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

Catherine Carrol

(1777)

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Cath Carrol.

A case but of short cont. under our care.

And without any remark. occurr. during that time dismissd cured.

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

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

Yet no room for suspecting that patients compl. imagin.

And some sympt. at least obvious.

While others at same time common character. of that affect. which obv. appear. would naturally indicate.

Here obvious part of disease an evid change in colour of complex. skin

Had acquired to certain degree at least a yellowish tinge.

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

This indeed must be consid varied by natural colour of complex.

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

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

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

In both these places extreme vessels not covered with prop [cutic].

Hence more readily shew state of [natur] contents.

And on this acct consid as giving most certain test of deviat of colour from nat state

This circum then might be supposed to give rise to some suspic.

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

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

And perhaps no other extrem matter. by which can be affected.

At least diff. matter entering alim [canal] which give deep tinge to secret. yet never in blood.

Thus yellow colour [commun] to urine by Rhubarb.

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

Probab. therfore that for this purpose very thorough diffus. perhaps even prop. solut in most fluid parts of serum requis.

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

In bile however a matter extran to blood have a fluid capab. of commun. such [tinge]

But although not affected by other extran matters yet no doubt that may be [acquird] from changes in serous itself fluids themselves.

This every day manif. in what happens in cases of ecchymos.

There no doubt that extravas. fluids assume yellow colour.

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

Thus for ex univ 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 depend on bile.

Although at same time must be allowd that respecting this best auth. not agreed.

Have however a less equiv inst in a common, perhaps may even say an univ affect of inf.

That yellowness viz gener. known by title of Gum.

From many circum, which elsewhere lately occas. to induce reason I appreh for [believ] that neither affect of bile, nor of any matter absorbd from alim. canal.

But any inquir of this nature here out of place.

And from what already observd may infer that many inst of yellow tinge not from bile.

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

And when does not give tinge to those places in gen. obs. most remark affect

From these circum then some room for doubt respect. pres. inst.

And to these perhaps may be though that should add as farther partic. [distin] between yellowness & other [most] urgent sympt

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

May be therefore presumd that origin from some other cause than what gener. induces such sympt in jaund.

But notwith all partic if not certainty of exist. of jaund. at least [reckon] it most probab. suppos.

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

From natural condit of complex. appear of yellowness may readily be supposed affected also

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

Not surprizing therefore that should not have penetrated to extr. vessels of adm.

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

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

From last partic high degree of oppr with slight yellowness not more diff.

Oppress & languor occurring in jaundice are indeed diff. expl.

Some cont. that to be consid as affect of introd of bile into blood.

On this suppos. might always be concluded to be in prop. to yellowness.

This however by no means case.

And in many inst have remarked that when very great on appear of consid yellowness remark. dim.

Rather agree therfore in opin with those who refer it to morbid state of tension in parts.

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

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

Or as more gener. beleivd & I think with better reason by means of regurgit.

While obstr cont. & secret. goes on without ready admiss into blood, distens & conseq. languor & pain must be greatest.

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

And on this appreh. that all pecul. in affect. to be explaind.

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

And viewing it in light of obs. disch want of bile in intest a still more essent part.

Must be allowed indeed that of this circum also have not here comp evid

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

Yellowness indeed may in some degr. be pres although [total] obst to bile.

As may be acquired from other matters in intest.

But bile cannot be pres. without giving tinge.

Hence when wanting certain that bile not depos. in intest.

But what state of disch by belly here had not opport. of knowing.

For till med used to which compl. yeilded had not attended to this circum.

But in bound state of belly had a circum giving presumpt. of want of bile in intest.

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

But certain also that bile in intest a cause stimul. to action.

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

From all circum then presumpt of this affect.

Yet must be admitted that by no means distinctly marked.

And not without doubt.

This then a circum. giving some room for hesitat respecting prognos.

On suppos of jaundice might [from] some partic have consid it as slight & favour. case.

Obvious appear at least not to great degree

And jaundice in general though sometim may proceed from fixd causes, yet for most part an affect. admitting of cure

For when calcul. most common cause of obst. cannot make way into intest is is in gener forced back into gall bladder

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

On these grounds then disp. to hope for such termin as in reality took place.

Yet must own that high degree of langor & oppress. created some suspicion.

And consid these sympt. to be affect of obst. without free admiss into blood

Lookd upon case to be more unfav. than if yellow tinge had been deeper.

But susp. in this respect soon after treatment begun were happily dispelld.

Consid this affect to depend on obst to biliary duct first great obj to remove it

And taking it for granted that most common obst cause calcul. thought of attempting removal by that agitat which vomiting capab. of inducing.

Till howevr restorat of bile in intest could be affected necess to obviate [some] of most urgent sympt.

And of these none more remarkab. here than costiveness.

This therefore naturally indicated [some] of same stimul to alim canal.

And it was as a stimul. which might cont to repeat for some length of time that had here recourse to aloet pill.

Besides farther expected from this there would be means of evac viscid sordes accumul. in intest. canal.

And thought that some probab of [even] from this circum removing the affect.

As in some slighter inst at least obst. seems to depend on sordes alone.

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

But of this at least some probab.

And in obvious operat were not disap.

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

With these manif operat. sympt of disease also dimin.

And this equally case with respect to obv. sympt & feelings of patient.

While change of complex in evid dimn of yellowness was forced also from uneasinss at pit of stomach.

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

In this situat thought it imposs to cont pills to same extent as formerly.

And therfore merely ordered to such quantit as thought might serve to keep belly gently open.

Even small quantit howevr had more affect than this

[Which] considered as strongest proof that compl. effect removed.

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