CHAPTER XV. ON JAUNDICE, OR ICTERUS.
If a distribution of bile, either yellow, or like the yolk of an
egg, or like saffron, or of a dark-green colour, take place from
the viscus, over the whole system, the affection is called Icterus,
a dangerous complaint in acute diseases, for not only when it
appears before the seventh day does it prove fatal, but even
after the seventh day it has proved fatal in innumerable
instances. Rarely the affection has proved a crisis to a fever
towards the end, but itself is not readily discussed.
It is formed not only from a cause connected with the liver,
as certain physicians have supposed, but also from the stomach,
the spleen, the kidneys, and the colon. From the liver in
this manner: if the liver become inflamed or contract scirrhus,
but remain unchanged with regard to its functional office, it
produces bile, indeed, in the liver, and the bladder, which is
in the liver, secretes it; but if the passages which convey the
bile to the intestine, be obstructed from inflammation or
scirrhus, the bladder gets over-distended, and the bile regurgitates;
it therefore becomes mixed with the blood, and the
blood, passing over the whole system, carries the bile to every
part of the body, which acquires the appearance of bile. But
the hardened fæces are white and clayey, as not being tinged
with bile, because the bowels are deprived of this secretion.
Hence also the belly is very much dried up; for it is neither
moistened nor stimulated by the bile. The colour in this
species is whitish-green.
If jaundice make its appearance in connection with the
spleen, it is dark-green, for its nutriment is black, because the
spleen is the strainer of the black blood, the impurities of
which it does not receive nor elaborate when diseased, but
they are carried all over the body with the blood. Hence
patients are dark-green from icterus in connection with the
spleen; but the colour is darker than usual in the customary
discharges from the bowels, for the superfluity of the nutriment
of the spleen becomes recrement from the bowels.
And icterus also is formed in connection with the colon and
stomach, provided their powers of digestion be vitiated; for
digestion takes place even in the colon, and from it a supply of
nutriment is sent upwards to the liver. Provided, then, the
liver receive its other food in a cruder state than usual, it
indeed goes through its own work, but leaves that of the other
undone; for in distribution it diffuses the blood which carries
the marks of the inactivity of the colon to all parts of the
body. The indigestion in this case is connected with the
formation of the bile in the colon.
Thus icterus may be formed in any viscus, not only of those
which send nutriment to the liver, but also of those which receive
it from the liver. For nature sends nutriment to all parts,
not only by ducts perceptible to the senses, but much more so
by vapours, which are readily carried from all parts to all,
nature conducting them even through the solid and dense
parts. Wherefore these vapours become tinged with bile, and
discolour any part of the body in which they get lodged.
Moreover, in jaundice connected with the colon, the evacuations
are not white; for the liver is not disordered as regards
the function of bile, and is not impeded in the transmission of
bile to the intestines.
The general system, likewise, is most powerful in producing
icterus; for the cause is seated in the whole body. It is of
this nature: in every part there is heat for concoction; in
every part for the creation and secretion of humours, different
in different places, but in each that which is peculiar to it: in
flesh, indeed, sweat; in the eyes, tears; in the joints and nose,
mucus; in the ears, wax. If the heat, then, fails in the performance
of each of its operations, it is itself converted into
that which is acrid and fiery; but all the fluids become bile,
for the products of heat are bitter, and stained with bile. But
if indigestion happens in the blood, the blood assumes the
appearance of bile, but is distributed as nourishment to
all parts, wherefore bile appears everywhere. For it is a
dire affection, the colour being frightful in appearance, and
the patients of a golden colour; for the same thing is not
becoming in a man which is beautiful in a stone. It is
superfluous in me to tell whence the name is derived, further
than that it is derived from certain four-footed and terrestrial
animals, called
ἰκτίδες, whose eyes are of this colour.
1
There are two species of the affection; for the colour of the
whitish-green species either turns to yellow and saffron, or to
livid and black. The cause of these is the same as the cause
of the two kinds of bile; for, of the latter, one species--namely,
the light-coloured--is yellow, thin, and transparent; but this
species is also sometimes tinged so as to resemble saffron or the
yolk of an egg. The other is of a darker character, like leeks,
woad, or wholly black. There are innumerable intermediate
varieties of colour, these being connected with the heat and
humours. The viscera, also, co-operate in this; for the viscus
is either a bright-red, like the liver, or dark-red, like the
spleen. When, therefore, the icterus is connected with any
viscus, if from the liver, it bears traces of this viscus, and if
from the spleen, of it; and so, also, with regard to all the
others. But if it possesses no appearance of any, it is an affection
of the general habit. These appear manifest in the white
of the eyes especially, and in the forehead about the temples;
and in those naturally of a white complexion, even from a
slight attack, the increased colour is visible.
In cases, therefore, of black icterus, the patients are of a
dark-green colour, are subject to rigors, become faintish, inactive,
spiritless; emit a fetid smell, have a bitter taste, breathe
with difficulty, are pinched in the bowels; alvine evacuations
like leeks, darkish, dry, passed with difficulty; urine deeply
tinged with black; without digestion, without appetite; restless,
spiritless, melancholic.
In the whiter species, the patients are of a light-green colour,
and more cheerful in mind; slow in beginning to take food,
but eat spiritedly when begun; of freer digestion than those of
the former species; alvine discharges, white, dry, clayey; urine
bright-yellow, pale, like saffron.
In both cases the whole body is itchy; heat at the nostrils,
small, indeed, but pungent; the bilious particles prickly. The
taste of bitter things is not bitter; and yet, strange to tell,
it is not sweet; but the taste of sweet things is bitter. For
in the mouth the bile lodged in the tongue, prevailing over
the articles of food, sophisticates the sensation; for the tongue,
having imbibed the bile, does not perceive them, while, during
the season of abstinence from food, the bile remains torpid,
neither is the tongue unpleasantly affected with that to which
it is habituated; but the bile, if heated up by the tastes of the
articles of food, impresses the tongue. When, therefore, the
food is bitter, the sensation is of the bitter things; but when
sweet, of the bilious. For the sensation of the bile anticipates
the other, and thus deceives those who suppose that bitter
things appear sweet; for it is not so, but because it is not exacerbated
by the bitter lodged in it from being habituated to
the disease, the phantasy of sweet is created; and there is the
same condition in sweet and bitter tastes; for the bile is the
screen of the fallacious tastes.
When, therefore, it appears without inflammation of any
viscus, it is usually not dangerous, though protracted; but if
prolonged, and the viscus gets inflamed, it terminates most
commonly in dropsy and cachexia. And many have died
emaciated, without dropsy. It is familiar to adolescents and
young men, and to them it is less dangerous; it is not altogether
unusual also with children, but in them it is not entirely
free from danger.
