DEP/DUA/1/14/11 (Normalised version)

Catherine Carrol

(1777)

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Cath Carrol.

A case but of short continuation under our care.

And without any remarkable occurrence during that time dismissed cured.

May perhaps here be some doubt as to name of affection.

And cannot be [refused] that whatever disease was, at the utmost a slight affection.

Yet no room for suspecting that patients complaint imaginary.

And some symptoms at least obvious.

While others at same time common characteristics of that affection which obvious appearance would naturally indicate.

Here obvious part of disease an evident change in colour of skin

Had acquired to certain degree at least a yellowish tinge.

Though must be allowed that had not external appearance of that bright & deep yellow commonly attending jaundice.

This indeed must be consider varied by natural colour of complexion.

But besides this with our patient tinge not so universal as common.

And not observed in some particular parts in which can be little affected by [marked] colour of skin.

These are Tunic. adnata of eyes nails & [hair]

In both these places extreme vessels not covered with proper cuticles.

Hence more readily show state of contents.

And on this account considered as giving most certain test of deviation of colour from natural state

This circumstance then might be supposed to give rise to some suspicions.

Especially when added that yellowness by no means of itself certain characteristic of jaundice.

Must indeed be allowed that [admission] of bile into blood most common cause of yellow tinge on surface.

And perhaps no other extreme material by which can be affected.

At least different matter entering alimentary canal which give deep tinge to secretion yet never in blood.

Thus yellow colour [communicated] to urine by Rhubarb.

And even in madder giving red tinge to hardest bones no appearance of change.

Probable therefore that for this purpose very thorough diffusion perhaps even proper solution in most fluid parts of serum requisite.

And this probably not to be affected by matters which have not strong affinity to [illegible] fluid.

In bile however a matter extraneous to blood have a fluid capable of communicating such [tinge]

But although not affected by other extraneous matters yet no doubt that may be [acquired] from changes in fluids themselves.

This every day manifested in what happens in cases of ecchymosis.

There no doubt that extravascular fluids assume yellow colour.

What here occurs in [partial] manner from some other causes takes place more generally.

Thus for example universal yellowness on bite of certain serpents.

And little doubt that this in no degree affect of bile.

Perhaps same also may be said of yellow fever of West Indies.

At least some writers of discernment who hold that in no degree dependant on bile.

Although at same time must be allowed that respecting this best authors not agreed.

Have however a less equivalent instance in a common, perhaps may even say an universal affect of [influence].

That yellowness viz generally known by title of Gum.

From many circumstances, which elsewhere lately occasion to induce reason I apprehend for [believing] that neither affect of bile, nor of any matter absorbed from alimentary canal.

But any inquiry of this nature here out of place.

And from what already observed may infer that many instances of yellow tinge not from bile.

That other causes operate the rather to be suspected when yellowness does not put on usual appearance.

And when does not give tinge to those places in general observe most [remarkable] affects

From these circumstances then some room for doubt respecting present instance.

And to these perhaps may be thought that should add as farther particular [distinction] between yellowness & other [most] urgent symptoms

Though tinge at utmost but slight yet languor & oppression with which patient affected very great.

May be therefore presumed that originate from some other cause than what generally induces such symptoms in jaundice.

But notwithstanding all particulars if not certainty of existence of jaundice at least [reckon] it most probable supposition.

Though yellowness from other causes yet bile by much most frequent.

From natural condition of complexion appearance of yellowness may readily be supposed affected

And may occur even as general affect where yet not universal.

Not surprising therefore that should not have penetrated to extreme vessels of adm.

For cannot suppose that first affect a part so remote in system.

May only I apprehend conclude that taken as mark, not that first affected or that takes place from slight degree but because when affected is not obvious

From last particular high degree of oppression with slight yellowness not more different.

Oppression & languor occurring in jaundice are indeed differently explained.

Some contend that to be considered as affection of introduction of bile into blood.

On this supposition might always be concluded to be in proportion to yellowness.

This however by no means case.

And in many instances have remarked that when very great on appearance of considerable yellowness remarkably diminished.

Rather agree therefore in opinion with those who refer it to morbid state of tension in parts.

And on this footing may be supposed even greatest before bile has found ready passage into blood.

Whether that passage as some suppose by means of lymphatic system.

Or as more generally believed & I think with better reason by means of regurgitation.

While obstruction continues & secretion goes on without ready admission into blood, distension & consequential languor & pain must be greatest.

This then take to have been case with patient before us.

And on this apprehend that all peculiarities in affection to be explained.

For to be remembered that presence of bile in blood but one part of jaundice

And viewing it in light of obstructed discharge want of bile in intestines a still more essential part.

Must be allowed indeed that of this circumstance also have not here [compiled] evidence

Perhaps only certain mark is want of yellow colour in faeces which acquires from bile

Yellowness indeed may in some degree be present although [total] obstruction to bile.

As may be acquired from other matters in intestines.

But bile cannot be present without giving tinge.

Hence when wanting certain that bile not deposited in intestines.

But what state of discharge by belly here had not opportunity of knowing.

For till medicine used to which complaint yielded had not attended to this circumstance.

But in bound state of belly had a circumstance giving presumption of want of bile in intestine.

Not indeed to be [refused] that constipation may arise from other many causes.

But certain also that bile in intestine a cause stimulating to action.

And that from want of this jaundice very universal with bound state of belly.

From all circumstances then presumption of this affection.

Yet must be admitted that by no means distinctly marked.

And not without doubt.

This then a circumstance giving some room for hesitation respecting prognosis.

On supposition of jaundice might [from] some particulars have considered it as slight & favourable case.

Obvious appearance at least not to great degree

And jaundice in general though sometimes may proceed from fixed causes, yet for most part an affection admitting of cure

For when calculus most common cause of obstruction cannot make way into intestine is in general forced back into gall bladder

To all this may be added that present a first attack & but of recent date.

On these grounds then disposed to hope for such termination as in reality took place.

Yet must own that high degree of languor & oppression created some suspicion.

And consider these symptoms to be affect of obstruction without free admission into blood

Looked upon case to be more unfavourable than if yellow tinge had been deeper.

But suspicions in this respect soon after treatment begun were happily dispelled.

Consider this affection to depend on obstruction to biliary duct first great objective to remove it

And taking it for granted that most common obstructive cause calculus thought of attempting removal by that agitation which vomiting capable of inducing.

Till however restoration of bile in intestine could be affected necessary to obviate [some] of most urgent symptoms.

And of these none more remarkable here than costiveness.

This therefore naturally indicated [some] of same stimulation to alimentary canal.

And it was as a stimulant which might continue to repeat for some length of time that had here recourse to aloetic pill.

Besides farther expected from this there would be means of evacuating viscid sordes accumulated in intestinal canal.

And thought that some probability of [even] from this circumstance removing the affection.

As in some slighter instances at least obstruction seems to depend on sordes alone.

How far cure to be ascribed to any of these measures not perhaps perfectly clear.

But of this at least some probability.

And in obvious operation were not disappointed.

Vomit full & free operation & although belly before bound yet from pills several loose stools every day.

With these manifest operations symptoms of disease also diminished.

And this equally case with respect to obvious symptoms & feelings of patient.

While change of complexion in evidence diminishment of yellowness was forced also from uneasiness at pit of stomach.

Hence concluded then, that now free passage for bile in natural course.

In this situation thought it impossible to continue pills to same extent as formerly.

And therefore merely ordered to such quantity as thought might serve to keep belly gently open.

Even small quantity however had more affect than this

[Which] considered as strongest proof that complaint effectively removed.

And in this situation dismissed her from any farther attendance here.