§ 214. Icterus, jaundice.

Idiopathic icterus consists in a limited or suppressed secretion of bile in the liver, inducing a derangement of the digestive functions, and a deposition of bilious pigment in other secretory organs, particularly the skin, kidneys, and lastly, in the mucous and serous membranes.

Suddenly or gradually the albuginea assumes a yellow tinge, which spreads rapidly over all the other parts of the body; at first it is a pale-yellow, afterwards the yellow becomes darker, reddish, saffron-coloured; in the highest degree of jaundice, the skin is brown, or even black-yellow. Bilious pigment likewise makes its appearance in the urine, which becomes yellow, brown, or even black, and, like the sweat, tinges the linen yellow. The tongue is somewhat whitish, coated with mucus, the taste is flat, frequently bitter, attended with inclination to vomit, or vomiting of mucus and a bilious substance, the abdomen is distended, sometimes there is pain in the region of the liver, the stool is scanty or suppressed, white, gray, clayey, without bilious pigment, and frequently accompanied with colicky pains around the umbilicus. If fever be present, the chilliness is of short duration, not very violent, the heat is somewhat considerable, the pulse is accelerated but soft, the thirst increased, and the fever has distinct remissions in the morning. Sometimes the humours of the eye even look yellow, and everything then appears to the patient in a yellow or faint-red light.

§ 215. We distinguish the following varieties of icterus:

(1.) Icterus neonatorum. This comes on between the third and fourth day after the birth of the infant, very rarely on, but never after, the seventh day. Within 12 or 24 hours the skin becomes yellow, rather of an orange-colour, except the albuginea, which remains unchanged; the abdomen is not distended, but soft, painless; there is little or no bilious pigment in the urine, the stool is either retained or thin, but greenish and mixed with bilious pigment.

Afterwards, between the second and tenth month, another malignant form of jaundice sometimes develops itself, distinguished from the other form by the dark, brass-coloured appearance of the skin, (even of the albuginea,) by the presence of a quantity of bilious pigment in the urine, and by the supervention of fever, spasms, and sopor.

(2.) Icterus acutus, febrilis, spasticus. This form sets in suddenly, without precursory symptoms, and is always attended with fever.

(3.) Icterus vulgaris, chronicus, afebrilis. The colour is light-yellow, the urine becomes dark-red, gradually black, the tongue is clean, although the taste is bitter and even foul; there is no appetite, but rather an aversion to certain kinds of food, particularly to meat. Striking symptoms are the increasing slowness of the pulse, which sometimes falls to 40, and the irritable mood of the patients; their anger is excited by the least circumstance, they feel feeble, and get tired from the least exercise.

(4.) Icterus senilis. This being occasioned by biliary calculi and an arthritic diathesis, we shall treat of this subject hereafter.

Idiopathic jaundice cannot well be confounded with a similar symptomatic affection accompanying hepatitis, organic affections of the liver or bilious fever, on account of the absence of all symptoms denoting an inflammatory affection of the liver or characterizing bilious fever.

§ 216. Acute jaundice generally occurs in individuals at the age of pubescence, with a delicate skin, in midsummer; and is occasioned by taking cold when the skin is covered with sweat. It may even become an epidemic disease when the hot atmosphere is suddenly cooled by a thunder storm. Jaundice may likewise be caused by overloading the stomach, or by eating hurtful food, by cooling the stomach or liver by means of cold water or ice while the body is heated, by an impeded circulation of the blood in the liver, (hence in pregnant females,) by abuse of China, rhubarb, Mercury, (particularly calomel,) mercurial and sulphur ointments, in conjunction with improper diet; and lastly, it may arise from intermittent fevers, by a sort of metaschematismus.

Icterus neonatorum is probably always occasioned by a cold, or may perhaps arise from the retention of the meconium, or from the immoderate use of chamomile tea, during the latter part of pregnancy, by the mother, or, afterwards, by the infant.

The different varieties of jaundice run a different course. The icterus neonatorum runs its course in from 6 to 10 days, and almost always terminates in complete recovery, with copious discharges of black and afterwards bilious matter; it very rarely assumes a malignant character, in which case it may last weeks and months, frequently terminating in atrophy, scrofula mesenterica, softening of the stomach, eclampsia, acute hydrocephalus, and death. The icterus febrilis runs its course in from 7 to 14 days, and recovery generally takes place by means of critical sweats, sedimentous urine, and bilious evacuations; it is only in consequence of great mismanagement that this form of jaundice sometimes passes in hepatitis or bilious fever. The icterus afebrilis frequently continues for weeks and months; but if it should have been caused by hurtful food, the disease may terminate in two or three days, the white stools again becoming bilious, and the dark urine clearer; it is very seldom that dyspeptic symptoms or hepatitis supervene.

The prognosis is generally favourable, particularly in icterus neonatorum and icterus febrilis; in icteru a feb-rilis recovery is iikewise generally certain, except if it should have arisen from abuse of mercury, in which case the prognosis is some what doubtful. In icterus neonatorum malignus the prognosis is unfavourable, if the disease have lasted some time, if the skin be of a dark brass color, the abdomen distended, if the children utter a squeaking noise, with spasms or sopor, if the region of the stomach be hot and painful to the touchy and if putrid vomiting set in.