(From the golden thrush, from the complexion of the patient resembling in colour the plumage of that bird. Pliny ridiculously observes, that if the jaundiced person looks on this thrush, the bird dies, and the patient recovers;) the jaundice, morbus arquatus, aurigo, morbus regius, cachexia ecterica, or icteritia; by Paracelsus, leseoli morbus. It is owing to an obstruction of the discharge of the bile, into the bow els, and its return into the blood by the absorbents. Dr. Cullen places this disease in the class cachexia and order impctigines; defining it a yellowness of the skin and eyes; white faeces; the urine of a deep red, tinging a white rag of a yellow colour when dipped into it. The species are:
1. Ioterus calculosus, when there is acute pain in the hypogastric region, which increases after eating, and when bilious concretions pass through the intestines.
2. Icterus spasmodicus, without pain, and the yellowness of the skin happening after spasmodic diseases or affections of the mind.
3. Icterus hepaticus, without pain, following a disease of the liver.
4. Icterus gravidarum, arises during pregnancy, and disappears after delivery.
5. Icterus infantum, happens soon after their birth. A yellowness of the skin sometimes arises from a deficiency of the red particles of the blood, or the effusion of the serum. The appearance deceives common observers, but may soon be distinguished by an experi-rienced eye. The yellow tinge of the urine will at once decide any doubt. Infants have a yellowness often independent of bile from the red effusion under the skin, assuming a yellow colour, after being partly absorbed. The true jaundice of infants probably arises from the hardened meconium obstructing the duct.
The genuine jaundice arises from an obstruction of the duct, by gall stones, or viscid bile. Sydenham speaks of a symptomatic jaundice produced by hysteric symptoms; but this complaint is probably the icterus spasmodicus. The yellowness from the bite of a viper is not a species of jaundice. Women arc generally more subject to this disease than men, either from a slower action of the intestines or from a more sedentary life.
The cause of the true jaundice is the bile mixing with the blood in consequence of its obstruction from gall stones, spasms, scirrhus, and sometimes even from flatulence or a gravid uterus. A scirrhous liver is the cause of the most fatal kind; and a jaundice is often a mark of a constitution wholly decayed: in such cases the liver is often scirrhous In a late publication Dr. Gottlieb Richter thinks it probable, that"the most common cause of jaundice is a stimulus or irritation acting upon the hepatic system, which prevents the afflux, secretion, and excretion of the bilious fluids; or, rather so deranges the circulation in the hepatic system, that the several parts do not reach their destined places, according to the laws of health, but are again mixed with the general mass." In proof of which he recites a case of a high degree of jaundice, where no gall bladder was found; but, in its place, only a skinny substance of a very small size, without any cavity. The whole liver was full of white concretions, apparently of the nature of calcareous earth, of different sizes, from that of a pea to that of a cherry, and which floated in water." In this case, however, though the bile formed was not collected, it was evidently obstructed, and of course absorbed. He confirms his opinion by the authority of Chaux, who, in the seventy-fourth volume of the Journal de Mederine, endeavours to show that the jaundice can be cured by sedatives alone; by that of Selle, who, in his Medicina Clinica, p. 292, imputes the jaundice to a stimulus; and of Vogel, who, in his Treatise on Jaundice, published at Wetzlar in 1791, has, he thinks, proved in a very convincing manner that the jaundice is occasioned by a state of irritation in the liver. See Richter's Medical and Surgical Observations.
These opinions were formerly common, but have long since been rejected; and jaundice is now very generally attributed to obstruction of the bile from the causes which distinguish the species. However, when the jaundice affects the habit, the skin and whites of the eyes are usually yellow, the excrements most frequently white, and the urine deposits a copious dark sediment. Besides these, an inactivity, anxiety, sickness, indigestion, uneasiness, or acute pain, at the pit of the stomach, itching in the skin, and other symptoms, occasionally attend. In general every function is disordered, for the bile mixes in part with every secreted fluid, except, perhaps, the milk; but the principal inconveniences arise from its obstruction, which prevents its action on the stomach and intestines.
