JAUNDICE. 137 
There is still one more way in which the trouble may be produced; namely, 
by obstruction of the gall-duct by a plug of thickened bile, worms, or gall-stones. 
This accident, however, is not of frequent occurrence. 
The yellowish stain in the eyes is unmistakable evidence of the affection. 
For a short time previous to its appearance, and while the liver trouble con- 
tinues, the victims are usually low-spirited, languid, sleepy, and averse to exer- 
tion; they appear cold and shiver, there is a disposition to scratch, the pulse 
falls below the normal, the temperature rises possibly two or three degrees, and 
the functions of the body generally seem torpid. 
These symptoms are attributable to the bile in circulation, which doubtless 
has a narcotic effect upon the nervous system; and when the same is pro- ' 
nounced, the respiration becomes less frequent, the appetite is capricious or 
disappears, thirst is excessive, and vomiting frequent; as a rule the matter 
expelled being greenish. 
Pain of colicky character is commonly present, and when so the abdomen is 
hard and back arched. Dryness and usual heat of the nose, mouth and breath 
are also associate symptoms. 
The bowels are usually constipated until towards the last of the trouble, 
although diarrhoea may occur early, and the discharges are of diagnostic signifi- 
cance. For instance, if they are clayey, it is evident that bile is entirely shut 
off from the intestines, whereas if they approach the color of health, the obstruc- 
tion to its flow is only partial. 
Finally, the urine contains bile if the usual quantity does not enter the 
intestine, and it is so high colored that it leaves a decided stain when the 
jaundice is intense. 
Nutrition may for a time be but little affected; but if the trouble persists, 
the coat loses its glossy look and becomes dry and staring, and emaciation is 
rapid. 
Generally the symptoms described come on insidiously, and slowly grow 
more pronounced; but now and then the disease runs a very rapid course, the 
signs manifest themselves suddenly and with great intensity, and death occurs 
within twenty-four hours. Such cases, however, are exceedingly rare, and as a 
‘rule, even in fatal attacks, the unfortunates live three or four days. 
Manifestly the chances of recovery depend on the cause. Obstruction to the 
gall-duct in consequence of inflammation in its lining, generally yields in the 
course of a week. If due to lodgement of a worm or gall-stone, the outlook 
is less favorable; while a plug of bile will generally be in time removed. As- 
sociated with intestinal obstruction, if the same gives way the jaundice ought to 
quickly disappear. When the liver itself is at fault and diseased, the chances 
are the smallest, although recovery is not impossible even then. 
To determine the actual cause in any case will never be easy, indeed, it will 
always be difficult, but the following facts may assist towards a diagnosis. 
