suffici5t   
quantity1 & 9 a pure /ate4 ,b we h no   
pro( t su* is ! case4 ,on ! contr>y1 we 
"k1 at lea/ 9 z  f> z *lor(orm is       
conc]n$1 t exactly ! opposite is ! fact2
  = no soon] does *lor(orm become       
absorb$1 & m+l$ ) !  con/itu5ts ( !     
blood1 ?an x becomes decompos$1 ! *lor9e

  comb9+ ) ! blood1 & ! =mic acid be+   
set free4#bi ,&  ev5 suppos+ t sulphuric
 e!r & *lor(orm exi/$ 9 ! blood  9 a    
free /ate1 !y c\ld n possibly d s 9 a   
suffici5tly #aba  conc5trat$ =m to be   
able to act z solv5ts ( bili>y calculi4 
,footnote #bh3 ,ed94 ,m$4 ,j\rn4 #ahfa1 
p4 #cih4    ,footnote #bi3 ,jackson1    
,comptes ,r5dus1 ,febru>y #be?1 #ahef4  
,my own exp]im5ts on animals h %[n me h[
 rapidly fatal ev5  small quantities (  
*lor(orm are :5 inject$ into !          
circulation1  & a simil> rem>k is       
equally applicable to sulphuric e!r4 ,a 
few  drops ( ^! sub/ances c v readily be
 inject$ into !  circulation )          
impunity2#cj b ! quantity mu/ n be      
increas$  beyond a c]ta9 am\nt1 f> less 
?an c\ld possibly dissolve a s+le  gra9 
( *ole/]9e1 o!rwise imm$iate dea? foll[s
 ! op]ation1  by induc+ a /ate ( body   
closely resembl+ rigor mortis1 f :i*  ! 
animals nev] recov]4 ,i am1 !re=e1      
completely at a loss to  und]/& h[ ^!   
rem$ies c be ( s]vice 9 dissolv+        

gall-/ones 9 ! liv+ body2 & z ,i make x 
a rule z seldom z  possible to prescribe
 a rem$y )\t a k ( its physiological    
action1 ,i h n yet v5tur$ on an         
empirical trial ( ! effects (  sulphuric
 e!r or *lor(orm adm9i/]$ int]nally 9   
cases (  gall-/ones4 ,= "s rem>ks on !  
passage ( bili>y calculi1 see  page     
#abc4    ,footnote #cj3 ,vide ! ,au?or's
 pap] on a new me?od ( produc+  diabetes
 artificially 9 animals1 by ! injection 
(  /imulants--alcohol1 e!r1 *lor(orm1   
ammonia1 c4--into ! portal  circulation4
 ,comptes ,r5dus de la ,societ de       
,biologie de ,p>is4 #ahec4    #abb      
,t>axacum has be5 widely us$ 9 hepatic  
disease associat$ )  jaundice1 & is     
believ$ to be p>ticul>ly well adapt$ to 
cases  aris+ f conge/ion4 ,z 9 su* cases
 ,i g5]ally tru/ to m  pot5t drugs1 my  
exp]i5ce ) ?is rem$y has be5 too limit$ 
to  admit ( my (f]+ an op9ion ( its     
value4    ,! majority ( cases ( jaundice
 f ob/ruction1 are mu* less "u  ! p[] ( 
rem$ial ag5ts ?an ^? aris+ f            

suppression1 =  we h "h ?ree di/9ct     
conditions to combat3 ,fir/ly1--,!      
d]angem5ts orig9at+ 9 ! abs5ce ( bile f 
! dige/ive  canal4 ,secondly1--,! morbid
 effects aris+ f its accumulation 9  !  
ducts1 & consequ5t int]ruption to !     
hepatic functions4  ,?irdly1--,! g5]al  
poison\s action on ! sy/em1 ( !         
re-absorb$ bile4    ,z reg>ds ! fir/ (  
^! effects1--namely1 ! d]angem5ts  aris+
 f an abs5ce ( bile f ! dige/ive canal1 
x may be  said t if ^! 7 ! only         
difficulties ) :i* we _h to  cont5d 9   
cases ( jaundice f ob/ruction1 !y c\ld  
easily be  ov]come4 ,=1 9 ! fir/ place1 
! abs5ce ( bile is n att5d$  ) any      
imm$iate dang]1 a circum/ance :i* has l$
 to ! common  belief t ! pres5ce ( bile 
is n absolutely ess5tial to life4       
,exp]im5ts on dogs #abc ) bili>y fi/ul1 
l ^? be=e  ref]r$ to1 z well z cases 9 !
 human subject1 h prov$ t  life may be  
su/a9$1 "u c]ta9 conditions1 = a v long 
p]iod1 )\t bile rea*+ ! inte/9es4       
,inde$1 ! only  imm$iate bad effects :i*

