JAUNDICE. 377 



Itching of the skin, without the occurrence of any eruption, is sometimes a very 

 obstinate and annoying symptom in jaundice. It may be so intolerable as to drive 

 the sufferer almost crazy. 



It is an old notion that to the jaundiced eye all things appear yellow. By many 

 this is regarded as a mere poetical fiction, but certainly it is sometimes, though very 

 rarely, a fact. Curiously enough, in one case everything appeared yellow when 

 looked at with one eye, but not with the other. 



Jaundice usually induces a condition of general debility and exhaustion, asso- 

 ciated with mental depression and irritability of temper. The temperature of the 

 body, provided there be no concurrent cause of fever, is usually slightly below the 

 normal standard. The pulse is often reduced to 50, 40, or even 20 beats in the 

 minute. This slowness of the pulse is particularly noticeable when the patient is 

 lying down ; when he stands up the circulation is quickened. 



Jaundice', as we have seen, may depend on a great number of different causes. 

 One of the commonest is obstruction of the bile-duct the duct leading from the 

 liver to the intestine by a gall-stone. Sometimes the bile itself gets so thick that 

 it blocks up this duct. The bile may even become quite hard, and may ultimately 

 be passed in the shape of a black, gritty powder very like powdered cinders or coal- 

 dust. Sometimes, curiously enough, a round-worm crawls from the bowel into the 

 duct, and causes the mischief. It would seem at first sight that such cases must be 

 very exceptional, but they are not so in reality. Worms appear to have a passion 

 for wriggling into any little hole they may find about, and the mouth of the duct 

 affords them a good opportunity of displaying this proclivity. Sometimes the lining 

 membrane of the duct gets inflamed and swollen, and, by obstructing it, gives rise to 

 jaundice. In certain cases the complaint may arise from organic disease, such as 

 cancer of the liver or one of the adjacent organs. Fits of anger, of fear, or of alarm 

 have been followed by jaundice, and it has also been produced by great bodily suf- 

 fering, by a severe surgical operation, or perhaps by the dread which attended it. 

 An instance is recorded in which an unmarried woman, on its being accidentally 

 disclosed that she had had a child, became in a very short time quite yellow. "We 

 remember the case of a medical student who had an attack of intense jaundice which 

 could be traced to nothing else than the excitement and worry of an examination at 

 which he was a candidate. It is said that cases coming on thus suddenly are more 

 serious than when the jaundice arises from a more ordinary cause, and that they 

 sometimes prove fatal. 



It has been noticed that jaundice occurs most frequently in hot weather, and it 

 is probable that a high atmospheric temperature, long continued, exerts some influ- 

 ence in producing certain forms of this disorder. Jaundice occasionally comes on 

 during pregnancy, and disappears after childbirth. The pressure of the womb may 

 thrust other organs a loaded intestine, for instance against the liver, and so im- 

 pede the passage of the bile. The little exercise that pregnant women take, and the 

 costiveness that frequently attends their condition, is probably not without its 

 influence. 



Children, a few days after birth, frequently become jaundiced. It is seldom 

 attended with any disturbance of the health, and usually passes off in a few days. 



