James F. Weir

Chronic hepatitis with jaundice (biliary cirrhosis)

The term “biliary cirrhosis” implies that the toxic agent enters through the biliary ducts. This is true of the obstructive types of cirrhosis which have been briefly described. The toxic and infectious type and the type associated with chronic atrophy present the following features.

The diagnosis of jaundice

Abstract Although much study from a clinical and laboratory standpoint has been devoted recently to jaundice and hepatic diseases, the differential diagnosis is and should continue to be based essentially on clinical data. The presence or absence of pain and its character when present is the most important single fact in such differentiation. Laboratory procedures have given new impetus to study of these cases, have changed methods of practice to some extent, and have introduced new conceptions of the mechanism of jaundice. Thus, duodenal drainage to determine the amount of bile entering the intestine is used more frequently because they give more definite information than examination of the feces and urine. The reaction of the serum to the van den Bergh test, and the height and contour of the curve of bilirubin give a much more accurate idea of the type of the icterus, its severity, and its fluctuations than does observation of the color of the skin or examination of the urine and feces. We feel that the van den Bergh test is one of the most useful of the various tests that have been advocated in the study of jaundice. The coagulation time of the blood is also a valuable procedure, but must also be coupled with clinical observation of the patient. The conception has developed that all jaundice is not obstructive in cause, but that jaundice may also be of hepatic or hemolytic origin. Although the majority of cases are probably distinctly of one type, yet in practice cases are seen in which the icterus originates in more than one way. Thus, the cases of hemolytic jaundice may have an associated hepatic or obstructive element or the cases of obstructive jaundice may have an associated hepatic element. At present there is not any specific test for distinguishing between hepatic jaundice and obstructive jaundice if the obstruction is partial. The need for such a test is especially great when obstruction has developed without the accompaniment of pain. The mechanism of the icterus in hepatic jaundice is not understood. The classification of the group is unsatisfactory. Although some forms of jaundice, such as that due to chloroform, have largely disappeared, other forms have appeared since the introduction of the arsphenamine and cinchophen drugs. Precautions in the use of these drugs are constantly necessary.

Phenomena including recurrent ulcer following resection of benign lesions

Abstract Recurring ulceration, after partial gastric resection for peptic ulcer, is infrequant. However, when it occurs, it often is a serious lesion. When such a condition develops, the early symptoms are characteristically of the type of ulcer, but soon these features may be lost on account of the penetrating and inflammatory nature of the lesions. The distress is severe; often frequent feedings at night and even opiates are required for relief. The pain may be referred to parts far distant from the site of the ulcer. The symptoms often are extremely refractory to medical treatment and in some cases there has been more than one recurrence.