Jaundice

“ But in jaundice the whites of the eyes and the tears are tinged yellow, and, besides, the feces are paler than they should be, the urine is yellow, and other serious symptoms are added. If the bowels be costive, or irritated to frequent efforts, if the abdomen swells and becomes tense, if the child is uneasy and inclined to vomit, if it refuse the breast and frequently moans as if in pain, if it emaciate rapidly, jaundice in a bad form is present, and there is probable disease of the liver. ”

“ As the respiratory function and that of the skin increase in activity, the jaundice will disappear of its own accord. Great attention must be paid during its continuance to avoid exposure of the child to cold, while no other food than the mother's milk should be given. If the bowels are at all constipated, half [Pg 40] a grain of grey powder or a quarter of a grain of calomel may be given, followed by a small dose of castor oil, and the aperient will often seem to hasten the disappearance of the jaundice ”

“ If, for example, we closely examine cases of acute hepatitis without jaundice, we find they are those in which only a portion of the liver is affected. It matters not whether it be one lobe or two, the surface or the centre of the organ, the disease is invariably circumscribed; and there is enough hepatic tissue left in a sufficiently normal condition to prevent the constituents of the bile accumulating in the blood, and producing jaundice. ”

“ CAUSES.——The immediate cause of the jaundice is an obstruction of the bile. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, &c. the bilious or hysteric colic; violent passions, as grief, anger, &c. Strong purges or vomits will likewise occasion the jaundice. Sometimes it proceeds from obstinate agues, or from that disease being prematurely stopped by astringent medicines. In infants it is often occasioned by the meconium not being sufficiently purged off. Pregnant women are very subject to it. It is likewise a symptom in several kinds of fever. ”

“ JAUNDICE ARISING FROM ACUTE ATROPHY OF THE LIVER.
Acute, or yellow atrophy of the liver, is one of the most formidable of human diseases. It is sudden in its onset, rapid in its course, fatal in its termination. It is more common in women than in men; seldom attacks those above thirty years of age, and occurs most frequently in the earlier months of pregnancy. The immediate exciting cause of this strange disease appears to be, in the majority of cases, mental depression. The symptoms usually observed are jaundice, rapidly followed by sickness, and vomiting ”

“ In jaundice arising from obstruction, the pipe-clay stools are, as in the case of jaundice from suppression, entirely due to the absence of bile from the intestinal canal. The yellowness of the skin is in like manner caused by the accumulation of the bile pigment in the blood, from whence it exudes, and stains the tissues; and, lastly, the saffron-coloured urine results in a similar way from the elimination of the pigment from the blood by the kidneys. ”

“ This effect, that all of us must have experienced in a slight degree in our own persons, several may have observed to a greater extent in the persons of others, even to the production of well-marked jaundice. At this very time I have under my care a young married lady, who during the last two years has twice suffered from an attack of jaundice induced by witnessing her child in convulsions, and this I regard as an example of jaundice from enervation. ”

“ When any new symptom becomes superadded to jaundice, it must be immediately combated. Fever, injection of the vessels of the conjunctiva, constipation, diarrhœa, or the discoloration of the urine, require one bleeding at least, with some mucilaginous drinks. Purgatives are always injurious at the commencement of the disease. ”

“ It is no real jaundice, but is merely the result of the changes which the blood with which the small vessels of the skin are overcharged at birth is undergoing; the redness fading as bruises fade, through shades of yellow into the genuine flesh colour. ”

“ It is seldom that jaundice attacks persons in an epidemic form; as it does so occasionally, however, and that too in almost all countries, it is necessary that I should say a few words on its pathology. ”

“ Jaundice being a disease which often goes off without any remedies, has been, in all ages, a favourite with empirics. Alsaharavius treats of the disease in much the same terms; recommends bleeding when it is connected with an inflammatory cause, and attenuants, bitters, purgatives, and the hot bath according to circumstances. Rhases, who gives a very full account of jaundice, states that the disease generally arises from obstruction either in the liver or its ducts. He particularly recommends drastic purgatives, such as scammony, along with wormwood, fennel-seed, and the like. ”

“ In last November several persons were attacked with jaundice, and now not less than 150 persons are suffering from it. None of those who were attacked by the late fever are suffering from the present epidemic. ”

“ The gravity of jaundice varies as much as its causes. It is well known that the system may be saturated with bile, and the tissues and urine deeply stained without much constitutional disorder. The pigment alone is not an active poison. But there may be much attendant suffering from obstructed biliary ducts or bowels, from diseases of the lungs, or from disintegration of the blood globules and imperfect nutrition, or there may be profound nervous prostration and disorder from uræmia, or from the presence in the blood of an excess of effete and partially oxidized albuminoids (See Azotæmia) . ”

“ A large amount of diseased tissue may exist in certain portions of the liver, and yet fail to produce jaundice, while a much smaller amount of the same diseased tissue, placed in another situation, may induce it. Should the morbid deposit, for example, be so placed as readily to interrupt the flow of the secreted bile, jaundice may rapidly occur, and be due as much to the re-absorption of the secreted bile, as to the suppression of the biliary secretion. ”

“ A further explanation of the reason why jaundice occurs in an epidemic form, may be found in the circumstance that in all febrile states of the general system some one or other of the internal organs is liable to become congested. ”

“ The success of our treatment will therefore depend on our powers of diagnosis.
The general principles upon which the treatment of jaundice must be founded are as follows:—
The first and great object is, of course, as in the case of every other disease, to remove, if possible, the exciting cause. When that is accomplished, we can with safety turn our attention to the removal of its effects. ”

