DEP/DUA/1/18/17 (Normalised version)

Robert Burns

(1778-1779)

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Robert Burns

Of his case have not before had opportunity of saying any thing.

And although in some respects might afford room for many observations yet at present reckon it unnecessary to say much with respect to it.

Upon whole may observe that disease to which he was subjected neither [obscure] nor uncommon.

While at same time had not in practice occasion to employ a mode of cure in any respect different from what generally in use

And to this very soon yielded.

Here from obvious appearance could be little doubt as to affection to which was subjected.

Yellowness of eyes conjoined with that of skin in other parts of body gave at least strong presumption of jaundice.

Mere yellowness however may proceed from other causes than presence of bile in blood.

Is only however when proceeds from this particular cause that to be reckoned jaundice.

And if to consider this disease as consisting in obstructed discharge which in my opinion proper view of it, even this not sufficient.

For besides proof of introduction into blood must have also evidence of being wanting in alimentary canal.

Of this however in present instance unquestionable evidence from white colour of stools & bound state of belly.

While at same time change in urine could leave no [doubt] that yellowness from presence of bile in blood.

And pain at region of stomach almost only other symptom mentioned in case to be considered as affect of obstruction.

Upon whole then could have no doubt in pronouncing patient subjected to Jaundice

And that too without any complications.

From viewing affection as uncomplicated & recent was led to entertain favourable hopes of recovery.

Jaundice one of these affections in which for most part at least may give favourable prognosis.

Yet no doubt that this entirely regulated by causes on which depends.

In some instances obstruction from such as totally impossible for us to remove by art.

Such for example as scirrhous of neighbouring parts particularly of pancreas.

Adhesion of sides of duct to each other from preceding inflammation & like.

Same also in some instances the case where arises from pancreas.

And where stone so large that cannot pass, & so firmly impacted that cannot be moved backwards.

From these circumstances then some grounds in every case for apprehension.

But still more frequent obstruction from causes easily removed.

Such for example as smaller calculi or even viscid mucus in intestines.

And always grounds at least for hoping such a cause where disease has not been of long continuation.

Where has occurred suddenly or without any [prevailing] affection giving indication of other diseases.

And lastly where has not resisted which remedies as might naturally expect to be capable of removing obstruction.

In such circumstances, even without aid of medicine, obstruction often removed by influence of system itself.

And where this would not be affected readily brought about by intersession of art.

On these grounds then was disposed in present case to entertain favourable hopes.

And in this expectation have not been disappointed.

But how far was really consequence of any measures directed by us is with me matter of great doubt.

Am upon the whole inclined to consider greater part of cure as having been affected before patient came under care

All practices used in this affection in general intended with one of two views.

Either for removal of cause obstructing passage of bile into intestines.

Or for mitigation of symptoms till this can be effected.

With first intention few means more powerful than such as serve to give agitation of system.

On this principle exercise giving [quick] motion often a successful means of cure.

An operation however still more powerful in this way to be had from use of emetics.

And accordingly few modes of cure on which greater dependence is in general put.

Before patient came under our care had used at short intervals three different emetics.

All of these attended with brisk operation.

And from last in particular had experienced mitigation of affection especially of pain & tension at stomach.

From this conjoined with other circumstances when patient came under our care was inclined to hope that obstruction already removed.

And wished at least to allow some interval to elapse without then pushing use any farther.

Was principally then with intention of not seeming inactive that put patient on use of aloetic pills

From these however farther hoped that by emptying intestinal canal & removing sordes obstruction might be more completely [carried] off.

How far had really any affect in this way cannot pretend to say.

Had at least however obvious operation of gently moving belly

During use symptoms suffered manifest & considerable decline.

From every circumstance had evidence that bile no longer carried into blood but free passage into intestinal canal.

And in about space of fortnight after came under care dismissed free from any complaint.