JAUNDICE (ICTERIJS).
Defluition.—This is not a disease, but only a symptom-group, occurring under a variety of conditions and characterized by a yellowish discoloration of the skin, tissues, and fluids of the body with bile pigment, and the excretion of the pig ment in the urine.
It has been customary to classify all cases of jaundice into the two great I groups of obstructive and non-obstruct c jaundice, but, the more thoroughly the pathology of the condition investi gated, the g„reater is the number of non ebstrueti, c eases dint are found in reality to be obstructive. and in time it is prob able that in all conditions jaundice will proNe to be obstructive in origin.
William limiter, "Allbutt's System of •Aledicine,- desig,»ates the two groups jaundice as obstructive and toxannic; these seem to be the most suitable terms .
present available. The obstructive group includes all cases dependent on palpable obstruction: and the toxvemic those occurring in connection with some general infection.
Jaundice resulting from mental emo- • tion, usually of a depressing nature, can not be placed in either group: its nature is quite uncertain.
Case of jaundice due to emotion. It capillaries. The bile reaches the general circulation through the blood-capillaries of the hepatic veins and only to a slight extent through the lymphatics of the larger bile-channels. Browiez (Wiener kliti. Woch., Aug. 30, 1900).
Blood-serum is found stained in iete rus. even in the mildest grades and tlion.gh the urine at the time show abso lutely nothing. The early diagnosis of icterus often cannot be made by an ex amination of the urine. A simple and accurate method for making the diag nosis is to puncttire the ear or finger and to fill several capillary tubes, one and a half inillimetres in diameter and ten millimetres long, with blood; then to close the tubes at each end with seal ing wax, place them vertically, and ol.serve them after a few hours, when the serum and blood will have become separated. A yellow tinge to the serum is an early and important indication of jaundice. Hamel (Deutsche med.
Wochen., Sept. 25. 1902).
parently not neurotic, and manifested itself five or six hours after the nervous shock. Talamon )16d. Mod., Aug. 23. '93).
Ca:se of jaundice developed after an in strumental delivery in a highly-sensitive young woman. E. A. Lubbock (Brit. Med. Jour.. Apr. 21, '94).
Three eases noted in which jaundice supervened in children of nervous di athesis after emotional excitement. Coulon (Brit. Med. Jour., May 19, '94).
Jaundice from suppression of liver function cannot now be accepted as pos sible, as bile-pigment can only occur as the result of hepatic cell-activity. Fur ther, the removal of the liver or the com plete severance of its connections by liga ture doe.s not cause jaundice.
Jaundice is due to increased function of normal liver-cells, by different stimuli. A normal liver-cell which can take up and elaborate an excess of nutriment, and thus produce an increased quantity of bile, can eliminate this excess into the intercellular bile-passages. A part of the bile passes into the blood: in part, di rectly through the walls of the blood Obstructive Jaundice (Hepatoge . nous Jaundice; Extrahepatic Jaundice).
General Symptoms.—The color of the skin varies according to the intensity and duration of the jaundice. In cases of catarrhal jaundice with sudden obstruc tion the snrface becomes rapidly stained a deep yellow. -When jaundice has ex isted for a considerable time it changes to a greenish hue, which gradually passes into a dark-olive color, doubtless on ac count of the action of the air on the bile pigment in the skin. This very dark color known as "black jaundice," though not pathognomonic of cancer in the liver, is rarely produced by any other disease. The icteric hue shows most distinctly on the pallid parts and to a much less degree on highly-colored parts, as the lips, florid cheeks. mucous membrane of the mouth, etc. We. therefore. look to the conjunc tiv for the first signs of icteric discolor ation.