 appe> to result f its abs5ce1 are      
co/ive b[els1 great flatul5ce1 &        
extremely (f5sive /ools4 ,!  indirect   
bad results1--namely1 loss ( fle%1 c41 z
 has be5 prov$  by exp]im5ts on animals1
 c be c\nt]act$ by giv+ an additional   
am\nt ( food2 & ev5 ! direct results (  
con/ipation1  flatul5ce1 & foetor1 may  
be ov]come by appropriate rem$ies4    ,!
 second>y morbid effects1 namely1 ^?    
aris+ f !  accumulation ( bile 9 !      
ducts1 are un=tunately n s easily  "u   
control4 ,c\ld we remove ! cause (      
ob/ruction1 ^! w\ld1  ( c\rse1          
imm$iately cease4 ,?is1 h[ev]1 is seldom
 9 our p[]1  except 9 ! case (          
gall-/ones1 ! expulsion ( :i* we c aid 9
  v>i\s ways4 ,9 g5]al1 we c v          
successfully aid ! passage ( a  /one    
?r\gh ! ducts by adm9i/]+ an anodyne    
conta9+ a full  dose ( ! t9cture (      
belladonna1 :i* app>5tly assi/s 9       
dilat+ ! duct4 ,plac+ ! pati5t 9 a w>m  
ba? is also (  s]vice2 & :5 ! p>oxysms (
 pa9 are v sev]e1 ! occasional          

inhalation ( ! vapor f a c\ple #abd (   
dra*ms ( sulphuric  e!r p\r$ on a       
h&k]*ief1 made into ! =m ( a cup1 is    
g5]ally att5d$ ) great relief4 ,ea* ( ^!
 modes ( treatm5t  may be foll[$ ei!r by
 a brisk emetic1 or purgative1 9 ! hope 
t ! ef=ts ( vomit+ or purg+ may ha/5 !  
expulsion ( !  /one1 ei!r by ! m\? or   
rectum4    ,x ought nev] to be =gott51 t
 ! evil results ( a gall-/one  d n      
always cease :5 x has rea*$ ! inte/9al  
canal4 ,ev5  dea? itself has result$ f !
 impaction ( a gall-/one 9 !  duod5um4  
,:5 we h any suspicion t ! /one is l>ge1
 our  treatm5t mu/ !re=e be cont9u$     
until its extrusion by ! m\?  or rectum 
has be5 accompli%$4    ,:5 ! occlusion (
 ! common bile-duct is caus$ by an      
organic  tum\r1 no treatm5t ( ours c be 
expect$ to remove ! ob/acle1  & soon] or
 lat] ! pati5t is c>ri$ to an untimely  
grave4 ,our  ef=ts ( relief 9 su* a case
 ought !re=e to be direct$ to  ano!r    
*annel2 & "h1 9 ord] to give ! suff]] at
 lea/ "s  *ance ( recov]y1 ev5 al?\gh x 

be little bett] ?an a =lorn  hope1 ,i _c
 refra9 f recomm5d+1 9 cases ( p]man5t  
occlusion ( ! duct1 9 :i* !re is great  
di/5sion ( !  gall-bladd]1 ! e/abli%m5t 
( an artificial bili>y fi/ula4 ,7  ?is  
done1 ! pati5t w\ld be plac$1 z #abe    
ne>ly z possible1 9  ! same condition z 
an animal 9 :i* ! op]ation has be5      
p]=m$ = physiological purposes1 &1 we   
might almo/ hope1 )  an equally         
fav\rable result1 at lea/1 9 z f> z !   
bili>y  functions are conc]n$4 ,9 ! fir/
 place1 we w\ld h remov$ all  !         
d]angem5ts result+ f ! int]ruption to ! 
fl[ ( bile1  & consequ5t ^u ! di/5sion (
 ! ducts4 ,9 ! second place1  we w\ld h 
obviat$ ! dang] aris+ f ! poison\s      
effects (  ! re-absorb$ bile1 :i* !     
exp]im5ts previ\sly cit$ 7page #ih7  %[ 
are ( no trifl+ nature2 &1 la/ly1 we    
w\ld only require to  combat ! evils    
aris+ f ! abs5ce ( ! bili>y secretion 9 
! dige/ive process1 :i*1 z 0 be=e said1 
c to a c]ta9  ext5t be ov]come by giv+  
an additional quantity ( food1 & pay+   

