JAUNDICE. 713 



/n the next section. This is particularly true of the Karlsbad springs, 

 which have a world-wide reputation for their efficacy in jaundice. 

 Many patients, who have gone to Karlsbad with the most intense 

 jaundice, return cured in a few weeks ; but these are only persona 

 whose icterus depended on catarrh of the bile-ducts, or on their ol> 

 struction by gall-stones. If jaundiced patients, with an incurable ob- 

 struction of the bile-ducts, go to Karlsbad, their jaundice is not im- 

 proved by the use of the waters ; but they die soonei than they other- 

 wise would, because the symptoms of congestion are increased, and 

 the destruction of the liver-cells is hastened by the augmented secre,- 

 tion. This assertion is well supported by cases. The internal use of 

 nitrate of potash, calomel, of the bitter and soluble extracts, of emetics 

 .and purgatives, does just as little good as the Karlsbad waters in 

 icterus, unless it fulfil the causal indications. 



When we succeed in removing the obstacle to the excretion of bile, 

 the indications from the disease do not require any thing further ; 

 when we cannot succeed, they cannot be fulfilled. 



The symptomatic indications require, first of all, an improvement of 

 the depressed state of the patient by a proper diet. We should order 

 meats, particularly cold meats and strong soups ; but as fat is not ab- 

 sorbed when the bile does not enter the intestines, and consequently 

 is not well borne, the use of gravies, butter, etc., should be just as 

 strictly forbidden, while the patients remain at home, as when they go 

 to Karlsbad, where, according to the diet list, the use of these articles 

 is very reprehensible. In the next place, we should particularly attend 

 to the constipation, from which most patients with jaundice suffer, and 

 which depends partly on dryness of the fasces, partly on absence of 

 irritation of the intestinal mucous membrane from the bile ; but we 

 should avoid saline laxatives, using instead slight drastics, such as in- 

 fusion of senna, lenitive electuary, and rhubarb and aloes. As quan- 

 tities of bile-pigment are evacuated with the urine, we may attempt to 

 hasten the disappearance of the icterus by prescribing diuretics, such 

 as bitartrate of potash, soluble cream of tartar, acetate and carbonate 

 of potash. These are urgently indicated when the amount of urine 

 is diminished, as the obstruction of the uriniferous tubules, to which 

 Frerichg has called attention, may cause a retention of the con- 

 stituents of the urine, and it is possible that the obstructions may be 

 washed away by an increased secretion of urine. When the biliary 

 obstruction has been removed, we may advise lukewarm baths, steam, 

 soap-and-potash baths, to cause a more rapid removal of the epidermis, 

 and thus relieve, as quickly as possible, the annoying itching and the 

 jaundiced color. 



