Jaundice.
Synonym:—Icterus.
Definition:—A symptom of retention of bile; an evidence of absorption of bile. A condition in which bile in the blood deposits its pigments in the tissues and secretions, imparting a yellowish hue.
Etiology:—The condition follows a catarrhal condition of the bile duct, or a gall stone or parasites in the ducts, or other obstruction of the duct, which may occur from stricture or from a small tumor, or external pressure, from various causes. The jaundice of newborn infants is supposed to be due to faults of blood pressure in the liver, permitting the resorption of the bile.
Catarrhal Jaundice.
Synonyms:—Catarrh of the common bile duct; hepatogenous jaundice; Icterus catarrhalis.
Etiology:—Catarrh of the common bile duct, is not dissimilar to catarrh of other mucous membranes. It is usually a secondary condition, occurring during the course of infectious fevers, or as the result of catarrh in the duodenum. It may follow disorders of the stomach or catarrh of that organ. There is no doubt that it occurs directly from cold and exposure, or other conditions that will produce congestion. This simple form of jaundice may also result from great emotional excitement or mental disturbances, and from the ingestion of poisons, especially of phosphorus. Jaundice from obstruction due to the presence of gall stones, is described under cholelithiasis. This form may also be induced by the excessive use of tea and coffee, and is common among those who are addicted to the excessive use of alcohol.
Jaundice is quite common in childhood, occurring frequently before the age of ten years. It occurs at all times of life, more frequently in males than in females.
Symptomatology:—A number of cases, especially those among children, have begun with malaise, general impairment of health, listlessness, fretfulness, anorexia, disordered digestion, and inactive bowels; the feces being pale, or clay colored, or of a grayish hue, are usually light, and will float upon water. From the onset there has been some fever, although the temperature seldom rises above 101.5° F. In other forms of obstructive jaundice there is often no fever and occasionally there is a subnormal temperature, with slow, full pulse.
Very early, with the development of other symptoms, is the appearance of a slight discoloration, first observable in the conjunctivae, later in the skin of the forehead, neck and chest, then in the face and over the body. As the disease progresses the color deepens until it becomes a deep yellow, brownish or bronzed tint. An early examination of the urine will occasionally show the presence of bile before there is any discoloration of the conjunctivae or skin. It may be found also in the sweat, from which the clothes are readily discolored. The urine is scanty, and gradually assumes a dark yellow color, which increases until it becomes a clear reddish brown. In many cases there is no sediment in the urine; in others there may be an excess of the urates upon standing, or some blood may be present. While the feces, deprived of bile, are pale colored, as described, they are apt to have a characteristic unpleasant odor; in other cases there may be a quite severe diarrhea. There is considerable itching of the skin, with boils, urticaria, and other disorders. Occasionally there are yellowish spots quite distinct in character, or ecchymoses, or hemorrhage in the skin and mucous membranes. Nervous irritation, restlessness, insomnia, and mental depression are common symptoms, with some nausea, vertigo, headache, and distorted vision. Occasionally objects appear yellow for a time; at other times the patients are listless, dull, drowsy, and inclined to sleep. This condition may increase until stupor and coma, or convulsions and delirium may supervene. A careful examination of the liver shows that the area of dulness is increased and there is considerable enlargement. The gall bladder may extend below the margin of the liver.
Diagnosis:—The discoloration of the conjunctivae and skin, with the pale color of the feces, are diagnostic. Other characteristic evidences are sufficient for a differentiation between this condition and others for which it might be mistaken.
Prognosis:—The prognosis in catarrhal jaundice may be said to be always favorable. Fatal cases of jaundice are usually the result of serious complicating disease.
Treatment:—In the treatment of those cases characterized by the symptoms which I first named, I have administered aconite, to modify the temperature, and have given from ten to thirty grains of the sodium phosphate every two hours at the onset of the disease. This has usually been sufficient in children. With adults I have found it necessary occasionally to administer bryonia, or belladonna, if there is much hepatic enlargement, and to give from one to five drops of specific chionanthus every two hours.
In those cases where there is but little evidence of disease, except the discoloration of the skin, I have given ten drops of chionanthus every two hours in hot water. If there is soreness over the region of the liver, with considerable enlargement, I apply heat persistently for several hours each day. An excellent combination in jaundice with stomach complications, is thirty minims of iris, a dram and a half of chionanthus, in four ounces of an elixir of hydrastis; or the first two remedies may be combined with five drams of colorless hydrastis, half of a dram of the tincture of capsicum, in sufficient port wine to make four ounces, of which a teaspoonful is given every two or three hours.
In those cases where there is sluggishness of the circulation with fulness of the veins and of the tissues, and an atonic condition of the muscular structures, the tongue will usually be found to be thick, pale and heavily coated, and occasionally there will be extreme vertigo. For these I have advised full doses of podophyllin, followed by a full laxative dose of magnesium sulphate. A trituration of podophyllin one part, with sugar of milk thirty parts, may be given in grain doses every two hours, where there is a uniform yellow moist coat on the tongue. Chelidonium will be found a valuable remedy in certain cases of catarrhal jaundice. Myrica may be given when the cause is malarial in character, and when it is accompanied with severe morning headaches, slow pulse and muscular aching. In jaundice due to faulty conditions of the heart, iberis amara is a specific remedy.
In occasional cases, there will be strong indications for an acid remedy, when nitric acid, or dilute hydrochloric acid may be administered for a short time, with benefit. These patients should drink an abundance of water, preferably of hot water, and should eat very plain but nutritious food. They should avoid condiments of all kinds, and pastry, and nuts. I believe the administration of sweet oil regularly, is as beneficial in promoting a complete cure of these cases as it is in the relief of gall stones. A mild faradic current is occasionally of much service. It should be used three or four times each week, from eight to fifteen minutes at each time.