att5tion to ! b[els4 ,9 ^! rem>ks ,i h  
omitt$ tak+ into  consid]ation ! effects
 t might arise f ! tum\r1 or o!r        
ob/ruct+ cause to ! bili>y secretion1 = 
^! w\ld 9 no way  be directly influ5c$  
by ! e/abli%m5t ( ! bili>y fi/ula4    ,!
 artificial e/abli%m5t ( a bili>y fi/ula
 9 ! human subject1  is n su* an        
,utopian idea z might at fir/ be imag9$4
 ,di/5d$  gall-bladd]s hav+ be5 sev]al  
times tapp$ ) #abf success1 bo?  9 ?is &
 o!r c\ntries1 & ! p]man5t e/abli%m5t ( 
a  fi/ula1 if done 9 ! mann] ,i %all    
imm$iately po9t out1 w\ld1 9  my op9ion1
 be a mu* less haz>d\s op]ation ?an     
simple tapp+4  ,bili>y fi/ula 9 dogs are
 g5]ally made 9 a s+le op]ation1 by     
cutt+ ?r\gh ! abdom9al p>ietes1 seiz+ ! 
gall-bladd]1  /it*+ x to ! lips ( !     
w\nd1 & ins]t+ a cannula4 ,"h  !re is   
always "s dang] ( ! w\nd n heal+ by !   
fir/  int5tion1 & ( ! passage ( bile    
into ! abdom9al cavity4 ,9 !  case ( !  
human subject1 ,i %\ld1 !re=e1 recomm5d 
! induc+  ( ! adhesion ( ! gall-bladd]  

to ! abdom9al p>ietes by means  ( an    
es*>otic1 be=e mak+ ! op5+2 9 :i* case1 
,i c  sc>cely imag9e t ! op]ation w\ld  
prove "o ei!r (  difficulty or dang]4 ,b
 ev5 suppos+ t x 7 n entirely free  f   
ei!r1 x w\ld /ill surely be pref]able to
 give ! pati5t at  lea/ a *ance (       
prolong+ 8 life1 r ?an to p]mit a fatal 
affection to run its un9t]rupt$ c\rse1  
:i* we "k c1 at be/1  be calculat$ by   
mon?s only4    ,9 ^? cases ( jaundice f 
ob/ruction1 :]e x might be  consid]$    
inadvisable to adopt ! plan "h sugge/$1 
we ought 9  our treatm5t c>efully to    
avoid ! common error ( #abg  adm9i/]+   
m]cury1 or o!r sub/ances suppos$ to h ! 
p[]  ( augm5t+ ! bili>y secretion4 ,we  
mu/ equally avoid !  adm9i/ration (     
foods likely to produce a simil> effect1
 = !  suff]+s ( ! pati5t are n s mu* due
 to a defici5t secretion1  z to a want (
 bili>y excretion4 ,our :ole en]gies    
%\ld be  direct$ to su/a9+ ! /r5g? ( !  
pati5t1 & mitigat+1 if  possible1 !     
physical effects ( ! accumulation ( !   

