Definition

Jaundice is known by the name of icterus. It is characterized by a yellow coloring of the skin of the body; also the mucous membrane and the fluids of the body are tinged with bile pigment. Jaundice is a symptom depending upon a great variety of causes, and the causes are obstructive.

Etiology

A foreign body, such as a gallstone, may lodge in the gall-duct, or parasites may pass from the duodenum into the duct. Catarrhal inflammation may cause enough closing of the duct to impede the flow of bile and become a cause of jaundice. Inflammation may also cause stricture of the duct. Tumors may press upon the duct. Tumors of the liver, stomach, pancreas, kidneys, and omentum may, by pressure, cause obstruction; occasionally an enlarged gland. Such enlargements as pregnancy, ovarian cysts, and even fecal accumulations have been described as causes of jaundice. It is barely possible that this may be true, but not very probable. Constipation might be the cause of toxin poisoning, and in this way cause jaundice.

General Symptoms

Yellow tinting of the skin; itching of the surface of the body; yellowing of the sclerotic coat of the eye. The tinting of the skin will vary from a very slight yellow to a deep brown or bronze. The exceedingly dark coloring comes from complete obstruction. Under such circumstances the urine is also very dark. The tissues of the entire body are involved in the coloring. In the chronic form of this disease, pruritis, or itching, becomes a very distressing symptom. Sweating is another symptom. The clothing of such patients has the appearance of having been dyed yellow. Skin troubles are not uncommon where there is obstruction of the bile. Piles often occur.

Where no bile whatever passes into the intestine, the stools are very light-colored--sometimes of a grayish coloring--and the odor is pronounced. The clay-colored stools are common in those who are troubled with inactivity of the liver. This may occur in cases where there is very little coloring of the skin. It cannot, however, exist for any great length of time without the urine showing that the bile is failing to pass into the intestine.

Constipation is common; yet, on account of the decomposition taking place when the bile fails to enter the bowels, diarrhea may be a constant symptom. Bile is, so to speak, an antiseptic. It has a tendency to prevent decomposition. Where the stools are offensive, and there is hearty eating or overeating to account for it, the probable cause is a lack of the secretion of bile. Many of these cases present irritability and depression of spirits. One of the peculiar influences of bile on the system is to produce melancholia. In acute derangements of the liver, brought on from excessive eating or debauch, the debauchee will have great depression of spirits and gloomy forebodings of the future. While the patient is in this state, the world is all going wrong, his business is going to smash, and he is ready to sell out for a song and get away from the smash-up; but within twenty-four to forty-eight hours after this depression--this influence of bile in his blood--everything is lovely, the goose hangs high, and you could not buy him for one hundred and fifty cents on the dollar.

In low forms of fever there is a toxemic jaundice which augurs badly. Indeed, it is a symptom that might be avoided by preventing the disease from taking on a septic state. Such fevers as typhoid, if not medicated and fed, will fail to develop septicemia; hence the complications, such as jaundice, will never develop. This is not only true of typhoid, but it is true of every disease. These symptoms are secondary, and are possible only in malpractice. The word "malpractice," as used in this sense, includes the malpractice supposed to be scientific medicine.

There is said to be a hereditary icterus. In all probability it is due to some anatomical defect, or to some peculiar style of eating, on the part of the families of the various progenitors, all of them having the tendency to eat in such a manner as to bring on liver derangements--to develop a hepatic diathesis, if you please. Why should not this be true when families for several generations live in such a way as to produce engorgement of the liver? Why should not the tendency for developing this derangement become so fixed that it is transmissible? The true definition of heredity is a tendency to take on certain forms of disease. There is no such thing as inheriting a disease.

Icterus Neonatorum

New-born children often develop a jaundiced condition within the first week after birth. As a rule, this needs no special attention, even when so pronounced that the urine will dye the diapers an orange yellow. Fatal cases, however, have been known. It is my opinion that such cases come from obstruction of the biliary duct. Where the condition is purely functional, it is aggravated by too frequent and excessive eating. If the error is not suspected, the child may be driven into a fatal illness.

Anemia Of The Liver

Anemia of the liver cannot be thought of in these days of much starch-eating; for starch, sugar, and fat have a tendency to produce hyperemia. Possibly, after the hyperemia has been developing for years, a hardening may take place that in time will end in anemia. Then the disease would be of a secondary character and come under the head of sclerosis. Hyperemia is divided into two classes--active and passive congestion.

Active

After a meal the liver will always be found engorged because of the absorbed food. All the vessels are filled. This state passes away in a few hours--as fast as the food material can be absorbed and utilized by the body. Where the engorgement is excessive there may be a feeling of weight and heaviness in the region of the liver, and, if eating is frequent and excessive, the hyperemia becomes a fixed state. The border of the liver may come down much below the ribs. This state is diagnosed as enlargement of the liver. It is found in those who are steady imbibers of alcoholics, as well as in those who eat excessively.

Passive

Passive hyperemia is more common. it is said to result from pressure on the efferent vessels. This affection is found in valvular diseases of the heart, emphysema, sclerosis of the lungs, and thoracic tumors. The skin of patients in this state often has the appearance of having been smoked; or their faces may seem cyanotic or flushed. This affection is brought on more frequently from heart derangement than from liver derangement, but these two conditions are often found together.

General Treatment

The treatment for obstructive icterus must be the removal of the obstruction. This may require surgery, and it may be a derangement that surgery cannot remedy. In gallstone obstruction the feeding of eliminating foods, such as fruit and raw vegetables, will in a reasonable time bring about a disintegration of the stone in the gall-bladder. Then there will be a passing into the bowels of the sand that results from the disintegration; and, if this style of eating is persisted in, the patient will make a complete recovery. Where the obstruction is due to a catarrhal inflammation of the gallduct, proper feeding will overcome it. What is proper feeding? Any normal style of eating that will include the necessary amount of eliminating foods, such as fresh, uncooked fruit and vegetables. In severe cases of this character the patient should fast for a week or two, and then live on fruit for a week or two, depending upon the severity of the symptoms and the rapidity of relief. In all these cases--it matters not how severe they are or what the character of the obstruction is--the patient should be kept away from sugar, starch, and fat. That will give the liver--the portal system--rest; and rest is the foundation on which all curative therapeutics must be based. Physiological rest is of more importance than all other forms of rest. Physical and mental rest are also needed, however; for these are allies of physiological rest.

In the jaundice of children, no hesitancy should be felt about taking the child off its mother's breast and giving nothing but water until the severe symptoms have passed. Then the feeding should be light enough to prevent a return of the icterus.

Hot baths should not be neglected in the treatment of any of these diseases. Where the symptoms are urgent, the bath water should be as hot as the patient can bear, and the duration of the bath should be in keeping with the patient's resistance. Where patients weaken quickly, the bath should be of short duration; but where they can stand it for fifteen to twenty, and even thirty, minutes, there should be no hesitation in extending it until complete relaxation is secured. Then a bath of from five to ten minutes' duration should be given daily. Absolute rest in bed, and no feeding until it is justified by a decided betterment of all symptoms, should be the treatment in any of these cases.