From a uniform success of 6 eases the subcutaneous injection of hydrochlorate of pilocarpine is recommended for the re lief of itching in patients with jaundice. Goodhart (Brit. Med. Jour., Jan. 19, '89).
The good effects of olive-oil in the treatment of jaundice due to simple ob struction emphasized. T. Oliver (Lancet, Oct. 7, '93).
Massage recommended in the treatment of catarrhal jaundice. The method con sists in rhythmical compression of the hepatic region for ten minutes. thrice daily. Wechsler (Wratseh, No. 19, '93).
For itching in jaundice the following is recommended to be rubbed in several times a, day:— It Ichthyol, l'/, to 2 V, drachms. Alcohol, Ether, of each, 2 fluidonnees.
BouHard (Ges. Therapie, p. 380, '9S).
Slight attacks of jaundice are of com paratively little surgical importance, and the majority of surgical diseases of the biliary pa.ssages have no jaundice at all. Persistent jaundice, especially if pro gressive, is usually ft contra-indication to surgical measnres; on the other hand, intermittent, deep jaundice, especially if associated with chills and a rise in tem peratnre, denotes the presence in the common ditet of a stone that urgently demands removal. Archibald Alaclaren (Med. News, Nov. 17, 1900).
For the pruritus of jaundice sponging the body with sodium bicarbonate, 3 drachms in 1 pint of hot water, or McCall Anderson's dusting-powder of:— 13. Camphor, 11/2 drachms; Zinc sulph.,V,„ ounce; Starch, 1 ounce; are useful. Gilman Thompson (Practical -.Medicine; Med. News, Dec. 1, 1900).
The following causes of chronic jaun dice must be taken into consideration: (1) common - duct eholelithiasis; (2) chronic panereatitis; (3) simple strie. titre of the common bile-duct; (4) inflanunatory adhesions causing pressure on or stenosis of the hepatic or of the common bile-duet; (5) hydatid disease of the liver pressing on, or discharging into, the bile-ducts; (6) gummata im plicating the ducts; (7) chronic catarrh of the bile-ducts; (S) cancer of the com mon bile-duct; (9) cancer of the head of the pancreas; (10) cancer of the liver associated with jaundice due either to catarrh or to pressure; (11) cirrhosis of the liver; (12) other rare causes, such as aneurism of the hepatic artery or of the aorta, and other tumors of the liver, gall-bladder, pylorus, or kidney, pressing on or occluding the contmon bile-duet.
Surgery holds out a good prospect of cure in the first five causes enumerated: medical treatnient alone is advisable for causes 6 and 7, and in the remainder with certain exceptions relief can be hoped for only from medical or surgical treatment. .As in many other condi tions, pain is the most valuable guide in establishing a differential diagnosis be tween those possible causes. A painless onset of chronic jaundice points to chronic catarrh due either to cancer of the liver or of the head of the pancreas, or both. On the other hand, pain in the upper abdomen, followed within twenty four or thirty-six hours by jaundice, strongly suggests cholelithiasis. Here the jaundice is less intense and is pretty certain to be accompanied sooner or later by intermittent fever, chills, and sweats, with very marked icteric fluc tuations. Ascites is very sugg,testive of malignant disease: it points to it per haps more strongly than any other sin gle symptom. Other diagnostic anti operative aids are as follows: Jaundice in cancer of the bile-ducts and head of the pancreas tends to become absolute; in almost every other condition it is va riable. Fat in the faees and glyco suria, with very rapid wasting, are very suggestive of pancreatic trouble. If the anti-operative signs be difficult of true interpretation, those found after the abdomen is opened call for as much or more acumen. Adhesions in the neigh borhood of 2t contracted gall-bladder suggest stones, but this may be induced by a simple pyloric tileer. If the head of the pancreas be swollen and harder than normal, one shottld not too lmsti13 pi-01101111(Jc it cancer; it may very prob ably be a simple chronic panereatitis, curable by cholecystotomy. Again the discovery of enlarged glands does not warrant a gloomy prognosis, for discrete nodules are frequent in common-duct cholelithiasis and in chronic pancrea lids. If they are fused, however, the outlook is bad. The tumor composed of matted omentum and the viscera adja cent to an inflamed gall-bladder always presents a conundrum which aspiration even may not solve: it should not be pronounced malignant. until the liver has been carefully inspected for nodules.