DEP/DUA/1/25/11 (Transcript version)

Andrew Reid

(1780-1781)

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Andw Reid.

Of case of this patient little to be said do not rekon is necess to offer many observat.

And that both as affect very sim to one lately treated & as has been but little subj of pract here

While at same time do not know what has been event of case.

Disease a very distinct markd inst of Icterus or Jaundice.

And here equally cert. evid of pres of bile in blood & of absence in alim canal.

First indicated not more cert by yellow colour than by deep tinge to urine.

Jaundice indeed may take place where lattr sympt does not exist.

For though bile pres in blood yet state of urin organs may be such that cannot in this way have free exit.

From abs. therfore cannot infer that jaund not pres.

Yet when does occur even less [equiv] mark of pres of bile in blood than yellow colour

For this in conseq of change in [serum] may happen even indep. of bile

And is probab. on this princip that to acct for tinge, in chloros. yellow fever & like.

But in inst before us, even if urine not affected, no such cause could here be susp.

And should have consid yellow colour alone as suff evid of introd of bile into blood.

In appear of stools again, evid of want in alim canal.

For although belly not bound [thus] deprivd of usual yellow tinge.

Hence then no doubt that consid if not total obst. to passage of bile into intest

Or in other words that disease jaundice.

And in hist here introd, most if not all those appear, which the common attend of that affect.

While at same time no few occur in pres case which can be reckond pecul. – Of these howevr some few

Unless perhaps be [enterd] such that no conts [issue] claimin attention. And first with [respec] to time of disch, belly natural.

Bound state of belly, it must be allowed a common sympt in Jaund.

And indeed a natural conseq of want of that stim to peristal. motn of intest which bile affords

At the same time, though in gener influ, yet not essent necess.

And inst may occurr where [ingest] or other secret fluids besides bile which still [pourd] into intest may in this way have full effect.

Such then suppose to be cause, of this singul if can be calld such when [time] [occur]

Anoth partic which may perhaps be consid as uncommon is freq [inclin] to disch. urine

This can by no means be repres. as a sympt never occur in Jaund

At same time not commonly markd in hist of the disease.

But perhaps rather surp as others, that does not more freq. occurr.

Partic in those cases where urin obtains very deep tinge.

For then no doubt that a pecul. matter impreg urine to be thrown off.

And from sensib qualit in alim canal, may concl. that here also stimul. power.

Hence then perhaps greater diff to expl. which why should ever be watery, than why sometimes occurrs.

In every inst however must be much affected by state of sensib.

And from more than common sensib are prob to acct for occur to uncommon degree in pres inst.

Here then only pecul. if can be calld such which here deserve [mention]

And upon whole

If in these however what to be consid in any degree as pecul. one still more stricking in mode of attack

Affect we are told commen after severe attack of univ Rheum.

And was immed conseq of Rheum pains sudden. ceasing.

If these circum in any degree connected as cause & effect, must be allowed very great singul.

But no reason to concl. that this is the case.

And while one set of circum may have given rise to cure of Rheum, anoth may have induced Jaund.

And this the rathr probab, as very diffic to conceive how cure of Rheum, & cause of obstr to bilious ducts, can be consid as in any deg. connected.

These then only pecul. if can be calld such, which deserve notice.

And upon whole, while pron case inst of Jaund, may at same time say that without any very uncom occur.

To apply this observat to prognos. would lead us to entert fav hopes.

For at least in greater number of inst disease removed without much diffic.

And as in case last treated here also I think reason to presume that depend on calcul.

A circum which if not cause of very slightest inst of Jaund. is at least seldom origin of incur cases.

Hoped therfore that by prop treat should soon have fav termin

Such an event there is some reason to presume has alr. taken place.

At least when patient last visited us, appear such as fav this suppo

But as has not of late attended no opport of knowing for cert. concl.

During attendance plan pron same as in former case

Repeated emet. directed with view to concuss.

By this hoped that calcul [migh] be disch & radic cure of affect obt.

Here indeed cathart not indic as means of obv. costiv.

But imagind that means of still farther gently moving belly, might be prop.

Partic as tending to disch of calc. if should make way from biliary duct into intest canal.

At first report after these med directed, appear as already observd very fav.

For not only mitigat of sympt but such change on colour of stools as gave reason to hope that obstr. already removed.

Perhaps therefore in reality no farther meas necess.

But still consid it as most adv plan, to rep emet & cont pills.

And hoped that at subseq repor still more convin evid of cure.

But as have not since seen patient cannot speak with confid as to termin of case.

At same time some ground for pres. that patients desertion has proceeded from having no farthr occas for assist.