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

Robert Burns

(1778-1779)

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Robt Burns

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

And although in some respects might afford room for many observat yet at pres. reckon it unnecss. to say much with respect to it.

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

While at same time had not in pract occas to employ a mode of cure in any respect diff from common what generally in use

And to this very soon yeilded.

Here from obvious appear could be little doubt as to affect to which was subj.

Yellowness of eyes conj with that of skin in other parts of body gave at least strong presumpt of jaund.

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

Is only however when proceeds from this partic cause that to be reckond jaundice.

And if to consid this disease as consist in obst disch which in my opin prop. view of it, even this not suffic.

For besides proof of introd into blood must have also evid of being wanting in alim canal.

Of this however in pres. inst unquest evid from white colour of stools & bound state of belly.

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

And pain at region of stomach alm only other sympt mentiond in case to be consid as affect of obstruct.

Upon whole then could have no doubt in pron patient subj to Jaund

And that too without any complic.

From viewing affect as uncomplic & recent was led to entert fav hopes of recov.

Jaundice one of these affect in which for most part at least may give fav prognos.

Yet no doubt that this entirely regulat by causes on which dep.

In some inst obst. from such as totally imposs for us to remove by art.

Such for ex as schirros of neighb parts partic of pancreas.

Adhes of sides of duct to each other from preceding inflam & like.

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

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

From these circum then some ground in every case for appreh.

But still more freq obstruct from causes easily remov.

Such for ex as smaller calculi or even viscid mucus in intest.

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

Where has occurrd suddenly or without any prev. affect giving indic of other diseases.

And lastly where has not resisted which remed as might naturally expect to be capab of remov. obstruct.

In such circum, even without aid of med, obstr. often removed by influ of syst. itself.

And where this would not be affectd readily brought about by interss of art.

On these grounds then was disp. in pres. case to entert favour hopes.

And in this expect. have not been disappointed.

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

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

All pract used in this affect in general intended with one of two views.

Either for removal of cause obst passage of bile into intest.

Or for mitigat of sympt till this can be effected.

With first intent few means more powerful than such as serve to give agitat of syst.

On this princip exercise giving [quick] motion often a successf. means of cure.

An operat however still more powerf in this way to be had from use of emet.

And accord few modes of cure on which greater depend is in gener. put.

Before patient came under our care had used at short interv. three diff emet.

All of these attended with brisk operat.

And from last in partic had exper mitig of affect partic tension especially of pain & tension at stomach.

From this conj with other circum when patient came under our care was inclin to hope that obstr. already removd.

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

Was princip then with intent of not seeming in act. that put patient on use of aloet. pills

From these however farther hoped that by empt. intest canal & remov. sordes obst might be more completly [caried] off.

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

Had at least however obvious operat of gently moving belly

During use sympt sufferd manif & consid decline.

From every circum had evid that bile no longer carried into blood but free passage into intest canal.

And in about space of forthnight after came under care dismissd free from any compl.