“ Slattery," continued Mrs. Billiter, "it is very necessary that people should be aware."
"Why, there is always danger in every disease," answered the surgeon, who abominated a straightforward answer to such questions; but then, bethinking himself, and seeing that it might be better to be a little more explicit, he added, "Jaundice, even the green, or black jaundice, as it is sometimes called, which your master has, is not in itself by any means a dangerous disease; but there are accidents, which occur in the progress of an illness, that may produce very fatal results, sometimes in a moment. ”

“ Definition.—Infectious jaundice is a spirochaete infection, caused by Leptospira icterohaemorrhagiae. This spirochaete is a common parasite of rats in various parts of the world and man possibly receives his infection from this source. There is a sudden onset with rather high fever, headache and vomiting. The jaundice appears about the third or fourth day when the urine shows albumin and bile. Haemorrhages, especially epistaxis, are common and the liver rather than the spleen shows enlargement. A polymorphonuclear increase is a feature. ”

“ The first excrement of a man sick with dysentery was mixed with salt as a “magnetic” cure; to this, some people added the powder of eel-skins (Frommann, “Tractatus,” p. 1012, et seq.) . Yellow jaundice patients urinated upon clean linen sheets; if they succeeded in dyeing them yellow they would recover soon; if not, not (p. 1012) ; roots wet with the patient’s urine were burned as a cure for the yellow jaundice (p. 1013) ; all the clothing of an epileptic patient was burned, and the ashes [413] thrown in a stream, down-stream (p. 1013) ”

“ There are, as a rule, pain, fever, vomiting, and prostration. The pain is located in the upper part of the abdomen and may be quite severe. The vomiting may continue for a number of days. The bowels are usually constipated. After a few days the jaundice sets in and may be quite intense. After the jaundice is established the stools are gray or white in color and there is much gas in the bowel. The urine is very dark and may be yellow or yellowish-green in color. The child complains of headache, is dull and listless, and appears sick and weak. ”

“ Cause.—Jaundice or Liver Congestion is due to constipation where there is an inactive or torpid condition of the bowels and the bile which passes into the intestines is absorbed and produces a yellow staining of Jaundice. Jaundice is merely a symptom of a disease and ought to direct attention to ascertain if possible the cause or causes which give rise to it. Inflammation of the liver usually occurs as a complication of infectious diseases. ”

“ All races were attacked; the patients were mostly adults; no liver-complication could be detected; nor could any resemblance be traced between the disease and yellow fever. It was fatal to females only, especially during pregnancy. Of thirty pregnant women who were attacked at St. Pierre, ten only arrived at the full period of pregnancy without presenting any other symptoms than those of ordinary jaundice. ”

“ Jaundice from obstruction, for example, cannot long exist without becoming complicated with jaundice from suppression. The continued backward pressure exerted on the hepatic parenchyma by the over-distended bile-tubes, sooner or later impedes the circulation in the organ to an extent sufficient to induce an impairment, if not an almost total arrest of the biliary secretion. Hence it is, that in the last stage of jaundice from obstruction, the biliary acids gradually diminish, and at last finally disappear from the urine. ”

“ Thus the yellow eye of the bird drew out the yellow jaundice. Pliny tells of another, or perhaps the same, bird, to which the Greeks gave their name for jaundice, because if a jaundiced man saw it, the disease left him and slew the bird.​ [274] He mentions also a stone which was supposed to cure jaundice because its hue resembled that of a jaundiced skin.​ [275] In modern Greece jaundice goes by the name of the Golden Disease, and very naturally it can be healed by gold. To effect a perfect cure all that you have to do is this. ”

“ When a jaundice is thus produced it will gradually disappear without the aid of any medicine; the kidneys are the principal means by which all unnecessary bodies are extracted from the circulating mass, a portion of bile will therefore under such circumstances be eliminated in every discharge of urine.
The different emetics employed in practice are derived from the vegetable and mineral kingdoms, some of which appear to produce their effects by an immediate impression upon the nerves of the stomach, while others require to be absorbed into the circulation before they display their energies. ”

“ Thus a young woman affected with jaundice is mentioned in the German “Annals of Clinical Homoeopathy” as having been cured in twenty-nine days by pulsatilla and nux vomica. Rummel, a well-known writer of the same school, speaks of curing a case of jaundice in thirty-four days by Homoeopathic doses of pulsatilla, aconite, and cinchona. I happened to have a case in my own household, a few weeks since, which lasted about ten days, and this was longer than I have repeatedly seen it in hospital practice, so that it was nothing to boast of. ”

“ Jaundice may also exist during the presence of simple constipation, hepatitis, biliary calculi, abscesses, hardening of the liver, etc.
Treatment.—When jaundice exists we must endeavor to rid the system of the excess of bile, and this is best accomplished by giving purgatives that act upon the liver. Calomel, 2 drams, with aloes, 7 drams, should be given. Glauber's salt in handful doses once or twice a day for a week is also effective. May apple, rhubarb, castor oil, and other cathartics that act upon the first or small bowels may be selected. ”

“ Should the jaundice depend on advancing organic disease of the liver, such as cancer, the tinge becomes gradually deeper, and the emaciation and debility more marked towards the fatal termination, which in such cases is seldom long postponed. Apart from this, however, jaundice from obstruction may exist for many years, as in those instances where the walls of the bile ducts are thickened from chronic catarrh, but where they are only partially occluded. In the common cases of acute catarrhal jaundice recovery usually takes place in two or three weeks. ”

“ The breathing is difficult, and the patient complains of an unusual load or oppression on his breast. There is a heat in the nostrils, a bitter taste in the mouth, loathing of food, sickness at the stomach, vomiting, flatulency, and other symptoms of indigestion.
If the patient be young, and the disease complicated with no other malady, it is seldom dangerous; but in old people, where it continues long, returns frequently, or is complicated with the dropsy or hypochondriac symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow. ”