Jaundice
Although the appearance of jaundice immediately suggests a disease of the liver yet as a matter of fact those diseases of the tropics in which the liver involvement is the sole or chief feature rarely show marked jaundice.
In tropical hepatitis or congestion of the liver or, as it is often termed, tropical liver, there is rarely a distinct jaundice and if such occur it is only temporary. Such terms as earthy, muddy, sallow, sub-icteric or pale lemon tint are more often applied than jaundice.
Liver abscess rarely gives rise to a definite jaundice unless the abscess be so situated as to cause pressure on the bile ducts.
In clonorchiosis, or the liver fluke disease of man, jaundice is not a feature of the disease except in the very late stages.
In those liver cirrhoses associated with Katayama disease, malaria or kala-azar there is no typical jaundice.
The tropical diseases in which jaundice is an important diagnostic feature are yellow fever, blackwater fever, bilious remittent fever and relapsing fever.
Yellow Fever.—There are cases which succumb without having shown jaundice but immediately following death the yellowish discoloration has been noted. At autopsy the yellow fever cadaver is almost invariably deeply jaundiced.
Very important is the fact that the jaundice of yellow fever does not appear until late, about the third or fourth day. When jaundice appears earlier, as by the second day, the prognosis is almost surely a fatal one.
According to Dutroulau the designation red fever would be more appropriate for the deeply congested facies of a yellow fever case in its first days.