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

Christian Downie

(1780-1781)

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Christ. Downie.

Of disease with which affected no room for doubt

From external appear. little diff. in at once pron. it jaundice.

And this conf. beyond all doubt from state of disch by stool & urine

From cond of first evid of want of bile in alim canal.

From that of last equal proof of introd into circul. blood.

In these essent constit of jaund.

And while evid liab. to this affect no sympt of any other.

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

While however thus pron disease to be jaund of matter. conseq. both to prognos & pract. that one step farther.

For judgem both in one & other to be in good meas regul. cause of obstruct.

And on this subj often very [great] diffic

For well known may arise from many diff causes.

Sometimes merely viscid bile or even viscid mucus in intest.

Sometimes coalit of ducts or [schir] of pancreas or other neighb. [viser.] giving compess.

In first case very easily removed

In latter for most part incurable.

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

These with cert. constit at least very liab. to be formd in the Gall [blad]

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

In this manner cause of jaund when impacted in ductus commun.

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

That calcul. cause of obstr. in pres. inst some presumpt. from being most freq.

Still more howev from suddenss of attack.

From height to which arose in short time.

And from severity of pain with which attended.

Formr not the case where effect of schirros.

Latter does not happen where proceeds merely from mucus.

Hence then though patient never before observd to disch biliary calculi yet strong presumpt.

And on this both prognos & pract. to proceed.

With regard to former of these indeed observat now entirely superceded.

For patient already dismissd free from affect.

This however may observe was the termin expected from commen.

And that princip from reasons already given by which inclind to think that depend on calcul.

For few inst of jaund from that cause which do not admit of cure.

And although not slightest case yet where nature insuff. will for most part yeild to artif meas.

That these employd in this way, had some effect. not I think import

Here will observe suppos affect to proceed from calcul. great obj to obtain removal.

And that either from being pushd back into gall bladder or from being forced into intest.

These ends cheifly to be expected from concuss & agitat.

And concuss not more effect obt in any way, than by use of emet.

For this purpose even single emet may often be suffic.

But although fails still room for hopes by same meas.

And where reason to concl. that has succeeded repet still prop.

For where dispos to [biliar.] calculi seldom that single

And as most easily disch when made by repetit return prevented.

These then reasons for direct two emet in first week.

At same time also prescribd aloet pills.

Only howevr to extent of gr V

And with no other intent than to obviate costiv

A conseq. naturally result from want of bile in alim canal.

And often even prod of worst sympt with which affect. attended.

Effect of these med seemd in every respect to answ to wishes.

For not only obvious operat intendd, but this also followed by all conseq. which could have desired.

From both emet brisk & free opr.

Soon after stools natural yellow colour.

As strong presumpt evid at least that obstr. already removed, & that bile now found way into intest.

From this perhaps as much as from pills to acct for regul disch by belly.

Yet little doubt that in prod this effect aloet. pill had also some influ.

Still howev to be consid as fav appear.

And this not less the case with anoth change viz dimin of yellowness

An evid indic that bile in [circ] mass now less abundant.

Still indeed deep colour in urine.

But this not evid of contin of obstr. nor even an unfav sympt.

For unless obstruct to disch of bile by this [emenat.] must necess contin till all introd into blood thrown off.

And always fav for patient, that free disch thus afforded.

In this situat then was now in hopes that nothing more in reality requis for cure.

But for reasons already [illegible] for repetit of emet. directed that should still persist at least for space of anoth week in same plan.

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

For with remarkab. dimin of yellowy stools & urine had now nearly acquird natural appear.

And even almost entirely free from any remain stom compl.

In this situat thought farthr contin of emet. unnecess.

Still howevr wishd that might contin attend for a little longer.

And was rathr with view of [secur] this than that thought then now requis that directed contin of Aloet Pills.

With these went on for forthnight longer.

And at end of that period dismissd free from affect.

Hence then from cure as well as other circum of case presumpt that depend on calcul.

And that removed by the operat of emet.