The symptoms are due to the fact that the bile, not being able to pass into the bowel, is absorbed into the blood and distributed through out the body, staining the tissues through which it passes. The chief is yellowness of the skin, varying from a mere sallowness to a golden yellow or bronze tint. Sometimes in extreme cases the sweat stains the clothes. The urine is coloured also a saffron-yellow or a dark greenish colour, or any degree of yellowness between these, owing to the presence of bile. The whites of the eyes are deeply coloured, and in them the first signs of the approaching jaundice may be detected. Along with these are symptoms due to the want of bile in the bowels, costiveness, the motions being pale and like clay in colour, and having a very bad smell, sickness and vomiting, hiccough, flatu lence, inability to digest fat, and perhaps the passage of fatty matter in the stools. Result ing from the presence in the blood of improper materials are itching of the skin and perhaps eruptions, feebleness of the heart, exhaustion, drowsiness, giddiness, and lowness of spirits, &c. It is not common for a jaundiced person to see things as if they were yellow, though this is a popular notion. Jaundice occurring in newly born children is considered under DISEASES OF CHILDREN.
Treatment.—Jaundice arising from conges tion of the liver, inflammation of the bile:ducts, &c., must be treated accordingly. Often it will be relieved by 5 grains of calomel, followed by a full dose of castor-oil or Henna. Many of the worst cases arising from obstruction are incur able, and the patient must simply take light food without fat or stimulants, must have moderate exercise, and may occasionally take a warm bath to help the skin. But, jaundice being a sign of disease rather than a disease in itself, it is necessary to discover its precise cause in order to treat it properly. An accurate determination is often extremely difficult.
Malignant Jaundice (Acute Yellow Atrophy of the Liver).—This is a rare affection, in which the cells of the liver (p. 200) are rapidly de stroyed. The disease is usually sudden in its onset, accompanied by jaundice, vomiting, and intense headache, and delirium. A feature of the disease is the absence of bile from the motions. The bile ceases to be formed by the liver. This condition is called acholia (Greek a, want of, and thole, bile). There is a great tendency to bleeding, blood being poured out in little patches under the skin, and being also vomited. Death is seldom delayed beyond a
week.
(Biliary Colic) are little masses formed of the colouring matter of the bile. They are usually produced in the gall-bladder, probably from stagnation of the bile and con sequent deposit of the colouring matter. They are of a dark-brown colour usually, and may be very small, like grains, when they are spoken of as "gravel ;" or may attain a variety of size, that of a pea or bean, or even larger. There may be only one stone or several; if several, the stones are not round, but flattened on the sides by contact with one another. A gall-stone may become dislodged from the gall-bladder, and proceed to force its way down the cystic duct (p. 201) towards the bowel, giving rise to biliary colic. Gall-stones are more frequent in women than men, and they occur usually after the age of thirty.
Symptoms.—Severe pain comes on suddenly, and may be so intense as to cause the patient to cry out in agony. It is described as cutting or tearing, and is felt in the neighbourhood of the pit of the stomach or navel, and extends lower down and through to the back. It lasts a varying time and then ceases, only probably to return some time later. It thus occurs in spasms. It causes sickness and vomiting, faintness, and often actual fainting. If the gall-stone block the bile-duct, costiveness is likely to arise and the stools to be clay-coloured; and jaundice appears after a day or two. The gall-stone may be arrested in its passage along the bile-duct, and may remain in this position, completely blocking the duct, in which case the symptoms of obstructed bile-duct are developed. The only conclusive evidence that the spasms have been caused by a gall-stone is the finding of a stone in the motions. To effect this the motions must be carefully examined in the manner de scribed on p. 240. If the stone have escaped from the bile-ducts into the bowel, it is often two or three days after the last spasm before it is passed in the motions, so that the fasces should be examined for a number of days after the attack has passed. A person who has had one attack of biliary colic is always liable to another.
Treatment is devoted to relieving the pain and aiding the passage of the stone, by placing large hot poultices or hot bottles over the belly, and by the use of opium; 1 grain of the latter may be given at a time, repeated as often as may be necessary, the patient being carefully watched to see that too much is not being given.