When a scirrhus of the liver, or the gall duct, is the cause, a cure can scarcely be expected; and a haemorrhage, which shows that the blood is both acrid and thin, is highly dangerous. In adults this disorder often may continue many months without any considerable danger; but, in general, its duration for a long time shows that the obstructing cause is firmly impacted; and the injury which the bile, when again deposited, docs to the digestive organs often occasions an incurable dys-pepsia, or a chronic debility, with a general dissolution of the fluids. After a fit of jaundice has disappeared, another slight one will often follow, which yields with little difficulty, and the disease is not peculiarly liable again to recur.
During the whole of this disorder the patient should use frequent exercise, but without much fatigue; a warm bath and cheerful company greatly assist the cure: the diet should be attenuating and aperient.
Medicines in this complaint are of doubtful efficacy, and the disease often yields rather to the lelaxation of the duct, when the continuance of the stimulus renders it habitual. Stimulating the mouths of the ducts by the most soluble laxative, as soap and the neutrals; compressingthe duct by the joint action of the stomach, diaphragm, and abdominal muscles, as in the operation of vomiting; and alternating, with the emetics and cathartics, opiates, often in the most active doses, is the best plan. The operation of vomits has been supposed likely to induce inflammation; this consequence, however, we have never yet found; but should it occur, a large bleeding, with a blister externally, and cooling laxatives, are the best remedies. The castor oil has been preferred in those cases as a laxative, but it seems to possess no peculiar advantage. Mercurials have been lately given in jaundice and in hepatitis, it is said, with success. Calomel is undoubtedly often an useful purgative. The best exercise is riding on horseback.
If a viscid bile occasion this disorder, which is known by the absence of an acute pain at the pit of the stomach, shooting out from thence to the back, after bleeding, and an emetic, aloetic and mercurial purges are preferable; after these, the kali acetatum is the best remedy, for it hath all the advantages of soap without its disagreeable taste, and is at the same time an useful febrifuge. It may be given to a drachm, or a drachm and a half three times a day.
A redundancy of bile never produces jaundice, for the stools are highly coloured with the bile. In this case, the proper remedies are active purges, particularly the rhubarb and calomel, in doses adapted to the constitution of the patient. Acids and demulcents also contribute to the relief.
When the haemorrhage is a troublesome symptom, acids and demulcents, the ol. ricini, made into an emulsion, or a decoction of hemp-seed in milk, are the best remedies; and if fever require it, which is scarcely in any instance the case, a little blood may be taken from the arm.
In case of a scirrhus, the extractum cicutae may be given as an anodyne or palliative, but will do little real service.
As an attenuant, the rubia tinctorum is said to be useful, perhaps because it is yellow; and the waters of Bath and Harrow gate are highly esteemed. Bitters, and even the bile of animals, have been given to supply the place of bile; forgetting that much inconvenience arises from the bile secreted in the stomach when accumulated in the blood. After the disease is removed they may be useful to restore the strength of the stomach. See Calculus biliaris.
From the idea of jaundice arising from irritation, or spasmodic affections in the hepatic system, small does of ipecacuanha, tartarized antimony and valerian, asafoetida, cataplasms of cicuta and hyoscyamus, with linseed tea for common drink, blisters, locally applied, in case of pain, with opiates, have been severally administered, it is said, with success. See F. Hoffman; Saunders on Bilious Diseases; White on Diseases of the Bile; Huxham de Aere et Morbis Epidemicis. p. 143, etc.; Sydenham; Heberden's Observations in the London Medical Transactions, vol. ii. p. 123; Medical Museum, vol. i.; Cullen's First Lines, vol. iv.; Coe on Biliary Concretions; Maclurg on the Bile.
Icterus albus. See Chlorosis.