DEP/DUA/1/23/13 (Transcript version)

Mary Goodall

(1780)

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Mary Goodall.

Has not attended here for some time past.

But when left us so far in fav [tran] of recov. that can have little doubt compl. cure now effectd.

And that prob. in good meas by remed here employd.

Disease of patient so distinctly markd that could have no room for doubt as to name.

Extern appear of affect. markd by obvious yellowness of whole surface but partic of eyes.

This indeed taken merely by itself may proceed from diff causes.

And partic great reason to believe that sometimes is effect of change in colour of serum of blood.

Probab in some meas conseq of red glob being dissolved & broke down in it.

At least of this strong presumpt argt from what happens in case of ecchymosis.

There red glob effused in cellul memb.

Before taken up, well known give yello colour to all neighb parts.

But such yellowness as here occurs, though possib that from blood, yet much more freq matter introd.

And of all matters from none so often as from bile.

When occurs from this cause attend with lassit & debility.

While at same time occurs takes place in sudden manner.

And although most obv. in some partic places yet more gener extended than perhaps from any other cause.

Here then from these circum alone great reason to concl. that here dep. on jaund. bile.

Well known that introd of bile into blood constit at least greatest part of jaund.

And whether wherever occurs are to consid disease as jaund or not will in good meas dep on definit

For my own part am disp to consid absence of bile in intest canal as being an essent. constit.

And indeed hold that this disease with greater prop. referrd to obst. disch. than any other.

From state of disch though less obv. yet no less cert. charact.

For excret. of bile into alim canal in many respects essent. to syst.

And has partic very great influ. both on disch of faeces & urine.

In condit of these therefore as well as in yellowness, to seek for const. of jaun

Here however, at time hist of case taken, patient not able to give all satisf that could have been wishd.

Had [ordered] indeed obs. that urine of partic high colour.

But had never made any trials whether capab of giving tinge to [linnen]

That is whether cont. any of [colour] matter of bile

And to appear of stools had paid no attent.

While repres disch by belly as in point of time nearly regul.

With regard to these circum therfore farther enquir became necess.

And notwith appear. of counten, report might have been such as to led us to pron disease not jaund.

But on this subj, after observat of patn, gave fullest satisf.

For will observe that between 17^th of May, & 26^th, day of second report, had was not only subj to bound state of belly, but had found faeces of white colour & urine giving yellow tinge to [linen]

From these circum then no room to doubt that bile wanting in alim canal & pres in blood.

Or in other words that patient subj to jaundice.

That all these appear. the conseq. of obst. to passage between liver & intes univ allowed.

And therefore in strict prop I think to be held as [illegible] cause of disease.

That is cause from which prin sympt to be explaind.

Yet how this cause operates has been very much subj of debate.

Into this controv here foreign to our business to enter.

In pract. lect, deliver sentim on this subj at consid length.

And partic in exam argt employd by an ingen Prof. at this place, for [overt] suppos of regurgit. & demonst. that entirely effect of absorpt.

Here therefore shall wave all inquiry with resp to it.

May only obs. that in a late pract treat on jaund pub. in Germ lang. by Dr [Marcard] phys. at Hannov. a [hypo] somewhat diff. from any before prop enter is entert. is prop.

Of this treat, which cont. many ingen observat. will soon see analyst in a numb of Med Com now in prep

May only observe that author lab. to estab distinct between bile of liver & that which has undergone prepar & change in gall bladder.

Endeav to shew that former incap of giving jaund.

And hence infers that can arise only from latter.

This however he suppos not to be effect of immed absorpt from gall bladder.

But imagines that [trasudes] through coats, into cavity of abdom & thus [ab]

Although to this theory am not a [conv.], yet far from denying every part of it.

In first place may observe that sever obj to suppos of immed absorpt. to which is not liab.

2dly is a certain fact that the colouring matter of bile capab of transud. through coats.

And in third place, can be no doubt, of at least possib of absorpt from abdom.

