DEP/DUA/1/18/05 (Normalised version)

George Karr

(1778-1779)

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George Karr.

Symptoms with which this patient affected not numerous.

And may justly consider whole as constituting merely one disease.

May however be some question with [regard] to nature of this disease.

But still more respecting name.

And that rather from difference in definition of terms than from differences in sentiments.

To disease of present patient some would affix term of dysentery.

While with others would have appellation of Diarrhoea only.

If consider as Dysentery every disease in which bloody stools, complaint of present patient unquestionably well entitled to that appellation.

But if on other hand by Dysentery mean a peculiar febrile affection either deriving origin from contagion or capable of being communicated by it, no reason for supposing that patient has any such disease.

For my own part am disposed to adopt term in latter sense

And to confine term Dysentery strictly to what called putrid or contagious Dysentery.

In this view hold present patient to be affected with Diarrhoea.

And that notwithstanding occurrence of tenesmus & bloody stools.

Which indeed am disposed to consider both in Diarrhoea & Dysentery rather as accidental than as giving any characteristic of the affection.

But although not characteristic of genus, may yet often serve to elucidate nature of affection.

For here to be observed that when under diarrhoea comprehended every instance of increased discharge by belly forms very extensive genus.

And accordingly will observe that Mr Sauvages in his system has defined upwards of twenty species.

Although at same time considers as separate & distinct genera the Celiaca & Lienteria which Dr Cullen has with [perhaps] greater propriety ranked under genus of Diarrhoea

Of all species described by Mr Sauvages case of our patient corresponds most exactly with what he terms Diarrhoea vulgaris.

And these discharges which take place does not so much consist of matter that has been used in aliment, as of matter separate from circulatory mass of fluids.

When this this case more disposed to bloody discharge than in most other instances.

And from alteration in state of secretion by which mucus [abraded], with this species also, tenesmus more apt to occur.

For occurrence of these circumstances then, here led not merely to name but to nature of affection.

And disposed to view present complaint as [consisting] principally in disposition of intestinal canal to augmented secretion & increased action.

On this idea of affection, cannot give a prognosis so favourable as would do in some other cases

For many circumstances such for example as mere irritation to intestines, or like, which in nature very [transitory] yet capable of giving rise to this affection.

Is nothing also in favour of patient that complaint has already continued for space of several months.

And that took rise without any obvious accident as tending to induce it.

At same time nothing as yet at least in case before us which portends much danger.

Patient at that period of life when such vigour as to give good chance of natural recovery

And has not hitherto at least resisted use of those medicines calculated for removal.

Upon whole then inclined to hope that in no long time may have favourable termination under such treatments as shall be directed.

With this view from opinion given of nature of disease imagined that great objective to be aimed at is

To diminish disposition in intestinal canal to augmented secretion or increased action.

And this chiefly [to] be brought about by strengthening tone of secreting vessels & [moving] fibres.

This intention however more easily accomplished if due regard paid to some other circumstances.

Particularly by diminution of impetus of circulation at intestines.

And by removal of irritating causes tending to support or increase augmented action.

On these general principles will readily understand different practices to which have here had recourse.

Began practice here by ordering for our patient first an emetic & afterwards a purgative.

In these sole objective in view, was by evacuating alimentary canal to remove all irritation [there]

For notwithstanding frequent discharge yet often happens that no proper or free evacuation.

And that either sordes in stomach or that indurate scybala lodged in plica of intestines give constant irritation.

Hence then becomes very necessary prelude to medicine either strengthening tone or diminishing disposition to action.

In case before us reason to presume that intention here in view fully answered

For both from emetics & purgatives free evacuation.

After evacuation then obtained had immediate recourse to an astringent.

And with this view employed Succus Japonica or as is still called in Pharmacopoeia¹ although [with] impropriety the Terra Japonica.

For according to accurate account of this medicine by Mr Kerr published in 5 Volume London Medical Observations is a vegetable extract from species of [illegible]

Hold it in cases of Diarrhoea to be one of best astringents.

And although may be given in different forms yet none preferable to infusion.

Here combined infusion with Cortex Cinnamon as carminative & Syrup Diacodium as sedative

For consider operation in both ways if not absolutely necessary at least as proper in present case.

Since patient began this medicine complaint considerably alleviated.

And hope that by continuation may be entirely removed.

If this however not the case shall probably have recourse to other astringents unless prevented by new occurrences.

And should these happen impossible to foretell what measures may adopt.

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Explanatory notes:

1) 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.