Page:EB1911 - Volume 15.djvu/307

Rh retained bile, are apt to become affected in their structure by the long continuance of jaundice.

The symptoms of obstructive jaundice necessarily vary according to the nature of the exciting cause, but there generally exists evidence of some morbid condition before the yellow coloration appears. Thus, if the obstruction be due to an impacted gallstone in the common or hepatic duct, there will probably be the symptoms of intense suffering characterizing hepatic colic (see ). In the cases most frequently seen—those, namely, arising from simple catarrh of the bile ducts due to gastro-duodenal irritation spreading through the common duct—the first sign to attract attention is the yellow appearance of the white of the eye, which is speedily followed by a similar colour on the skin over the body generally. The yellow tinge is most distinct where the skin is thin, as on the forehead, breast, elbows, &c. It may be also well seen in the roof of the mouth, but in the lips and gums the colour is not observed till the blood is first pressed from them. The tint varies, being in the milder cases faint, in the more severe a deep saffron yellow, while in extreme degrees of obstruction it may be of dark brown or greenish hue. The colour can scarcely, if at all, be observed in artificial light.

The urine exhibits well marked and characteristic changes in jaundice which exist even before any evidence can be detected on the skin or elsewhere. It is always of dark brown colour resembling porter, but after standing in the air it acquires a greenish tint. Its froth is greenish-yellow, and it stains with this colour any white substance. It contains not only the bile colouring matter but also the bile acids. The former is detected by the play of colours yielded on the addition of nitric acid, the latter by the purple colour, produced by placing a piece of lump sugar in the urine tested, and adding thereto a few drops of strong sulphuric acid.

The contents of the bowels also undergo changes, being characterized chiefly by their pale clay colour, which is in proportion to the amount of hepatic obstruction, and to their consequent want of admixture with bile. For the same reason they contain a large amount of unabsorbed fatty matter, and have an extremely offensive odour.

Constitutional symptoms always attend jaundice with obstruction. The patient becomes languid, drowsy and irritable, and has generally a slow pulse. The appetite is usually but not always diminished, a bitter taste in the mouth is complained of, while flatulent eructations arise from the stomach. Intolerable itching of the skin is a common accompaniment of jaundice, and cutaneous eruptions or boils are occasionally seen. Yellow vision appears to be present in some very rare cases. Should the jaundice depend on advancing organic disease of the liver, such as cancer, the tinge becomes gradually deeper, and the emaciation and debility more marked towards the fatal termination, which in such cases is seldom long postponed. Apart from this, however, jaundice from obstruction may exist for many years, as in those instances where the walls of the bile ducts are thickened from chronic catarrh, but where they are only partially occluded. In the common cases of acute catarrhal jaundice recovery usually takes place in two or three weeks.

The treatment of this form of jaundice bears reference to the cause giving rise to the obstruction. In the ordinary cases of simple catarrhal jaundice, or that following the passing of gallstones, a light nutritious diet (milk, soups, &c., avoiding saccharine and farinaceous substances and alcoholic stimulants), along with counter-irritation applied over the right side and the use of laxatives and cholagogues, will be found to be advantageous. Diaphoretics and diuretics to promote the action of the skin and kidneys are useful in jaundice. In the more chronic forms, besides the remedies above named, the waters of Carlsbad are of special efficacy. In cases other than acute catarrhal, operative interference is often called for, to remove the gallstones, tumour, &c., causing the obstruction.

2. Toxaemic Jaundice is observed to occur as a symptom in certain fevers, e.g. yellow fever, ague, and in pyaemia also as the effect of certain poisons, such as phosphorus, and the venom of snake-bites. Jaundice of this kind is almost always slight, and neither the urine nor the discharges from the bowels exhibit changes in appearance to such a degree as in the obstructive variety. Grave constitutional symptoms are often present, but they are less to be ascribed to the jaundice than to the disease with which it is associated.

3. Hereditary Jaundice.—Under this group there are the jaundice of new-born infants, which varies enormously in severity; the cases in which a slight form of jaundice obtains in several members of the same family, without other symptoms, and which may persist for years; and lastly the group of cases with hypertrophic cirrhosis.

The name malignant jaundice is sometimes applied to that very fatal form of disease otherwise termed acute yellow atrophy of the liver (see ).

 JAUNPUR, a city and district of British India, in the Benares division of the United Provinces. The city is on the left bank of the river Gumti, 34 m. N.W. from Benares by rail. Pop. (1901), 42,771. Jaunpur is a very ancient city, the former capital of a Mahommedan kingdom which once extended from Budaun and Etawah to Behar. It abounds in splendid architectural monuments, most of which belong to the period when the rulers of Jaunpur were independent of Delhi. The fort of Feroz Shah is in great part completely ruined, but there remain a fine gateway of the 16th century, a mosque dating from 1376, and the hammams or baths of Ibrahim Shah. Among other buildings may be mentioned the Atala Masjid (1408) and the ruined Jinjiri Masjid, mosques built by Ibrahim, the first of which has a great cloistered court and a magnificent façade; the Dariba mosque constructed by two of Ibrahim’s governors; the Lal Darwaza erected by the queen of Mahmud; the Jama Masjid (1438–1478) or great mosque of Husain, with court and cloisters, standing on a raised terrace, and in part restored in modern times; and finally the splendid bridge over the Gumti, erected by Munim Khan, Mogul governor in 1569–1573. During the Mutiny of 1857 Jaunpur formed a centre of disaffection. The city has now lost its importance, the only industries surviving being the manufacture of perfumes and papier-mâché articles.

The has an area of 1551 sq. m. It forms part of the wide Gangetic plain, and its surface is accordingly composed of a thick alluvial deposit. The whole country is closely tilled, and no waste lands break the continuous prospect of cultivated fields. It is divided into two unequal parts by the sinuous channel of the Gumti, a tributary of the Ganges, which flows past the city of Jaunpur. Its total course within the district is about 90 m., and it is nowhere fordable. It is crossed by two bridges, one at Jaunpur and the other 2 m. lower down. The Gumti is liable to sudden inundations during the rainy season, owing to the high banks it has piled up at its entrance into the Ganges, which act as dams to prevent the prompt outflow of its flooded waters. These inundations extend to its tributary the Saī. Much damage was thus effected in 1774; but the greatest recorded flood took place in September 1871, when 4000 houses in the city were swept away, besides 9000 more in villages along its banks. The other rivers are the Saī, Barna, Pili and Basohi. Lakes are numerous in the north and south; the largest has a length of 8 m. Pop. (1901), 1,202,920, showing a decrease of 5% in the decade. Sugar-refining is the principal industry. The district is served by the line of the Oudh & Rohilkhand railway from Benares to Fyzabad, and by branches of this and of the Bengal & North-Western systems.

In prehistoric times Jaunpur seems to have formed a portion of the Ajodhya principality, and when it first makes an appearance in authentic history it was subject to the rulers of Benares. With the rest of their dominions it fell under the yoke of the Mussulman invaders in 1194. From that time the district appears to have been ruled by a prince of the Kanauj dynasty, as a tributary of the Mahommedan suzerain. In 1388 Mālik Sarwar Khwāja was sent by Mahommed Tughlak to govern the eastern province. He fixed his residence at Jaunpur, made himself independent of the Delhi court, and assumed the title of Sultan-us-Shark, or “eastern emperor.” For nearly a century