OF THE
JAUNDICE.
The Jaundice, or a yellow Colour of the Eyes and Skin, occasioned by an Absorption of Bile into the Blood, was another Distemper which appeared towards the End of each Campaign.
This Disorder, for the most part, takes its Rise[89] from Calculi lodged in the biliary Ducts[90]; and sometimes from a viscid Mucus or Pituita obstructing those Passages[91]; and it may be brought on by a Tumour, or any other Cause[92], compressing these Ducts, so as to prevent the free Flow of the Bile into the Cavity of the Intestines.
The yellow Colour, or Jaundice, observed in the Ague, and some other bilious Disorders, seems to arise sometimes from Spasms of the Ducts; or from too great a Quantity of Bile secreted and absorbed into the Blood, which seems evidently to be the Case where large Quantities of Bile are either vomited or discharged by Stool; a Proof that the biliary Ducts are clear, and free from Obstructions.
In the End of the Campaign of 1760, after a continued Rain for many Weeks, the Jaundice had been very frequent, and in a Manner epidemical, among the Troops, for some Time before they left the Field; and in passing thro’ Munster, about the End of December, I observed several ill of that Distemper in Hospitals, and met with a few Cases of this Kind in the Hospitals at Paderborn in January 1761; but during the Spring and Summer, we had only one or two now and then sent to the Hospitals for this Complaint; though towards the End of the Campaign it became more frequent, and several were sent down to Bremen; and some of the Garrison were likewise affected with it. During the Winter not above four or five were sent to the Hospitals I attended, and but a few to the flying Hospital, during the Campaign 1762. It frequently appeared in dropsical Cases, depending on obstructed Viscera.
Those in whom the Jaundice was the original Disorder, and not complicated with any other, generally got well soon; but where it appeared in dropsical Cases, depending on obstructed Viscera, it was commonly fatal.
In the Beginning of this Disease, Patients usually complained of Sickness, Heat, Thirst, and other feverish Symptoms; and some had a Vomiting, and Pain of the Stomach, for a Day or two before the Jaundice appeared; the Urine was always of a deep Colour from the first; and about the second or third Day the Skin, and the Whites of the Eyes, began to be tinged with a yellow Colour, attended with the common Symptoms of this Disorder.
Such was the Manner in which the Jaundice began in those who were taken ill in Garrison; but those sent us from the Army could seldom give any accurate Account of their own Cases.
In the Course of this Disorder, the Sick were inclined to be costive, though some few had a Diarrhœa; several, who had been reduced by Fevers, or other Complaints, before the Jaundice appeared, were attacked with violent Hæmorrhages from the Nose; and two had like to have died of them before the Bleeding was stopped. The Hæmorrhages did not prove critical, but seemed to depend on a dissolved State of the Blood.
On the Patient’s being first taken ill, if he was plethoric or feverish, or complained of Pain, attended with Sickness and Vomiting, some Blood was taken away. Next Day we gave twenty-five or thirty Grains of Rhubarb in a saline Draught, and afterwards the common saline and other cooling Medicines, till the Fever was abated. If the Pain and Fever did not abate, a Vein was opened a second Time, and a few Drops of the tinctura thebaica were added to the saline Draughts, while emollient Clysters were frequently administered, and the Stomach and Belly fomented with Flannels dipped in warm emollient Decoctions.