bile 9 !  gall-bladd] & bili>y ducts1 z 
well z ! poison\s action ( !  re-absorb$
 secretion4 ,?is1 ,i believe1 we c be/ d
 by adm9i/]+  light & readily dige/$    
food1 keep+ ! b[els op5 by g5tle        
purgatives1 & fav\r+ ! elim9ation ( !   
bili>y con/itu5ts  f ! blood by mild    
diuretics4 ,our object may be /ill fur!r
  advanc$ by artificially supply+ !     
place ( ! abs5t bile 9 !  dige/ive      
process4 ,n1 h[ev]1 9 ! way usually     
adopt$1 ( giv+  inspissat$ bile along ) 
! food2 a me?od ( treatm5t :i*  orig9at$
 ere mod]n physiology r5t ! veil (      
!rapeutical  empiricism4 ,9 ! fir/      
place1 ! bile prep>$ accord+ to !  me?od
 indicat$ 9 ! ph>macopoeias1 has its mo/
 ess5tial  prop]ties de/roy$ dur+ !     
process ( prep>ation4 ,& 9 !  second    
place1 we h hi!rto be5 in/ruct$ to      
adm9i/] x #abh  at ! v "t :i* mod]n     
rese>* has prov$ to be ! mo/  unsuitable
 t c\ld possibly be devis$4 ,9 adm9i/]+ 
bile  imm$iately aft] food1 z is usually
 done1 we mo/ effectually produce  !    

contr>y result to :at is int5d$4 ,:5    
bile m+les ) ga/ric  juice1 x de/roys ! 
dige/ive p[] ( ! latt]1 s t by giv+  !  
bile imm$iately or soon aft] a meal1 we 
really dim9i% in/ead  ( increase !      
dige/ive functions4 ,my exp]im5ts1 bo?  
*emical1 &  physiological1 h l$ me to   
propose n only a new me?od (  prep>+    
bile = m$ic9al purposes1 b also to      
sugge/ an entirely  new mode ( adm9i/]+ 
x4    ,fir/ly1--,z reg>ds ! me?od (     
prep>ation4 ,no?+ c be m  simple1 & at !
 same "t m effectual4 ,fre% bile1 tak5  
directly  f ! gall-bladd] ( ! newly     
kill$ pig1 is filt]$1 ?r\gh  v por\s    
filt]-pap]1 to free x f mucus2 x is !n z
 rapidly  z possible evaporat$ to       
dryness at a temp]ature n exce$+ #afj   
,fahr4 ,! bile1 z soon z dri$1 is ready 
= use4 ,simple z ?is  op]ation appe>s 9 
!ory1 !re are two practical difficulties
  connect$ ) x--#a/1 ,bile filt]s v     
sl[ly1 & consequ5tly  little mu/ be put 
into ! filt] at a "t4 #bnd1 ,bile is r  
hygroscopic1 & consequ5tly1 9 ord] to   

get x dri$ quickly1 x is  necess>y #abi 
to spread x ov] a l>ge surface4 ,if !   
bile has be5  well prep>$1 t is to say1 
?or\ghly fre$ by filtration f its  f]m5t
 mucus1 & well dri$1 x w keep 9 /opp]$  
bottles =  _m mon?s )\t los+ any ( its  
active prop]ties4    ,hav+ /at$ t bile z
 at pres5t employ$ m frequ5tly does  h>m
 ?an good1 by ret>d+ in/ead ( ha/5+ !   
dige/ive  process1 ,i h n[ to po9t out !
 mann] 9 :i* x may be giv5  ) advantage4
    ,if bile be adm9i/]$1 z ,i propose1 
at ! end ( /oma*al  dige/ion1 x w1 z 9 !
 heal?y organism1 act on ! *yme at !    
prop] mom5t1 & !reby r5d] x fit =       
absorption4 ,9 ord] /ill  fur!r to      
ensure ! action ( ! bile be+ delay$     
until ! food  is 9 a condition fav\rable
 to its action1 t is to say1 until x is 
ready to pass f ! /oma* into ! duod5um1 
,i h _h ! bile1  z above prep>$1 put    
into capsules1#ca :i* are n readily act$
  on by ! ga/ric juice4 ,:ile 9 ! /oma*1
 ! capsules1 h[ev]1  swell up f ! size (
 a pea to t ( a small gooseb]ry1 & at  !

