DEP/DUA/1/25/08 (Normalised version)

Christian Downie

(1780-1781)

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Christian Downie.

Of disease with which affected no room for doubt

From external appearance little difficulty in at once pronouncing it jaundice.

And this confirmed beyond all doubt from state of discharge by stool & urine

From [condition] of first evidence of want of bile in alimentary canal.

From that of last equal proof of introduction into circulatory blood.

In these essential constituents of jaundice.

And while evidently liable to this affection no symptoms of any other.

For nothing more common than to have pains about region of liver & stomach as concomitants of this affection.

While however thus pronouncing disease to be jaundice of material consequence both to prognosis & practice that one step farther.

For judgement both in one & other to be in good measure regulating cause of obstruction.

And on this subject often very [great] difficulty

For well known may arise from many different causes.

Sometimes merely viscid bile or even viscid mucus in intestines.

Sometimes coalition of ducts or scirrhous of pancreas or other neighbouring viscera giving [compression].

In first case very easily removed

In latter for most part incurable.

While these however sometimes [occur], a cause much more frequent than [illegible] in biliary calculus.

These with certainty [constitutions] at least very liable to be formed in the Gall bladder

And from thence, from motion of body or other accidental causes make way from gall bladder into ducts.

In this manner cause of jaundice when impacted in ductus communicated.

And sometimes even merely when situated in ductus [apt]. provided [illegible] such as to compress duct [illegible].

That calculus cause of obstruction in present instance some presumption from being most frequent.

Still more however from suddenness of attack.

From height to which arose in short time.

And from severity of pain with which attended.

Former not the case where effect of scirrhous.

Latter does not happen where proceeds merely from mucus.

Hence then though patient never before observed to discharge biliary calculi yet strong presumption.

And on this both prognosis & practice to proceed.

With regard to former of these indeed observations now entirely superseded.

For patient already dismissed free from affection.

This however may observe was the termination expected from commencement.

And that principally from reasons already given by which inclined to think that depended on calculus.

For few instances of jaundice from that cause which do not admit of cure.

And although not slightest case yet where nature insufficient will for most part yield to artificial measures.

That these employed in this way, had some effect not I think important

Here will observe supposing affection to proceed from calculus great objective to obtain removal.

And that either from being pushed back into gall bladder or from being forced into intestines.

These ends chiefly to be expected from concussion & agitation.

And concussion not more effectively obtained in any way, than by use of emetics.

For this purpose even single emetic may often be sufficient.

But although fails still room for hopes by same measures.

And where reason to conclude that has succeeded repetition still proper.

For where disposition to biliary calculi seldom that single

And as most easily discharged when made by repetition return prevented.

These then reasons for directing two emetics in first week.

At same time also prescribed aloetic pills.

Only however to extent of grain V

And with no other intention than to obviate costiveness

A consequence naturally resulting from want of bile in alimentary canal.

And often even product of worst symptoms with which affection attended.

Effect of these medicines seemed in every respect to answer to wishes.

For not only obvious operation intended, but this also followed by all consequences which could have desired.

From both emetics brisk & free operation.

Soon after stools natural yellow colour.

As strong presumption evidence at least that obstruction already removed, & that bile now found way into intestines.

From this perhaps as much as from pills to account for regular discharge by belly.

Yet little doubt that in producing this effect aloetic pills had also some influence.

Still however to be considered as favourable appearance.

And this not less the case with another change viz diminishment of yellowness

An evident indication that bile in [circulatory] mass now less abundant.

Still indeed deep colour in urine.

But this not evidence of continuation of obstruction nor even an unfavourable symptom.

For unless obstruction to discharge of bile by this [emanates] must necessarily continue till all introduced into blood thrown off.

And always favourable for patient, that free discharge thus afforded.

In this situation then was now in hopes that nothing more in reality requisite for cure.

But for reasons already [illegible] for repetition of emetic directed that should still persist at least for space of another week in same plan.

At end of that period had still [more] every appearance of complete cure

For with remarkable diminishment of yellowy stools & urine had now nearly acquired natural appearance.

And even almost entirely free from any remaining stomach complaints.

In this situation thought farther continuation of emetics unnecessary.

Still however wished that might continue attendance for a little longer.

And was rather with view of [securing] this than that thought then now requisite that directed continuation of Aloetic Pills.

With these went on for fortnight longer.

And at end of that period dismissed free from affection.

Hence then from cure as well as other circumstances of case presumption that depended on calculus.

And that removed by the operation of emetic.