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

James Keir

(1790)

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Jas Keir at 63.

In case of this patient, as formerly remarked obs had as well as in that of Jean McKenzie, a distinct markd case inst of Icterus.

For here unquest evid both of pres of bile in blood & absence in alim canal.

Condit, both of which, unquest essen to the disease.

And which when occur togeth, clearly demonst. obst. to natur pass.

This obstr. however as may readily concl. may proceed from diff cause.

Some much more readily remov than others.

Of all causes perhaps most freq. is biliary calc. making way into ducts

A cause very gener at least adm of recov in no long time.

For although in some rare inst so compacted as to be irremov, yet very gener can be either driven backw, or pushd forwards.

Partic from aiding effects of concuss. by that agitat relaxat which is given by [Antip]

This cause, calcul, from reasons formerly pointed out, supp. to induce affect in pres inst.

And on this ground was inclind to give fav prognos.

In this partic have not at least been disapp.

For in no long time, patient dism from attend entirely free from affect.

And this with some prob at least might I think be attrib to remedy here employd.

Began pract you will obs. by ordering an emet for patient.

As being easiest & readiest means of giving mechan concuss, tending to expell stone.

As an emet had here recourse to Ipecac.

An artic from which can more certainly command full vomiting than from any other which yet acquainted.

While at same time, neither dang. of operating by stool, nor of doing too much in way of Emet.

At same time that When ordered vomit, directed also aloet pills to extent of five gr om. n.

These in cases of jaundice useful on diff footings

Where obstr. merely from mucus may entirely remov it as prod. evac.

And from encr of persist motion of intest canal tend at least to aid even expuls of calcul.

But still more gener useful as obv costiv.

For this an almost necess conseq. of want of bile in intest.

And from costiv want of appet indigest, sickness & various other sympt prob. arise.

Operat of both of these med, fully answ expect.

For while from vomit Emet, had the concussion of full vomiting, from after use of pills had an easy stool, daily.

Had some reason even to believe that by this first emet obst. removd

For afterwards both stools appeard of darker colour, & counten less yellow.

In this situat however thought it still advis to repeat the emet.

For by no means that first [actin] of vomiting always suff for remov. of calcul.

According by some pract directed even to be repeated ever second day.

And even after remov. to be still contin, at longer interv.

Here then least first had not been effect, second natur suggest.

And if had removed obst. yet second emet would at least be prod of no inconv.

While equally little to be appr from pills.

In point of obv operat same effect derivd from med as before.

And now still more certain evid of removal obst cause.

For with great dimin of yellownss stools had regaind natural colour.

An evid proof of free passage of bile into intest, even although deep yellow colour should still rem.

For this often dep on effused bile into cellul memb. & not to be remov. till taken up by absorb.

And accord chiefly to be expected as grad operat of nature.

In this situat might perhaps have omitted med altog.

But directed contin of pills for anoth week, princip to secure attend.

And as then found that no remain either of yellowness or any other sym of jaund was dismissd.

Had not it must be allowed in this case certain evid of calcul from stom being disch.

But might either have been evac unobs. or thrown back into gall bladd

And addit evid of its depend on Calcul from cure.

To accompl of which think it prob that the emet. contrib.

While at same aloet pills good effect as obv. sympt.