 same "t become s s(t t !y w readily    
bur/ 9 pass+  ! pylorus into ! duod5um1 
& !reby all[ #acj ! bile to  escape1 &  
come 9 contact ) ! food at ! precise    
mom5t its  action becomes requisite 9 ! 
dige/ive process4#cb ,! capsules n  only
 pres]ve ! active prop]ties ( ! bile =  
an almo/  indef9ite p]iod1 b !y h !     
advantage ( mo/ effectually  prev5t+ !  
pati5t ta/+ ! rem$y4    ,footnote #ca3  
,! capsules 7 made by ,savory & ,moore1 
& ,i h  e reason to be satisfi$ ) !     
mann] 9 :i* !y accompli%$  ! object 9   
view4    ,footnote #cb3 ,prep>$ bile1   
made up into an ord9>y pill1 dissolves  
9 ga/ric juice 9 a qu>t] ( an h\r4 ,:5 !
 pill is silv]$ x  is dissolv$ 9 half an
 h\r1 & :5 gild$1 9 =ty m9utes4  ,:]eas1
 9 ! same specim5 ( ga/ric juice1 !     
capsules prep>$  = me by ,savory &      
,moore1 al?\gh swoll5 to m ?an ?ree     
times  _! orig9al size1 7 nev]!less     
intact at ! end ( an h\r &  a half4 ,!y 
readily broke on be+ g5tly squeez$      
betwe5 ! f+]  & ?umb1 x is n !re=e      

probable t !y w\ld pass !  pylorus 9 ?is
 condition )\t giv+ way1 & all[+ _!     
cont5ts to escape4    ,ea* capsule      
conta9s five gra9s ( ! prep>$ bile2 &   
five gra9s  is equal to "o hundr$ gra9s 
( liquid bile fre% f !  gall-bladd]4    
,two capsules !re=e repres5t two hundr$ 
gra9s (  pure bile1 a quantity 7?\gh    
less1 p]haps1 ?an ! heal?y organism     
consumes dur+ ea* dige/ion7 :i* 9 mo/   
cases w\ld be suffici5t  = ! wants ( !  
sy/em4 ,if1 h[ev]1 a l>g] am\nt be      
consid]$  necess>y1 !re is no reason :y 
?ree or m capsules %\ld n be  giv54 ,by 
! adm9i/ration ( prep>$ bile 9 ! mann]  
"h  describ$1 ! physician is enabl$ to  
imitate nature1 & #aca supply  an       
important elem5t to ! sy/em2 :i*1 al?\gh
 incapable ( cur+  ! disease1 c         
nev]!less w>d (f = a "t ! fatal         
t]m9ation4#cc    ,footnote #cc3 ,x is n 
alone 9 cases ( jaundice t ! prep>$     
bile may be ( s]vice1 b also 9 ! v>i\s  
=ms ( duod5al  dyspepsia1 s common among
 ! lit]>y classes1 consequ5t ^u ei!r  a 

defici5t quantity1 or an abnormal       
quality ( bile4      #acb ,,tabul>      
,,view ,,( ,,! ,,pa?ology ,,(           
,,jaundice1 ,,accord+ ,,to ,,!          
,,au?or',s ,,views4             ,f      
,en]vation4 4 4 4 4 4 ,fright4          
,suppression4                           
,anxiety4                               
,ov]-m5tal ex]tion4                     
,concussion ( ,bra94                    
,conge/ion ,active4 4 ,hepatitis4       
( ,liv]4            ,direct ,viol5ce4   
,dyspepsia4                             
,ague4                                  
,typhus4                                
,typhoid4                               
,sc>lat9a4                              
,pymia4                                 
,yell[ ,fev]4                           
,poison4  ,jaundice4                    
,passive4  ,he>t ,disease4              
,pneumonia4                             
,pleurisy4                              
,imp]fect ,circulation                  
9 ! ,newborn4                           

,abs5ce ( ,secret+  ,canc]4             
,sub/ance4          ,cirrhosis4         
,fatty ,deg5]ation4                     
,amyloid ,deg5]ation4                   
,atrophy4  ,acute4                      
,*ronic4                      ,f        
,cong5ital ,defici5cy ,small ,ducts 787 
,ob/ruction4  ( ,ducts4                 
,common ,duct4                          
,accid5tal ,ob/ruction,gall-/ones4      
9 c\rse ( ,duct4  ,hydatids4            
,=eign ,bodies                          
f ,inte/9es4                            
,closure ( ,outlet4 4  ,pressure (      
,pregnant                               
,ut]us4                                 
,impact$ ,fces 9                        
,transv]se ,colon4                      
,organic ,disease (                     
,pancreas1 or (                         
neighb\r+ ,organs4                      
,abscess 9 ,head (                      
,pancreas4                              
,ulc] ( ,duod5um4      #acc    ,,index4 
,a4    ,abscess 9 kidney1 #eh    9      

