THE EPIDEMIC JAUNDICE OF CAMPAIGNS
Authors: W. H. Willcox
Journal: BMJ (1916)

THE following paper is based upon the study of a considerable number of cases of jaundice in the Mediter- ratean area during the past six montlhs, and also on the study of a number of cases of jaundice from the Expedi- tionary Force in France during the earlier part of the war..Jaundice is of common occurrence amongst troops on campaign.In the Soutlh African war a considerable numuber of cases were reported.In the present war jaundice has occurred amongst our troops in almost all parts of the sphere of operations.The cases of jaundice of the epidemic type have fortu- nately been of a mlild nature generally, and very few deatlhs have been reported.A considerable amount of incapacity for duty lhas, however, resulted, so tlhat epidemic jaundice is a diseaseot importance from the military point of view.The epidemic jaundice of carnpaigns is of great patho- logical interest, since it tlhrows considerable light on the patlhology of jaundice generally.It will be convenient to consider, first, the symptoms of tlle common type of epidemic jaundice as seen in the Mediterranean area during the later half of the past year.Otlher varieties of jaundice wlhiclh were also observed will tlhen be considered, and the relation between them will be discussed. SYMPTOMS OF EPIDEMIC JAUNDICE (THE COMMON TYPE).The patient had usually some abdominal discomfort for a few days, associated with anorexia, nausea, and either diarrhoea or constipation.Pyrexia, generally of a mild type, would then set in, and this was associated with some chilliness, and in some cases by an actual rigor.Vomiting occurred sometimes at this stage, and also headachle.Sometimes there were "Pains all over."Abdomtinal discomfort in the lhepatic and epigastric regions usuallv occurred.The pyrexial period in some cases lasted only one or two days.Generally it was from two to four days, but cases have been observed in which it lasted as long as eighllt days.Liver: Gall Bladder.Jaundice now occurred, at first slight, but it gradually inicreased in intensity and became of the ordinary type of obstructive jaundice.Thie stools Were pale and the urine bile-coloured wlhen the jaundice became marked.Witlh tlle onset of jaundice the temperature usuallv fell to normal and remlained so.At this stage definite enlargemnent of the liverqcould be made out.It was felt usually extending to one or two inclhes, or even more, below the subcostal border in the righlt nipple line.The surface wvas smootlh and tlle enlargement uniform.There was slight tenderness on palpation over the liver.It imoved freely with respiration.In some cases there was definite enlargement over the gall bladder region, and on palpation the gall bladder could be felt.This enlarge- ment of the gall bladder occurred in about 10 per cent. of thlo cases, and it no doubt indicated an obstruction due to tIme catarrllal iniflammation of the duodenum, involviug the common bile duct and its ampullary orifice into the duodenun.Tlle stools were pale whlen the jaundice was marked, and unless aperients were given they were constipated. Spvleen.At this stage the spleeni could usually be felt, extending for lhalf an inchl, or considerably more, below the left sub.costal border on inspiratiou.In some cases there was dletinite tenderness on palpation over the spleen.Per- cussion over tlho splenic area slhowed an increase of dtllniess upwards.The tongue was often moist and clean, but in some cases it was moist and somewhat furred.