This is rarer than the catarrhal form, and occurs more frequently in elderly people. It is a diffuse, purulent inflammation of the biliary passages, and usually results, in the aged, from gall-stones.
Etiology.—It is supposed to arise, in the majority of cases, from microbic infection, especially the bacillus coli communis, either alone, or combined with the staphylococcus albus or aureus, or with the streptococci. The ascarides may also enter the ducts from the bowel, and thus give rise to the disease.
Malignant growths of the ducts may also be responsible for the affection. The toxins developed during typhoid fever, dysentery, cholera, malaria, pneumonia, and puerperal fever may also be considered as factors in the disease.
Pathology.—The inflammation may be confined to the common duct, the cystic duct, or both ducts and gall-bladder may be involved. The mucous membrane is thickened, the ducts dilated and filled with a mucopurulent fluid. The walls of the ducts in some cases show extensive ulceration, which may be perforated and give rise. to local peritonitis.
Symptoms.—Jaundice is present, although this .may have preceded the suppurative form, and of itself is not a characteristic symptom. The patient will suffer with chills or rigors, followed by an irregular fever and night-sweats. The' fever will assume a remittent or intermittent form. The patient shows marked emaciation, is anemic, and becomes greatly debilitated. Tenderness is marked in the hepatic region.
Complications are liable to arise, such as endocarditis, peritonitis, purulent meningitis, pylephlebitis, septicemia, etc. There are digestive disturbances, such as nausea, vomiting, and diarrhea.
Diagnosis.—The form of the disease would be recognized by the symptoms characteristic of suppurative processes; viz., septic fever, night-sweats, and emaciation; the symptoms of peritonitis, pylephlebitis, and abscess being present in a number of cases.
Prognosis.—This is a very grave disease, and the prognosis is unfavorable.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.