DEP/DUA/1/37/06 (Normalised version)

Jean Stalker

(1785)

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Jean Stalker February 5^th

Disease of this patient very distinctly marked even from slightest examination of countenance.

While at the same time from history as introduced into register¹ had every reason to believe that simple & uncomplicated.

From yellowness of eyes, & indeed of skin in general as well as from state of urine had manifest indication of presence of bile in blood.

While at same time from state of stools, had evidence of absence in alimentary canal.

In these two however, have great characteristics, of obstruction to natural discharge of bile, or in other [words] of Jaundice.

Could have no doubt therefore in considering it as being a distinctly marked instance of that affection.

And indeed in history only one circumstance which can I think be considered as singular.

Regularity viz of discharge by belly during course of affection.

In most cases of Jaundice belly bound.

In many even to obstinate degree

Probably consequence of want of that stimulation to intestinal canal which bile affords.

Hence faeces, while deprived of usual colour, want also accustomed acrimony

Thus obstipation, the usual state of this disease, easily explained.

But though thus readily accounts for that occurrence, yet no reason why in every instance of Jaundice, belly should necessarily be bound.

For besides bile, many other stimulants, by which peristaltic motion, even morbidly increased.

This particularly case at early periods of life.

And then indeed disposition to increased action in intestinal canal, seems to be very great.

Accordingly, with healthy state of infant belly commonly loose.

From period of life therefore at which disease here occurred, viz third year, this singularity may seem less extraordinary.

And at any rate, easily explained either from supposition that some other stimulant here supplies place of bile, or that intestines particularly irritated.

But when take notice of age of patient, may perhaps seem to be a singularity that occurred thus early.

And indeed in greater part of cases, jaundice of any obstinacy at least, occurs with those advanced in life.

At least if excepting what called Gum in infants & which some consider as jaundice

But even early periods of life by no means altogether exempted from it.

With them, may readily suppose, that ducts obstructed by viscidity either of bile itself, or of secretion in intestinal canal.

And when consider, that even in early periods of infancy, very considerable urinary calculus are formed, may readily suppose that, may also be liable to biliary ones.

With them indeed scirrhous of neighbouring viscera, perhaps a less frequent cause.

And accordingly in jaundice, with young subjects, prognosis very generally more favourable.

In present instance then, from this circumstance as well as from short duration of disease had reason to entertain favourable hopes.

As when applied for our assistance, had not been of above ten days duration.

At same time during that period had resisted use of these emetics.

Could not therefore view it as of slight or transitory nature which [arises] from spasm or viscid sordes.

And was disposed to consider it as an example of Jaundice from calculus.

On this idea of disease, notwithstanding want of success from former emetics thought that still best chance of removal by repetition

Directed therefore that during course of following week should at proper intervals take these.

And as most certain means of exciting full vomiting had recourse to powder of Ipecacuanha.

While ordered these directed also a mixture of Bitter infusion with elixir of aloes & rhubarb.

Which in such cases often serviceable as counteracting indigestion which occurs with Jaundice.

But while here principally exhibited that might not seem to be inactive.

What has been effects of these medicines have not learned.

For since were prescribed have seen nothing more of patient at this place.

And from what desertion has proceeded cannot pretend to say.

May have been consequence of her not [choosing] to follow our directions as having prescribed emetic which had already employed without success.

But reckon it more probable that it proceeded from having employed them with success & thus having no farther occasion for assistance.

And this indeed as have often [illegible] opportunity of learning, a frequent occurrence in Dispensary practice.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.