Jaundice is a diffusion of bile over the whole body, sometimes of black,
as we stated when treating of diseases of the spleen, and sometimes
of yellow. There are many varieties of this complaint, the causes and
diagnosis of which are as follows: If jaundice occurring suddenly in a
febrile complaint diminish the fever, it is critical, being occasioned by
a metastasis of the matter from the deep-seated parts, and, therefore,
stands in no need of medicines, but is soon removed by baths and
friction. But if it is attended with fever and bilious evacuations from
the bowels, and if there be a sense of weight in the right hypochondrium,
a hot inflammation of the liver is indicated, by which the blood, being
rendered bilious, is conveyed over the whole body. When there is heat
in the part without a sense of weight, the affection is occasioned by a
hot intemperament alone of the liver. If it is without fever, and the
alvine discharges are white, an affection of the gall-bladder, or of its
ducts, is indicated. When there is a sense of heaviness in the right
hypochondrium, it indicates that the ducts are obstructed; but when
without heaviness, weakness of some of its powers is indicated, either
of the attractive, by which it attracts the bile from the liver, or of
the expulsive, by which it propels the bile to the intestines. For when
the blood is not purged of bile, it is diffused over the whole body (as
we stated respecting the black jaundice); in which case the urine is
voided very much mixed with bile. But jaundice is also occasioned by a
hot intemperament of the solid parts, which convert into bile whatever
is brought to them in place of food, in like manner as in anasarcous
complaints a conversion to a pituitous fluid takes place. This variety
of jaundice is recognized by its not occurring at once but by degrees,
none of the afore-mentioned symptoms being present. Moreover jaundice
is occasioned also by drinking certain deleterious medicines, and by
the external application of poison from some venomous animal. The cure
of a hot intemperament of the liver, and of inflammation of it, and
of weakness of its powers, we have treated of under the head of the
affections of it; and what we said there is to be applied here without
alteration, that we may not be obliged to repeat the same thing. When
both the ducts of the gall-bladder are obstructed, or either of them
only, we must let blood from the right arm. But some, both in this case
and in jaundice from inflammation of the liver, open the vessel near
the middle finger of the right hand. And we must use anti-inflammatory
cataplasms, and purge with hiera. But persons affected with jaundice must
take the propomata from a decoction of parsley, maiden-hair, or dock,
or of wild thyme, reduced to a third part; or sprinkle wormwood on the
potion. Two cyathi of the juice of radish, drunk with a cyathus of wine,
is also of great use; also two or three cyathi of succory alone, and with
wine. In cases of jaundice from inflammation of the liver, give a draught
of mulse, or of a decoction of slender birthwort, or of St. John’s wort,
or of maiden-hair, or of fuller’s herb, or of madder, in like manner;
or a drachm of the shavings of hartshorn with wine, or the decoction of
carrot boiled in wine to one third; or they may take a drachm of native
sulphur in eggs. These things are of great use also in obstruction.
But viij scruples of the seed of orache, with Chrysattic, or any other
must, if drunk when in the bath, effect a proper evacuation. But the
picra may be properly given in powder, or with oxymel, and the one
called Theodoret; likewise the trochisk from bitter almonds. Give also
of cinnamon what can be lifted with three fingers in a cyathus of mulse,
or in mixed water; or of myrrh, the bulk of a bean, with twenty seeds of
pepper, and the same quantity of cinnamon. Those affected with jaundice,
owing to a warm intemperament of the solid parts, are to be treated with
gentle friction, moderate exercise, unction and baths, with a moistening
and moderately cooling diet, the juice of ptisan, intybus, endive,
succory, fish, and light watery wine. The treatment of those who are
affected with jaundice from drinking some deleterious substance, or from
the bite of some venomous animal, will be laid down in the Fifth Book.
When bile is lodged in the vessels of the face and eyes, inject elaterium
to the size of a vetch, with a woman’s milk, into the nose while in the
bath, and then direct the person to descend immediately into it, but not
to immerse his head; and after the bath, having given him a recruiting
diet, again inject the errhine in the sun. The juices of sow-bread, of
horehound, and of gith act in like manner. But let him draw into his
nostrils, while seated in the bath, some acrid vinegar, and compress his
nostrils for a short time, and it will produce a wonderful discharge.
* * * * *
COMMENTARY. See Hippocrates (de Locis in Homine, 40); Galen (de Med.
sec. loc. ix); Aretæus (Morb. Chron. i, 15); Celsus (iii, 24); Cælius
Aurelianus (Tard. Pass. iii, 5); Aëtius (x, 18); Oribasius (Cur. Loc.
Affect. iv, 99); Actuarius (Meth. Med. i, 11); Nonnus (188); Pliny (H. N.
xi, 37; xxvi, 76; xxviii, 64); Ruffus Ephesius (ii); Palladius (de Feb.
6); Alexander Aphrodisiensis (Probl. i, 90); Octavius Horatianus (ii,
14); Scribonius Largus (31); Marcellus (de Med. 22); Serapion (iv, 9);
Avicenna (iii, 15, 1); Avenzoar (i, 14, 6); Haly Abbas (Theor. ix, 33;
and Pract. vii, 41); Alsaharavius (Pract. xviii, 11); Rhases (Divis. i,
64; Contin. xvi.)
