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Montgomery of Coylesfield

you do me honour in Consulting me and it
makes me happy to Consult with persons from
whose judgement I can get much assistance.

In the present case however there is little
occasion for nice judgement. Yourme full and
exact account of the Case leaves no doubt with
regard to the nature of it. There has been a Collec¬
tion of Gallstones in the gall bladder which,
as ↑they have↑ successively passed and stuck a little in the
Ductus communis have successively produced
fits of Jaundice and the last from its prodigious
size produced a considerable degree of inflammation.
For expediting the passage of these stones and
obviating the disorders which these passed, produced
there could be nothing more proper more judicious
or more effectual than the measures you pursued.
I hope the collection is now exhausted or though

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it should not I hope there can be none remaining so large
as the one you described and the passage of that must
have dilated the duct so very much as to render the
passage of any smaller tolerably easy. But if I should
be mistaken in both suppositions and a new fit of
Jaundice should come on I must own that I can offer
nothing better than what you have practiced, that is,
the use of purgatives by the mouth or in glyster with
assiduous external fomentation. Allow me only to
observe that in cases of so much pain and even with
inflammatory symptoms which require such bleedings
as you properly practiced I have found Opiates of
great service and employed with safety. I believe
it is only in this case and that of Urinary Calculi
that opiates and bleeding can be properly united in
practice.

In such case the only desideratum was a solvent
for that Calculus but this so far as I know is not yet
known to any body. We now know indeed a solvent

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of Biliary Calculi out of the body but it cannot hardly
be imployed internally and at least with any hopes
of its reaching the calculus. There may be some hopes
as I shall say presently of preventing the formation
of biliary stones but the means for that purpose can
not possibly have any effect upon a stone sticking
in the Ductus communis. However as at present
the measures that I hope that are only necessary
for your valuable patient are those for preventing
the future generation of Calculi or perhaps dissolving
those still present in the gall bladder. I shall
give you my best opinion upon this subject. I
have frequently observed and it has been observed
by others that the same persons who are liable
to Urinary Calculi have been also liable to the
biliary and biliary and Coylsfields Case is one instance of it.
Upon this supposition I have thought that the
medicines which are useful in the one case might

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also be so in the other, and being therefore certain of the benefit
of Alkalines in the case of Urinary Calculi I have thought
of employing them in the biliary. Although these concre¬
tions are seemingly of different nature and yield to
or require different Solvents out of the body, which
however is not strictly true yet as these concretions
occurr in the same persons it shows some disposition
in the fluids incommon to both cases. And in short
I have therefore employed Alkalines in the case of
biliary Calculi and I think with advantage. In
Coylsfields case in which there has been so much trouble
of urinary Calculi I have no doubts in advising Alka¬
lines. I have formerly prescribed them for him
myself but don't now remember to have had any
report of their effects. I think I have heard that
they were not absolutely effectual but I never
heard of their doing any harm. I would certainly
advise them now if you can find no objection to
the contrary. I leave it at the same time to

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your discretion to employ the Caustic or the Alkali
in broth or otherwise as you shall think most conv¬
nient. I have only to add that Soap has been fre¬
quently employed in the case of biliary Calculi and
I have no objection to it as the only reason I can
find for its use is the same analogy as above men¬
tioned.

The only other measures I have known pro¬
posed in such a Case is the grass diet you mention
of Van Swieten and some German Author's but I
held it to be absolutely frivolous and useless and
however this may be I am of your opinion that
nt in the present case it is quite inadmissible. ¹

I hope as I said in the beginning that Coylsfields
distress is for the present over but it is very possible
from the repetition of severe pain and from the
violent strain which the biliary duct and its vi¬
cinity has suffered that he may continue to be
such, Valetudinary and with various complaints

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for which it might be expected I should advise, but
you must perceive that I cannot exactly foresee the
circumstances that were to occurr and therefore
cannot offer any advice. If any thing occurrs in which
I can advise I shall be glad to hear from you and
answer you very punctually. In the mean time
I am of opinion that the business is only to be properly
managed by a person on the spot and I can trust
every thing to you. With most respectful Compliments
to Coylsfield I am with sincere regard