Cirrhosis of the liver and icterus of four years' duration : with remarks on biliary cirrhosis / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Cirrhosis of the liver and icterus of four years' duration : with remarks on biliary cirrhosis / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    fi tlu*re was no dilntation or apparent incroasp in the number of bile capillaries. Surely, however, as there must be a tendency to obliteration of the minute bile ducts by the inflammatory fibrous tissue, and as the pressure exerted by the contraction of this newly formed tissue gradually causes more and more of the secreting hepatic cells to atrophy, the pressure of secretion, and the consequent distending force in the ducts, must also be diminished. It may even be sup- posed that in very chronic obstruction the secreting pressure may be reduced to nothing, the cells which remain un- atrophied, having adapted themselves to circumstances and having become accustomed to secrete their bile backwards (that is, into the blood capillaries and lymph vessels). It may possibly further be supposed that the great enlargement of the spleen (as in the present ease), probably more often found in biliary cirrilosis*’'than in ordinary forms of cirrhosis, may be due, not merely to obstructed blood current in tlie splenic vein, but may in part also be caused by the long- continued circulation in the blood of some substance normally excreted by the bile, which acts as a chemical irritant to the spleen and causes a very chronic inflammatory enlarge- ment. I may mention also that Dr. Robert Saundby,’ who has gone into the question, considers that increase in the bile capillaries is not a necessarily distinguishing feature of biliary cirrhosis. When excessively great dilatation of the small ducts has been observed in cases where calculi have for a long period been blocking the common bile duct, this has doubtless been often due rather to the mucus or muco-pus secreted by the inflamed ducts than to the pressure of mere bile secretion. I believe that the decided greenish colour of the liver, as seen at the post-mortem examination, may be considered to afford some confirmation to my view of the case. A greenish colour of the liver appears to be always observed in cases of biliary or hypertrophic cirrhosis with chronic jaundice. Dr. Norman Moore, in fact'®—except for the colour of the fresh liver—thinks it very often difficult to distinguish biliary cirrhosis from alcoholic cirrhosis. Possibly if fresh sections had been cut before hardening some green inspissated bile might have been found in the form of granules contained in the hepatic cells. I have heard it raised as an objection to the theory of the production of jaundice by obstruction in the bile ducts, that if the common bile duct be ligatured and micro-organisms ''* IT See Hanot, op. «■<.. p 62 Tliis cnlargeiiiont of the spleen reai'lies its maximum in chronic biliary or “hypertrophic ciirhosis with jaundice of children, where the splenic tumour may form the chief morbid feature of the case during life (see A. Gilbert and L. Fournier, Rev. Mcnmelle des Maladies de i'A'n/nnce, 1895, vol. xiii, p. 310). In a case of mine, which I now believe belonged to this group, the child’s spleen weighed ounces to the 26J ounces of the liver (Trans. Path. Soc.. 1895, p. 71). 1* Trans. Path. Soc., vol xxx, p 301. w Discussion on a case shown by Dr. Goodhart at the Pathological Society, British Medical Journal, 1889, vol. i, p. 892. s If the views of those are correct who maintain that the cirrhosis which follows ligature of the common bile duct is solely due to irrita- tion by chronic infection with micro-organisms, one would suppose that a cirrhosis would equally well or even more readily take place, when in addition to the ligature of the common bile duct a biliary cystotomy is made at the same time. That a cin-hosis follows likewise in such cases has, I believe, not yet been proved. In huinan beings, when no chole-