pancreas1 #hf    ,acids1 treatm5t by1   
#ajf    ( bile1 #h1 #cf1 #eh    ,acute  
atrophy ( liv]1 #cd    ,ague1 jaundice  
91 #bh    ur9e 91 #bh    ,album5 9 ur9e 
( ague1 #bh    ,album9ose1 #ad          
,alkalies1 treatm5t by1 #ajf            
,artificial jaundice1 #ie    ,atrophy ( 
liv]1 #cd      ,b4    ,b5zoic acid1     
treatm5t by1 #aji    ,bidd]'s rese>*es1 
#af    ,bile1 acids (1 #h1 #cf1 #eh     
te/s =1 #eh1 #fa    action (1 on album51
 #ad    action on fats1 #af    analysis 
(1 #hc    col\r (1 #aj    diseas$1 #hc  
drunk by ,caffres1 #ai    effects ( food
 on1 #aa    inorganic con/itu5ts1 (1 #aj
    pigm5t 9 kidneys1 #eg1 #hf    mode (
 secretion1 #aa    nature (1 #g1 #hc    
9 dige/ive process1 #ae    ess5tial to  
life8 #ac    specific gravity (1 #aj    
treatm5t ( jaundice by1 #abg    res91   
#aj    ,bili>y fi/ula1 #abd             
,biliv]d9e1 #g1 #ef    ,blood 9         
jaundice1 #ajj    ,budd's 7,dr471 views1
 #g1 #cj      ,c4    ,canc] ( liv]1 #cb 
( pancreas1 #df    ,c>bonate ( soda1    

treatm5t by1 #ajh    ,*]ry-/ones 9      
bile-ducts1 #de    ,*ole/]9e1 #h1 #hb1  
#ajh    ,col\r ( bile1 #aj              
,conge/ion1 hepatic1 #bd1 #ajd          
,cy/9e1 #hf      ,d4    ,diseases ) :i* 
jaundice is associat$1 #c    ,dyspepsia1
 #bf      ,e4    ,eiselt 7,dr471 #fh    
,en]vation1 #bb1 #aaj    ,epidemic      
jaundice1 #ij      ,f4    ,f>re 7,dr471 
case1 #ajd    ,fat 9 fces1 #ed1 #gb     
absorption (1 #af    ,flatul5ce1 #ac    
,fr]i*s on me*anism ( jaundice1 #f1 #cc 
,fright1 effect (1 #bc      ,g4         
,gall-bladd]1 abs5ce ( 9 animals1 #ab1  
#da    cong5ital defici5cy (1 #dj       
,gall-/ones--    mode ( escape f        
gall-bladd]1 #dd    mode ( =mation1 #dc 
9 common duct1 #dd    9 gall-bladd]1 #dc
    9 inte/9es1 #abc    treatm5t (1     
#ajh1 #aad1 #aai1 #abc    c>bonate (    
soda 91 #ajh    *lor(orm 91 #aai        
podophyll9 91 #aae    sulphuric e!r 91  
#aai    ,glyco*olic acid1 #h1 #ig       
,glyco*olate ( soda1 #h      inject$    
into blood1 #ci      ,h4    ,he>t       

disease1 jaundice 91 #cj    ,hepatic    
conge/ion1 #bd1 #ajd    ,hoppe's me?od1 
#eh    ,hydatids 9 bile-ducts1 #de      
,i4    ,impact$ fces1 effect (1 #df     
,inflammation ( liv]1 #bd1 #ajd         
,inorganic con/itu5ts ( bile1 #aj1 #hc  
,inte/9al excretion1 analysis (1 #ea    
,introduction1 #a      ,j4    ,jaundice1
 artificial1 #ie    f acute atrophy ( ! 
liv]1 #cd      abs5ce ( bile-duct1 #dj  
abs5ce ( gall-bladd]1 #da      abs5ce ( 
secret+ sub/ance1 #ca      ague1 #bg    
blood-poison+1 #bg1 #ic      bl[ on     
head1 #bd      canc]1 #cb               
en]vation1 #bb1 #aaj      entozoa1 #de  
epidemic1 #ij    f fright1 #bc          
gall-/ones1 #db1 #aaf      hepatic      
conge/ion1 #bd1 #ajd      m5tal emotion1
 #bb1 #aaj      active hepatic          
conge/ion1 #be1 #ajd      passive       
hepatic conge/ion1 #bi      disease ( ! 
pancreas1 #df      pregnancy1 #df       
ob/ruction1 #ci1 #ga      sc>lat9a1 #ic 
suppression1 #bj      typhus1 #bg       
tub]cle1 #cb      zymotic disease1 #bg1 

