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.