But allowing that bile thus taken up, does not follow that is only chan for admiss.

And to its being sole mode of introd there are I think many obj.

Cannot help still thinking, that neither this author nor any former [writer] have overturned argt argt brought to prove introd by regurgit.

Is however a matter of much less [con] in pract, by what means bile introd, than by what cause obt is affected.

For on removal of obst. cause remov of disease must dep.

And hence foundat both of progn & of pract.

In inst before us no circum which could lead to cert or even high probab of cause

Of all causes the most obstin, & what indeed often incurab. are comm of ducts from shirrous swelling of neighb visc

Contract, [indurat] or even [coalles] of ducts themselves from inflam or simil causes.

Here however none of those circum which univ forerunner of such affect

And indeed suddeness of attack with so little inconv in other respects strong obj to it.

Have a cause of jaund still [more] common in biliary calcul.

These formd in gall bladder from various accid, make way into ducts.

And perhaps from these greater number of inst of jaund proceed than from any other cause.

That this may have operated with pres patient by no means improb.

And from nature must appear to be cause sudden in action.

But at same time stone [implated] in duct seldom without some pain.

Of this our patient in no degree complaind.

A circum cheifly occurring only where obst from viscid bile, or viscid mucus.

And this a cause from which jaundice still more slight than those depend on calcul. often arises

From this circum then presumpt that may have oper taken place in pres. inst.

And although at first susp. calc. am now inclind to think that proceeded only from viscid bile or mucus

With regard to prognos, as consider case as having allready termin fav. all farther observat now superceded.

May only observe that when came under care was with no threat appear.

And from what already said, app. that did not consid it as depend on a cause which threatned an obstin or danger affect.

Yet had no reason to look for so exped or complete recov.

For by no means uncommon to find disease, even when appear slight yet contin with obstin for weeks togeth.

At same time even with firmly impacted calcul often very exped recov.

With respect to cure great object to be [aimed] at is remov. of obst. cause

And for this purpose various meas taken accord to nature of it.

When however affect of calcul, or of mucus, cheifly brought about in one of two ways.

1. By removal viz of causes tending to retain these ex spasm or like.

2 By giving addit force to that furnishd by system for expuls.

These princip, will suff. explain intent in pract. to which had here recourse.

As patient so free from pain had no reason to susp any partic circum tending to retain obst. cause.

Thought it therfore most prop to have immed recourse to meas for [exps]

And was with this intent that directed emetic to patient.

In jaund in gener. few modes of cure more freq empl. or more success. than emet.

Cases indeed such for example as those depend on schirrous in which not only unsuccess. but even hazard.

But where arises from calcul of such a size that can pass through ducts no pract. more success.

And even when cannot pass yet often effect in pushing backwards.

In both ways affect equally admits of cure.

For large calcul may exist in gall bladder without any jaund.

Princip on which effect here depends suffic obvious.

In no degree conseq of evacuation but solely of concussion.

Where succeeds therefore often an instant effect.

And where fails on diff. trials yet at least often brought about by repet.

Hence then in jaund from [calcul] no pract more common than course of emetics.

By some of best pract. repetit advised for some time every day

Such a course then, when began first emet. if necess. meant here to have employd.

And accord as from first no obvious good effect directed repet twice during course of succeeding week.

Besides this however had recourse also to anoth prescript viz Aloet pills.

From bound state of patients belly thought that these might with advan be comb. with emet.

And if obstr. merely from viscid mucus might even be means of remov.

Whether this was the case or not cannot posit pretend to say.

But vomits by some accid omitted.

Pills however had effect of gently open belly.

And after contin for space of week yellow colour very much dimin.

But had much stronger proof of removal of obstruct from both stools & urine assum entirely natur colour.

Not improbab however that this [rather] effect of first emet than of pills.

But to which ever owing gave cert evid that cause of disease gone.

In this situat although directed contin of pills yet consid farther meas as unnecss.

And although have not since seen any thing of patient yet look upon her as having obt. complete cure undr our care.