With regard to the etymology of the term icterus: in the first place,
Aretæus derives it from the animal ictis, which the Scholiast on Nicander
pronounces to be a wild ferret. On the identity of the _mustela_ and
_ictis_, see further Pliny (H. N. xxix, 16.) Schneider determines it to
be the _mustela furo_. (Ad Aristot. H. A. vi, 30.) Isodorus would seem
to agree with Aretæus, in his derivation of the term _Orig_. Suidas,
however, derives the word from ἰκτῖνος, a species of kite, and Pliny from
some unknown bird of the imaginary name of _icterus_ (H. N. xxx, 11.) We
have no hesitation in saying that we are disposed to follow the authority
of Aretæus.
Hippocrates directs us to give at first fatty things, and to use the
bath for three days; then to abstain from these things, and purge both
the belly and the head, and give diuretics. But he forbids cholagogues,
which, he says, only increase the disorder of the system. We have stated
in the Second Book, Sect. IV, his views regarding jaundice occurring in
fever. His commentator Theophilus explains that jaundice arises from
obstruction of the ductus choledochus. Hippocrates lays it down as a rule
that in cases of jaundice it is a bad symptom when the liver is hard.
(Aphor. vi, 42.)
Our author follows closely the views of Galen. He remarks that, when in
fever the bile is suddenly determined to the skin, it proves critical,
and is easily removed by baths of sweet water, and friction with a
discutient or rarefying oil. When the disease proceeds from obstruction
of the vessels of the liver, he directs the administration of hot
and detergent things, such as gentian, birthwort, and centaury. When
occasioned by inflammation of the liver, the remedies suitable to that
disease will be proper. When inflammation and obstruction are combined
together, they are to be removed by relaxants and detergents. He gives
from Andromachus and Archigenes a long list of compositions for jaundice;
but we must be content with explaining his general principles without
entering upon the detail of his practice. Galen, in another place,
remarks that the poisons of certain reptiles occasion jaundice. (De Loc.
Affect. vi, 8.) This fact is confirmed by modern observation. See Van
Swieten (Comment. 916); Dr. Simson (paper on Jaundice, vol. i of the
Medical Essays and Observations); and Rogerius (i, 47.) By the way, the
ancients maintained that the primary action of certain poisons is exerted
upon the liver. (See Book Fifth, XLII.)
Aretæus insists that jaundice is produced not only by disease of the
liver, as generally supposed, but likewise by affections of the spleen,
stomach, kidneys, and colon. He further states that jaundice is sometimes
engendered by the condition of the general system. He appears to allude
to non-elimination of the bile. When the biliary ducts are obstructed,
the bile regurgitates from the gall-bladder, and mixes with the blood
in the liver, whence it is carried all over the body. In this case the
alvine discharges are white, owing to their not being mixed with bile.
When the spleen is the seat of the disease, the skin is of a dark yellow
colour. He maintains that jaundice likewise arises from affections of the
stomach and also of the colon, as digestion is partly performed in the
latter viscus. But we must not follow out his description any further, as
it is too long for our limits.
Celsus having described the disease, directs us to cure it by abstinence
for one day, and then by opening the bowels; if fever is present, the
suitable remedies are to be applied, but otherwise scammony or bitters,
such as wormwood, are to be given. Some, he says, cured the disease by
attenuant food and diuretics, but Asclepiades rejected the latter, and
gave salt water as a purgative. Celsus approves of a salt Greek wine,
baths, and so forth. During the whole course of the complaint he directs
the patient to use friction, and take exercise; and if it is winter to
have recourse to the bath, but in summer to swim in the sea. He approves
of all kinds of exhilarating sports and amusements, whence the disease,
he says, has got the name of _regius morbus_. Isidorus, in like manner,
says of it: “Regium autem morbum inde estimant dictum quod vino bono et
regalibus cibis citius curatur.”
Pliny directs us to cure jaundice by producing perspiration with the root
of the cyclaminus or sow-bread.
Cælius Aurelianus says that jaundice is brought on by indigestion, or
by cathartic medicines which have been taken and have not operated.
Sometimes, he says, it is attended with enlargement or scirrhus of the
liver, and sometimes, though rarely, the spleen and stomach are affected
sympathetically. If the attack is violent, he does not disapprove
of venesection; after which the sick are to be restored by soothing
treatment, exercise, and food of easy digestion. The accessory symptoms,
such as hardness of the liver, spleen, and stomach, are to be attended
to; and the bile is to be carried off from the system by administering
acrid clysters, and giving infusions of wormwood or wild succory. He
also approves of sternutatories such as elaterium; of masticatories
given while in the warm bath, and of determining to the skin by
sudorifics and medicines which produce pruritus. He also recommends
change of air, gestation, swimming in water, frequent vomiting excited
by simple means, and acrid food such as capers, squills, &c. He approves
likewise of giving a thin wine, and the decoction of hellebore when the
disease is protracted; but disapproves of the indiscriminate use of
cholagogues, cathartics, and diuretics, such as scammony, and colocynth,
with wormwood, birthwort, St. John’s-wort, anise, &c. He thinks mental
relaxation and serenity of great consequence to the cure.
