DEP/DUA/1/20/09 (Normalised version)

Margaret Brown

(1779)

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Margaret Brown.

This patient may consider as now in great measure free from affection to which subjected when came under care

Symptom to which she was principally subjected frequent loose stools.

These attended with gripes, tenesmus & a discharge at times at least of bloody [nature]

Not however as entering the composition of matter discharged but in separate streaks.

This combination of symptoms according to some practitioners would constitute what they call Dysentery.

But confining that term entirely to a disease depending on peculiar febrile contagion, to disease to which this patient was subjected would give name of diarrhoea.

Besides what now enumerated indeed, some other symptoms in this case.

Particularly swelling of belly grinding of teeth etc.

These however considered as merely consequences of weakened state of bowels.

And would view also in same light, pain seated in breast with which affected but which from concomitant eructations, evidently depended on flatulence in alimentary canal.

These symptoms we are told even more urgent before looseness began.

And may probably be considered as indicating [constitutionally] weak state of alimentary canal.

In such a habit less surprising that from an accidental occurrence diarrhoea should be induced

And according to conjecture of patients mother, not improbable that was here consequence of exposure to cold, from walking bare footed.

Than this few measures perhaps which have more immediate effect as inducing constriction of the surface.

And from this well known that determination internally which must of course take place, very ready to induce frequent loose stools.

From continuation of these, intestines soon so far abraded, that gripes, tenesmus & bloody stools soon the consequence of affection

Have thus then stated sentiments respecting nature of patients affection [when] came under our care.

And had I then been to give prognosis should have been inclined to give favourable opinion as to event.

Could not indeed have expected that constituent weakness of bowels to which patient subjected for several years would have ceased in short time.

But should at least have entertained hopes of speedy & favourable termination of Diarrhoea.

Such an event has we may say already taken place.

For from some of last reports appears that patient, now as free from diarrhoea, as if had never been subjected to it.

Still indeed have some of those symptoms which give indication of weakness of stomach & intestines.

And with such not surprising if from any slight accident, diarrhoea shall return

This however hope will not be case while patient continues under our care

And indeed if no new appearance takes place see little farther benefits to be expected from attendance here.

In treatment of this case while Diarrhoea continues remedy principally employed & on which put greatest dependence was repeated emetics.

These long [recommended] & even held in high esteem by most eminent practitioners.

Differences indeed in sentiments with regard to most advantageous mode of administration.

Some recommend that should be given merely in such doses as without [actual] vomiting will excite nausea.

Can be no doubt that thus very great determination to the surface.

And indeed most common emetics in small doses operate as powerful sudorifics.

Cannot help thinking however with Dr Sydenham & many others that here great benefit from full vomiting.

And while not less influence as altering [balance] of circulation, is of service also as evacuating [contents] of stomach

That Emetics were of great use to this patient can I apprehend admit of little doubt.

For while attended with effect of exciting full vomiting from time that use begun symptoms [gradually] diminished.

And soon entirely free at least from looseness to which subjected for several weeks before.

Besides Emetics indeed took for short time a small quantity of Succus Japonica with Rhubarb & Cinnamon.

And probable that this medicine also from astringency had share in diminishing frequency of stools.

In present state of symptoms do not consider either continuation of this or of the Emetics to be necessary.

Still however, as indeed may be readily imagined, patient affected with those symptoms which arise from debilitation of alimentary canal.

This however as already remarked consider as in some measure constituting state of bowels.

And to be overcome rather by regimen than by medicines.

Was therefore more with view that might not seem totally inactive than with any other intention that directed friction with camphorated oil externally.

For was in hopes that during delay for space of week complaint might be mitigated.

And if after this find pain of breast easier is intention to dismiss this patient.

If not shall put her on use of some tonic or stomachic medicine conjoining some article for expulsion of wind.

Now hope however that upon whole little farther will be requisite with respect to this case

And therefore consider any other suggestions of practice as unnecessary.