DEP/DUA/1/13/03 (Normalised version)

Mary Lamb

(1777)

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Mary Lamb.

Disease of this patient with respect to name may be subject of some dispute.

Not however so much from any difficulty respecting nature as from different senses in which same term has been adopted.

Some who consider gripes, tenesmus & bloody stools as constituting dysentery.

And in this sense of term would necessarily bestow that appellation on present affection.

By term Dysentery however would wish to understand a peculiar febrile affection depending on a specific contagion.

Of such an affection in present case no room for entertaining any suspicion.

Used in sense in which I would adopt term have little difficulty in pronouncing disease of present patient to be Diarrhoea.

And while affords example of this affection to high degree is at same time in simple & uncomplicated state.

For besides morbid affection of feculent discharge all other symptoms such as common attendants of diarrhoea.

Thirst, parched skin etc natural consequences of serous discharge from the system.

While tenesmus & bloody stools in as far as do occur here merely affects of abraded state of intestines.

Want of menstrual discharge although for six years to be considered as natural state of system.

For to be observed that before this patient had arrived at forty fourth year.

A period before which not unfrequently leaves women

In history indeed one particular which would lead some to consider affection as somewhat complicated.

That is state of vegetable matters discharged

Are told that when these employed in alimentary come off undigested

This has by itself been supposed to constitute a particular genus of disease.

And in most nosological¹ systems distinguished by title of Lienteria.

Apprehend however that with impropriety considered as separate genus.

And cannot help thinking that Dr Cullen has followed best plan in conjoining with Diarrhoea.

Present instance affords even argument for such [apprehension].

For here lienteria affection holds only in partial manner

And while diarrhoea of long standing this symptom has never gone to any great height.

Respecting termination of this case am not entirely without apprehensions.

Cannot indeed say that has as yet had any very great influence on system.

Patient neither greatly weakened nor of apparently exhausted habit.

Has already however subsisted for considerable length of time.

And during that period has resisted affects of various medicines.

Of nature of these indeed have not been able to receive information.

But may reasonably presume that not the least powerful.

Since came under our care various articles used without effect of producing much change on affection.

And with regard to this disease may be observed that is one apt to become habitual to system.

When this the case both greater difficulty in cure & greater caution requisite.

As sudden means of checking often followed by very disagreeable consequences.

In such a case as present therefore objective to bring about rather gradual than sudden cure

And in attempting this endeavour [taken] employed.

Here after disease of so long continuation little reason to suspect any particular cause affording irritation to action.

Or at least if such existed could not imagine of that nature to be removed.

In present instance consider disease to be chiefly effect of increased disposal to action & augmented secretion by intestines.

At same time this augmented secretion not effect of increased determination to intestines.

For of this no evidence from state of pulse of heat or any other circumstance.

Would then upon whole consider the affection before us as principal effect of relaxed & irritable state of bowels.

And consider cure to be dependent on measures capable of restoring proper tone.

Which will at same time have effect of diminishing irritability.

This last however an end, at least more immediately obtained by means of proper sedative

Which in present affection may also be product of good consequences.

To be observed however that although have already said do not suspect any particular irritation to subsist constantly here yet such may be occasionally generated.

And from state of bowels now described may naturally suppose that there will occur remarkable disposition to acidity.

Of which accordingly at different times evident indications have appeared.

Is on these general principles that have already had recourse to the different medicines which have been used.

Particularly to Lignum Campeachy Terra Japonica & Rhubarb as astringents & tonics

To Magnesia as an absorbent.

And to Liquid Laudanum as a sedative.

From all these patient has obtained at least temporary relief.

And probably would have had more effect if had continued to take them regularly without intermission.

From inattention in this respect however after complaint somewhat abated, had again severe return.

But since that by use of Rhubarb conjoined with small proportion of Liquid Laudanum again considerably abated.

And if under this continues to recover should not think of changing it.

If however looseness still obstinate is intention to try with this patient a medicine which have used but little.

That is the Gum Kino

An astringent from vegetable kingdom which has not yet made its way into greater part of Pharmacopoeia²

And what indeed think somewhat strange not even in Pharmacopoeia Sueciae.

Upon authority however of trials by Dr Fothergill vid London Medical Observations has had a place in Edinburgh Pharmacopoeia.

And as found to make very elegant tincture have thoughts of employing it in that state

Should this also fail have next thoughts of trying Peruvian Bark

At same time conjoining it with a small proportion of an opiate.

And from one or other of these measures disposed to hope for good effects

Must however observe that in removal of present affection much must depend on avoid exciting causes.

And by cold producing determination to intent or by acrid matters supporting irritation there every other measure will be rendered abortive

Consider case therefore depending more on attention & regularity on part of patient than on any measures which we can employ

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.