Malignant Jaundice.

Synonyms.—Acute Yellow Atrophy of the Liver; Icterus Gravis.

Definition.—A grave form of jaundice characterized by necrosis of the hepatic cells and atrophy of the liver. Marked cerebral symptoms accompany this form of jaundice.

Etiology.—This is a rare disease, but seldom seen in this country and in Europe. It occurs more often in women than in men, and between the ages of twenty and thirty, though it has been found in children. Pregnancy predisposes to this form of icterus, and it has been known to follow fright or profound mental impressions.

The exciting cause Is not known, but from the rapid and extensive destruction of hepatic cells, a toxin of a virulent type is, in all probability, responsible for the disease.

Pathology.—The liver shows marked atrophy, being not more than two-thirds or one-half of the normal size, is thin, flabby, and the capsule wrinkled. On making a section, a yellow or 'reddish-yellow surface is presented. The hepatic cells are found in every stage of necrosis, from those in which the process is just begun to those completely destroyed. When the cells are entirely destroyed, there may be seen a fatty, granular debris, in which pigment cells and crystals of leucin and tyrosin are found.

There is usually granular degeneration of the kidneys, and fatty degeneration of the heart is quite common. Most of the organs are bile-stained, and hemorrhages are frequent. The spleen is found enlarged.

The bile-ducts and gall-bladder are found empty.

Symptoms.—The disease usually begins as though it were a case of catarrhal jaundice, gastro-duodenal symptoms being the most prominent. This may continue for but a few days, or for two or three weeks, during which time the skin has assumed an intense icteric hue. Finally vomiting of an intractable form develops, and not infrequently blood is ejected with the vomitus.

Cerebral symptoms now develop; there is intense headache, trembling of the muscles, delirium, and sometimes convulsions. The icteric hue now rapidly deepens, the patient becomes dull and drowsy, and typhoid symptoms develop. The tongue becomes dry and brown, with sordes on the teeth and lips; hemorrhages occur from mucous surfaces and in the skin, and the delirium assumes the typhoid type. The disease may run an afebrile course, although usually attended by fever.

As no bile enters the intestines, the stools are light or putty-colored. The urine is bile-stained, and contains tube casts, leucin and tyrosin.

Jaundice.—After the first few weeks, the disease presents symptoms that are characteristic; namely, persistent vomiting, hemorrhages, severe headache, delirium, and frequently convulsions, atrophy of the liver, and the presence of leucin and tyrosin in the urine. While cerebral symptoms may appear in any severe form of jaundice, and although the clinical symptoms of hypertrophic cirrhosis are almost identical with that of icterus gravis, yet the absence of leucin and tyrosin in the urine will enable one to make the differential diagnosis.

Prognosis.—This is a disease that has usually proved fatal; therefore the prognosis is not favorable.

Treatment.—The disease is so rare in our country that Eclectic remedies have been but little used. Should one meet the disease, we would try our antiseptics. Echinacea and baptisia would be among our first remedies tried, in the hope that the sepsis might be overcome and the toxins neutralized. Other remedies would be tried as the condition would indicate.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.