DEP/DUA/1/13/12 (Normalised version)

Elizabeth Curries

(1777)

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Elizabeth Curries.

Disease of this patient not every day to be met with.

Especially with one so far advanced in life as present patient.

For apprehend that affection, or rather peculiar modification of affection under which she labours is one more common with infants than at later periods.

Symptoms under which this patient labours as introduced into our register¹ in point of order not inconsiderable.

Imagine however that by much greater part of these, as debility, lowness of spirits difficulty of breathing etc consequence of disease.

And to same head may also refer considerable sensation of inanity.

For take this to be immediate consequence of food being discharged in indigested state

While at same time state of belly such that has commonly in space of 24 hours 2 or 3 loose stools.

This by most nosologists² considered as of itself constituting a particular affection.

Which distinguished by title of Lienteria.

May however I apprehend with greater justice be considered a mere modification of Diarrhoea.

And to be consequence of weak & irritated state of alimentary canal.

Consider diarrhoea then, & that too in particular state, to be great disease to which this patient subjected.

Cannot however represent it as only affection.

For although look upon it to have been cause of many symptoms yet others evidently unconnected

And even of earlier date than this affection.

That is whitish coloured serous discharge from vagina occurring at menstrual period.

Can be no doubt that this a certain degree of fluor albus.

Affection at utmost however but slight.

And with many women even to greater height is hardly considered as object of attention.

Consider it therefore as but very inconsiderable part of present patients disease.

And while plan of cure entirely [accurate] to diarrhoea consider this also to be only object which ought to regard in prognosis.

With regard to this must own was not disposed to entertain very favourable judgement

The affection in its nature one of those considered to be of dangerous tendency.

And unquestionably gives indication of most debilitated state of bowels.

In some respects indeed case before us with favourable circumstances.

Did not occur at early period of life which commonly attacks.

Our patient as being arrived at prime of life might be supposed to induce more than tender [infant].

But on other hand to be alleged that a greater deviation from natural state

And while already of considerable continuation had proceeded such a length as greatly to depress spirits & exhaust strength.

Should not therefore be surprised at its proving even soon fatal to her.

And apprehend that could not subsist under it for very long time in present state.

Am far however from representing affection as a desperate one

On contrary should here be disposed to hope for good effects from use of medicines.

And had patient continued regularly in attendance am inclined to think, that might have been able to alleviate if not to cure her disease.

To regular attendance however her great debility was strong objection.

And did not perhaps at first reap all benefits from prescription which she expected.

From these reasons probably it is that of late her visits to us have not been repeated.

And am even doubtful whether shall see much more of her.

After observations already given however, respecting what would conceive to be termination of disease shall briefly state plan of cure which would have reckoned it most advisable to follow.

And make few remarks on practices as far as went.

Have as already observed considered essential part of affection to be peculiar debilitated state of alimentary canal.

And that debility at same time conjoined with peculiar disposition to action.

Or perhaps rather inducing it.

Two great objectives then to be had in view are

1 The restraining inordinate motion

2 The restoring due tone to alimentary canal.

First of these ends chiefly to be [obtained] by gentle sedatives.

Last by astringent & tonics.

And such the nature of medicine which employed with this patient.

Began practice here by putting patient on a mixture of Confection Japonica.

In this medicine had an astringent & opiate united

And use soon followed by those affects which wished to obtain from it.

Went even length of binding patients belly

From which she complained that uneasiness in several respects increased.

To induction of such a state therefore this circumstance a strong objection.

And farther appeared that tone of bowels not so far restored as to give proper [illegible]

Thought it necessary therefore to avoid if could the recurrence of a similar state.

Was with this intention that wished to avoid Opiates

For to this not to the astringent ascribed this affect.

Considered to be merely effect of temporary removal of irritability not of stricture by tonic

By this circumstance determined to employ in place of electuary Japonica simple infusion of terra Japonica.

Although at same time consider these affects to be wholly founded in imagination of patient.

At same time with view of preserving discharge by belly & farther strengthening tone ordered patient to take daily small proportion of Rhubarb with Magnesia.

This course however not of much longer continuation than former.

For to Infusion Japonica patient disposed to ascribe worst affects.

Such for example as preventing sleep during night producing headache & occasionally even some degree of delirium

Soon therefore omitted use.

And with continuation of Rhubarb alone looseness rather increased.

In this situation thought of again making trial of Electuary Japonica as patient had before employed it.

Especially as she herself expressed some inclination for such a trial

After use however for space of eight days found symptoms nearly in same state as when came under our care.

And patient whose lowness of spirits soon led her to despair expected no farther benefits from use.

From this therefore again necessarily led to change, if wished that patient should take medicines.

Although at same time not satisfied that might not have derived advantage from persisting in course in which already put.

Although altered formula have continued former intention.

And still directed use of another astringent.

With this view had recourse to Lignum Campechense in form of Decoction.

What however has been effect of this have not learned.

As have seen nothing of patient since first put upon use of it.

May here however from this circumstance presume that not attended with desired effect.

And that disconsolable temperament of patient led her to apply to some other practitioner.

Had she continued under our care might have made trial of several other remedies.

Particularly of Rhubarb in different forms of Gum Kino of Peruvian Bark etc.

And reckon it not improbable that might at last have hit upon some tonic or astringent suited to habit from which might have obtained good affects.

Of future plans with this patient however need now say nothing.

As from absence for some time past probability is that will hear nothing farther with regard to her.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.

2) 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.