DEP/DUA/1/18/14 (Normalised version)

George Karr

(1778-1779)

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George Karr another of patients now dismissed continued about month under care

Although affection chiefly characterised by frequent loose stools consisting principally of bloody matter & accompanied with tenesmus considered as instance of Diarrhoea

Or at least as being in no degree that peculiar febrile affection to which term Dysentery in strictest sense of word, alone applicable.

Considering disease to depend on disposition of intestinal canal to augmented secretion & increased action had some doubts with respect to termination.

Was however in hopes that might at length be able to restore him to perfect health & to dismiss free from complaint.

This end sooner accomplished than expected when last spoke of his case.

Had then put patient on use of succus japonica.

An astringent from which in such cases have often seen best effects.

Although therefore have apprehensions that should be obliged to have recourse to employment also of some others yet resolved first to give this fair trial.

When formerly spoke of case had employed succus japonica only in way of watery infusion.

And this reckon one of most [plain] & elegant forms of exhibiting it.

For by this means entirely freed from earthy matter often adhering to it in great abundance.

And indeed to such extent as to have long given foundation to supposition that was really an earth. Hence name of Terra Japonica.

Now however known that whole adhering earth merely impurity from kilns in which prepared.

And cannot help thinking that a succus japonica [illegible] should be introduced into Pharmacopoeia¹.

In this state when to be exhibited in substance whether in form of bolus, powder or like, should have it most pure

Although under use of Infusion, symptoms mitigated, yet on seeming tendency to relapse, thought it advisable to push it to greater extent.

And accordingly with infusion combined employment of it in substance.

Here directed use in form of powder

A state in which at least as readily acted upon by stomach as any other.

Here however directed it to be combined with pulveris Cretacea.

In this intention was to correct any acidity which might exist in stomach.

And which if existing would necessarily tend to support & aggravate complaint.

Often however occasioned looseness where no evidence of superabundance either from vomiting or even from acid eructation.

When present in stomach may be destroyed by all tribe of absorbents & even of bitters.

Of these however few more affectively or conveniently answer the purpose than common chalk.

Especially proper where with destruction of acid want rather to [combine] the binding than the opening of belly.

Under formula of Pulveris Cretacea have opportunity of exhibiting it not only in most pure state, but as combined with different aromatics.

Nutmeg viz & Cloves.

These however which strong & acrid [illegible] enter composition only in small proportion.

Imagine therefore that present combination would sit more easily & lightly on stomach, from still farther addition of [illegible]

And was with this intention that ordered with these powders same proportion of Cinnamon

In this state patient sensible of no inconvenience from medicine as affecting stomach

And can not doubt that exerted [here] as well as through tract of intestines, [effects] as an astringent.

To its operation am inclined to ascribe favourable change which soon afterwards took place in state of patients complaint.

For in no long time dismissed free from affection to which subjected several months before

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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.