JAUNDICE.
The treatment of this sign or symptom is discussed under Gall-Bladder, Gall-Stones, Liver Diseases, &c. All forms of jaundice are obstructive, whether caused by a gross blocking of the main duct as in catarrhal and gall-stone eases or in the more obscure cases as Weil's Disease and ideras grapi.s, where some toxin exists in the blood which renders the bile so viscid that it blocks the finer biliary passages. The appreciation of this etiological factor is a considerable aid in assisting therapeutical methods.
Catarrhal jaundice caused by swelling of the mucous lining of the common duct is relievable by the measures detailed in the article on inflammation of the bile ducts on p. 295. The jaundice produced by gall-stones, stricture or cancer of the ducts, malignant disease pressing on the ducts outside the liver, or in the head of the pancreas, can obviously only be met by surgical measures when these are practicable.
The jaundice due to the hepatic congestion caused by mitral and tricuspid disease can only be relieved by cardiac tonics aided by saline purgatives and rest.
Idents nomatorion usually passes off when attention is given to the condition of the bowel and to measures calculated to improve digestion combined with the admission of a liberal supply of pure air, being either the result of catarrh of the ducts or of some temporary blood condition which renders the bile more viscid. It is to be distinguished from the rare form of congenital jaundice due to absence of the ducts, which is beyond the reach of remedies.
In the group of cases formerly known as hzcmatogenous, and now recognised as htemohepatogenous jaundice, where no obvious gross obstruction exists, the indication for treatment is the presence of the toxtcmia, which should he met by eliminatory measures as saline purga tives, diuretics and diaphoretics. The source of the poison being probably intestinal, such disinfectants as Calomel in small doses, Salol, Naphthalin and other bowel antiseptic's may be tried. Free lavage of the colon in such cases may be safely persisted in; the recent craze for feeding with the Lactic Acid bacilli may be indulged in, hut little is to be expected from it even if the toxins are the result of microbic changes. Good acid butter milk or home-made Koumiss is,however, an excellent dietetic article in all eases of jaundice.
Search should be made for inorganic poisons as phosphorus, antimony or arseniuretted hydrogen, and ordinary obstructive jaundice may be eliminated by a careful examination of the urine, which shows no increase of the bile acids and salts these may be entirely absent, and the stools will contain bile pigment and the Proteus filtoreseers bacillus of Jaeger may be detected. In most acute forms of this type of icterus graves the
high temperature will require to be checked by sponging or cold packs, and the dangers of renal congestion or albuminuria averted by counter irritation over the loins and intracellular injection of saline solution, in addition to purgation with Mag. or Socke Sulphas. Though the treatment of every form of jaundice is thus to be directed by an assault upon its primary cause, and all methods of treating the icterus as if it were a disease and not a mere symptom or sign should lie regarded as quackery, never theless several empiric remedies may he legitimately employed when the cause is found to be irremovable.
Salicylates are regarded as possessing the power of rendering the biliary secretion more fluid or less viscid, and the soda salt may be given in full doses (Is grs.) thrice daily. Ragwort (Stnecio Jacoba'a), Carlsbad, Vichy and other alkaline waters, Chloride of Ammonium, small doses of Calomel, Euonymin, Podophyllin, Iridin, Oil of Turpentine, diluted Nit.-Hyd., and many other empiric agents are sometimes employed with success, but it is manifestly irrational to prescribe drugs which arc believed to stimulate the function of bile formation when the common duct is blocked by a calculus or by a malignant growth. Occasionally the absence of bile in the intestines in the markedly obstructive types of jaundice may be remedied by the administration of dried Ox Bile in keratin-coated pills, which will pass unaltered through the stomach. The value of Carlsbad treatment apparently lies in the powerful elimina tory effect of large quantities of fluid which remove out of the system bile pigment and bile salts by the urinary, intestinal, and cutaneous tracts.
Pilocarpine is a drug of much values it possesses the power of diminish ing the intolerable itching of the skin caused by the influence of the reabsorbed bile upon the terminal sensory nerves. It may be given once in every 36 or 48 hours in hypodermic doses not exceeding gr. in both the obstructive and hicmohepatogenous types of icterus, and by some it is even claimed to possess specific action in the latter form of jaundice. The injection should be preceded by a hot pack or hot bath to induce sweating.
Iodides in large and fully diluted dosage sometimes relieve itching, so also does Antipvrine, and a prolonged immersion in a strong Sodium Bicarbonate bath often affords a considerable degree of relief.