Clinical manual for the study of medical cases / edited by James Finlayson.

Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual for the study of medical cases / edited by James Finlayson. Source: Wellcome Collection.

    378/616 (page 350)
    may produce in certain complexions a tinge resembling jaundice, and the serious disturbances of the general health induced by intermittent fevers, by the presence of malignant disease, and \>y syphilis, all resemble, at times, the cutaneous discolouration of jaundice. All these may usually be seen to differ from the jaundice tint on a critical examination; and in nearly all these affections the whiteness of the conjunctivae, which often indeed shine out with a pearly brightness, removes the cases at once from this category. The conjunctiva, however, sometimes pre- sents a dingy yellow colour, apart from jaundice, this being due to the presence of yellow subconjunctival fat, and this compli- cation presents a serious difficulty in determining the presence or absence of a slight discolouration; but when the colour is due to this cause it is usually more localised to special parts, and not so evenly diffused as in jaundice. The urine comes to our aid in such doubtful cases, for it very readily assumes the jaundiced colour. The method of testing for bile pigment is described in the section on urinary examina- tions (see Chapter xiii.). No great reliance can be placed on the reports of patients regarding bile in the urine, as they often mistake bloody or concentrated urine for bilious discolouration, -and the internal use of santonin or rhubarb may produce a -certain resemblance to bilious urine. The urine shows the pre- sence of jaundice earlier than anything else, but it likewise ceases the soonest to be affected, if the attack be passing off, so that the urine may be free although the conjunctivae remain really tinged. By watching the skin, the conjunctivae, and the urine, in different stages of the suspected jaundice, we are seldom left in much doubt. The urine in jaundice is often turbid from mucus : it seldom contains albumen, but usually deposits tube- casts. The appearance of the stools renders much assistance in the ;study of jaundice, for while everything else is discoloured, the motions are often free from bile, presenting a paler appearance than natural. This is often best described by the word clayey. But we may also have marked jaundice with much