#ij    me*anism (1 #ai    treatm5t (1   
#aja      ,k4    ,kidneys z elim9at+    
organs1 #aa    ,khne's views1 #eh1 #ih  
,l4    ,l5z's exp]im5ts1 #af    ,leuc9e1
 #fc1 #hj1 #ie    ,liv] cells1 #ch1 #he 
,liv]1 extirpation (1 #aa      ,m4      
,m>cet 7,dr471 #af    ,m>t9 7,dr471 #ij 
,matteucci 7,pr(471 #ag    ,melan9e 9   
ur9e1 #fh    ,m]curials1 treatm5t by1   
#ajb    ,milk 9 jaundice1 #bb      ,o4  
,ob/ruction1 ( bile-duct1 #ga    (      
pancreatic duct1 #ga    treatm5t 9      
jaundice f1 #abb      ,p4    ,pancreas1 
abscess 91 #hg    ,pancreat9e1 #gc      
,pancreatic juice1 #ah      abs5ce (1   
#gc    ,pa?ology ( jaundice1 tabul> view
 (1 #acb    ,pa?ological conditions )   
:i* jaundice is associat$1 #c1 #acb     
,pett5k(]'s te/1 #cf    ,pipe-clay      
/ools1 #eb    ,pneumonia1 jaundice 91   
#cj    ,podophyll91 treatm5t by1 #aab   
9 cases ( gall-/ones1 #aad    ,prance   
7,dr471 #ga    ,pregnancy1 jaundice 91  
#ia    ,pregnant ut]us1 effect (1 #df   
,prep>$ bile1 treatm5t by1 #abg      ,s4

    ,sa9t-,vel 7,dr471 #ia    ,sc>lat9a 
associat$ ) jaundice1 #ic    ,s*midt's  
rese>*es1 #af    ,specific gravity (    
bile1 #aj1 #hc    ,sputa 9 jaundice1 #bb
    ,/ools1 fat 91 #ed1 #gb    col\r (1 
#eb    ,sug>1 a normal con/itu5t ( bile1
 #aj    9 ur9e1 #gj    ,sulphuric e!r1  
#aai    ,suppression1 jaundice f1 #bj   
,sweat 9 jaundice1 #bb      ,t4         
,table ( ! pa?ology ( jaundice1 #acb    
,tauro*olate ( soda1 #h    ,tauro*olic  
acid1 #h1 #ig    ,te>s 9 jaundice1 #bb  
,!ories reg>d+ me*anism ( jaundice1 #e  
,treatm5t ( jaundice1 #aja    by acids1 
#ajf    by alkalies1 #ajf    by b5zoic  
acid1 #aji    by bili>y fi/ula1 #abd    
by c>bonate ( soda1 #ajh    (           
gall-/ones1 #ajh1 #aad1 #aai1 #abc    by
 ,li?ia wat]1 #aji    by m]curials1 #ajb
    ( jaundice f ob/ruction1 #abb    by 
podophyll91 #aab    by prep>$ bile1 #abg
    by t>axacum1 #abb    ,tub]cle1 #cb  
,tyros9e1 #fc1 #hj1 #ie      ,u4        
,urea1 #gj    ,uric acid1 #ef1 #gj      
,ur9e1 analysis (1 #ee      9 acute     

atrophy1 #cf    9 jaundice f ague1 #bh  
9 ob/ruction ( bile-duct1 #gd1 #gh1 #gi 
bile-acids 91 #cf1 #eh1 #gd1 #ig        
col\r (1 #ee    tyros9e & leuc9e 91 #cf1
 #hj1 #ie    melan9e 9 !1 #fh    uric   
acid1 #ef1 #gj    sug> 91 #gj           
,urohmat9e1 #g1 #ee      ,w4    ,wilks's
 cases1 #ce1 #dj      ,y4    ,yell[     
atrophy ( liv]1 #cd          ,,william  
,,/ev5s1 ,,pr9t]1 #cg1 ,,bell ,,y>d1    
,,temple ,,b>4