Aëtius gives an accurate account of the disease, but his views are very
similar to those of Aretæus. He maintains that there are other causes
of jaundice besides obstruction of the duct of the gall-bladder. When
the affection is not critical, he recommends bleeding and purging. He
says that strong purging with colocynth, scammony, and other drastics
is required to produce revulsion from the skin. He also approves of
deobstruents and diuretics, which are to be given while the patient is
in the hot bath. He speaks of sternutatories and sialogogues, like our
author. He likewise strongly recommends emetics (iii, 119.)
The treatment recommended by Oribasius, Actuarius, Nonnus, and Octavius,
is very little different from our authors. According to Actuarius,
the colour of the urine which is characteristic of jaundice is the
_cærulean_, that is to say, the colour of a ripe cherry, or of a
dark-coloured wine. (De Urinis, vi, 7.) Theophilus in like manner states
that the _cærulean-coloured_ urine indicates jaundice. (De Urin. 6.)
Ruffus the Ephesian describes very correctly the situation and use of
the gall-bladder, and remarks, that when its duct is obstructed jaundice
is produced, in which case the stools are white and clayey. Aëtius’
recommendation of emetics is upon his authority.
Alexander Aphrodisiensis states that the constipation of the bowels in
jaundice is occasioned by the want of the natural bile, which serves as a
stimulant to the intestines. For the same reason, he adds, the stools are
of a whitish colour.
According to Leo, jaundice arises either from obstruction or from the
conversion of the blood into bile by the heat of the system. He also adds
that jaundice is sometimes critical.
The poet Lucretius (iv, 333) and the philosopher Aristippus take it for
granted that persons in jaundice see every object tinged with yellow.
(Sextus Empiricus, adv. Math. vii, 195.)
According to Serapion, a redundance of yellow bile in the body is
occasioned either by the system’s not being properly purged of it,
or by an over-secretion of it, or by a combination of these causes.
Obstruction, he says, may take place either in the liver itself or in
the gall-bladder. Sometimes, he remarks, the liver having been inflamed,
becomes as hard as a stone, or its ducts are obstructed so that the blood
becomes mixed with bile, and in this state is carried over the whole
body. He adds, that perhaps the whole gall-bladder is affected, or only
one of its ducts, namely, either the superior one, by which it receives
bile from the liver, or the inferior, by which the bile passes down to
the intestines. In like manner he afterwards states, that sometimes the
superior duct losing its tone and becoming obstructed, the bile becomes
mixed with the blood; or, the inferior being obstructed, the bile
regurgitates to the superior, and becomes intermixed with the blood. And
sometimes, he says, the affection arises from the gall-bladder being
over-distended in like manner as the urinary bladder sometimes is. When
the disease is from obstruction he recommends attenuants, purgatives,
emetics, and the other remedies directed by the Greeks. A similar account
is given by Avicenna. Like Aëtius, he approves of venesection in certain
cases, in opposition to Galen, who, as a general rule, forbids to let
blood in jaundice. (De Purg. Virt.) Avicenna also describes the species
of jaundice connected with disorder of the general system, described
by Aretæus. Avenzoar says that the ducts are obstructed _aut verruca
aut pustula_. The exact signification of these terms cannot easily be
determined, but it seems probable that they refer to gall-stones. But the
following passage of Haly Abbas puts it beyond a doubt that the ancients
were acquainted with hepatic calculi or gall-stones: “Some,” he says,
“relate that calculi are formed in the liver, cæcum, and colon.” (Theor.
ix, 34.) Haly directs us, when jaundice is connected with inflammation,
to bleed, and purge with myrobalans, hepatic aloes, &c. He also makes
mention of emetics among his general remedies. When connected with
obstruction, particularly of the gall-bladder, he recommends bleeding
at the arm, a decoction of wormwood, hiera, scammony, and various
remedies of a like nature. To remove the yellow colour of the eye he
recommends the tepid bath, and the application to the eyes of the fumes
of vinegar. For the cure of jaundice of the spleen, he prescribes the
common remedies, and mentions one which he says he learnt from _a woman_,
and found very effectual. It was a draught containing lentils, fennel,
and the urine of a boy not come to puberty. Jaundice being a disease
which often goes off without any remedies, has been, in all ages, a
favourite with empirics. Alsaharavius treats of the disease in much the
same terms; recommends bleeding when it is connected with an inflammatory
cause, and attenuants, bitters, purgatives, and the hot bath according
to circumstances. Rhases, who gives a very full account of jaundice,
states that the disease generally arises from obstruction either in
the liver or its ducts. He particularly recommends drastic purgatives,
such as scammony, along with wormwood, fennel-seed, and the like. When
inflammatory symptoms are present he approves of bleeding and the warm
bath.