DEP/DUA/1/47/37 (Transcript version)

Jean McKenzie

(1790)

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N^o23. Jean McKenzie.

In disease of this patient as form obs. a distinct marked inst of jaund.

For in sympt. undoubted evid both of admiss of bile into blood & abs in alim canal.

Has been much subj of controv. whether former to be ascribed to regur. or absorpt.

But whether one or other very immater as to pract.

As cure to be effected only by remv of obst to pass into alim canal.

This however may be prod from very diff causes.

And accord to nature of obst. not only is disease pract varied, but disease more or less obstin.

Perhaps most common cause of jaund, of any obstin, admitting of cure, is where dep on calcul.

And most common inst of incur. jaund, where depends on shirros.

For hitherto at least, no remed discov. by which resolut of this when of cert stand to be effected.

And although may at first exist without giving total obstr. yet a cause which has tend grad to encr.

Thus at length gives not only total but irremov obstr.

To this cause schirros. was former disp to conj. that obstr. in pres case to be attrib.

And during time that patien attend cont here no reason to alter opin.

Disease indeed while heard any thing of this pat. had not fatal termin.

But contin only to receive reports of her, for about a month after case under our care.

And since last of these reports near two months have already elap.

What therefore may now be state or whethr has already had termin cannot pretend to say.

Not improb. I think that fatal conc may have already taken place.

But may here obs. that suppos conj as to schirros giving an incur disease being well founded, this by no means necess. follows.

For in this case patients will yet often cont subj to the affect for many months.

Partic where as [repres] to be case with our pat. copious disch of bile by urin org.

In this manner then reason to hope that disease might not be speedily fatal.

And that might at least have opport of empl. meas. which if not capab of curing might yet allev affect.

Began pract here you will obs by prescr. emet

This need hardly obs. one of the most success remed for jaund depend on shirros, calcul.

And success depends on calcul being removed by conc which occas.

Is however very evid that on this prin can be of no use in schir.

On contrary where gall bladder very much distend concuss may be prod of worst conseq.

Reason even to [appreh] [illegible]

Hence where decided evid of shirros. some have entirely prohib use.

Seldom however that can conclude with such confid as to this cause, as to deter from attempts to cure on other grounds.

And but rarely that state of distens such that from even severe vomiting any danger effects to be dreaded.

In pres inst, notwith adv age of patient, unfav to any great conc. yet consid trial as both adv & prop

And if did not afford expect of cure, at least from want of success would have negat evid of shirros.

On these grounds therefore notwith susp of schiros here directed the emet.

And as safest & most cert [empl.] the Ipecac to extent of Ji.

From this not at least disapp in brisk & prop operat.

But at same time without any evid. of effect in remov cause of the dis.

For at distance of eight days after, both skin & stools, contin of same colour as before.

And although change on formr, not always immed conseq. of remov. of obst. yet this unif case with resp to later.

But although first unsuccess, yet from reasons formerly ment. judged it prop to make 2^d trial.

And from this at least not deterrd by any bad effects result from first.

While however directed 2^d emet. thought it advis also, to do someth. with view of open belly.

For while constip natural conseq of want of that stim which bile afford tends always to augm stom ailm.

As rather here had recourse to Pil. Aloet.

Formd of combin of Aloes with extract of Gent.

One of most cert & consist laxat which can employ where single stool only is req.

And daily used with great adv. in jaund as well as various other aff.

Here neither disapp in operat of vomit nor cathart.

For while former brisk action, later had at least some effect in open belly.

And were told that after this yellowness of skin seemd rather to be somewhat dimin.

This however prob more effect of inaccur obs. than any thing else.

For in this respect even attent obs apt to be deceivd from diff in light in which pat placed.

At any rate no more reason now to imag obstr removed than before.

For matter disch by stool, still equally white as formerly.

And while in this situat was also much affected, both with pain of belly & want of app.

In this situat thought that had now suff evid, that obst. not to be removed by action of vomit.

And in place of pushing emet farthr, thought it prop. to do some with view of strength stom.

With this intent had recourse to a mixt of bitter & aromat Tinct.

And to comb with this a diur power added to it, a proport of Fixd veget alk.

By this hoped, that tone of stom might be encr. & thus app. prom.

And that by encr. dius, bile being more cop disch by kidneys less chance of a [illegible] in blood.

Thus then though not tend to cure might at least in some degree allev. aff.

Cannot however say, that exp in these partic altog. answ.

At least though imag stom somewhat relievd yet urine not encr.

And pills now ceased to keep belly open.

With contin of mixt therefore obligd to encr dose of these.

Without howev giving fair opp for trial pat may be said to have [deserted].

For have now heard nothin of her for near two months.