DEP/DUA/1/20/14 (Normalised version)

John Lyon

(1779)

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John Lyon.

Symptoms of this patient but few in number.

And of such nature that can have no difficulty at least respecting name of the disease.

Yet cannot be said to be altogether so plain that no room for doubt as to nature.

Disease consists in frequent loose stools to extent even of 10 or 12 in space of 24 hours.

A period during which in ordinary [health] at a medium not more than one.

Matter discharged however no farther altered from natural appearance than might expect from such frequency.

Is indeed we are told, of thin [consistency] & frothy appearance.

When consider that discharge so often takes place as to allow no time for absorption first of these necessary consequence.

While again with thin feculent matter air bubbles naturally [illegible] which cannot happen or at least cannot be obvious [when] more hard & firm.

That with such frequency should at times be affected with tenesmus cannot seem strange.

This a consequence naturally resulting [from] [every] cause by which mucus from return abraded.

With these different symptoms however feculent matter at least in as far as is compatible with change of consistency retains natural colour.

And may safely venture to say that in this respect has undergone no morbid change.

Nor again on other hand is any morbid condition indicated by change of smell.

From commencement even till present period has been entirely free from fever.

No suspicion that disease either originates from contagion or that has had any tendency to affect others in similar manner.

On contrary ascribed & probably with justice to a manifest cause, action viz of cold to surface.

From all these circumstances taken [together] can have no doubt in pronouncing disease to be diarrhoea

An affection in this climate by no means infrequent & in some cases very obstinate.

But although thus little doubt with regard to name must [observe] that is by no means on this ground that [rational] plan of cure can be founded.

And that all practitioners by no means agreed with respect to nature evident from consulting either nosological¹ or practical writers

Though all nosologists very much agreed as to definition, yet have assigned very different [places] to this affection.

And must own cannot see [with] what propriety this genus, as well indeed as Diabetes, referred by Dr Cullen to general class of neuroses & to order of spasms.

Do not mean to [affirm] that inordinate muscular action not [concerned] in induction of them, or that may not be [composed] under general affections, where lesion of [motion].

But if on these principles to refer two diseases now mentioned to head of spasmi appears to me a very different matter to say what affections may not include under that term.

While at same time inordinate action in as far as does take place occurs only as second consequence of other morbid states.

To all this may be added, that [certainly] no natural analogy, between this & other affections referred to same order, as Tetanus. Trismus Convulsions. Epilepsy. etc

Would then upon whole conclude that while this an artificial arrangement contradictory to nature & founded entirely on theory is at same time an improper one.

Must think therefore that these nosologists have done much better who have classed it under head of increased discharge to which striking & natural affinity.

And indeed is by the evacuation that debility & all other dangerous consequences of this disease are induced.

Here however to be observed that frequent evacuation may result from very various causes.

And accordingly find that Sauvages & other nosologists have formed of these a very numerous tribe of species.

But without entering into considerations of these may take more simple view of matter & more applicable to practice.

Whatever remote cause may consider it as ultimately referred to one of these sources.

1 The state of stimulation [illegible] applied to muscular fibres of intestines tending to induce action.

2. The state of matter to be discharged as having a preternatural fluid [consistency]

And third state of muscular fibres acted upon as having greater disposition to have action induced from any stimulation.

When merely from first circumstance perhaps always to be considered as to certain degree salutary.

And is unquestionably most ready [means] by which irritating causes to be expelled.

This also frequently the case with second.

Or at least when changes in distribution take place in fluids, in consequence of increased discharge by intestines, other evils avoided.

In [last] case however discharge to be considered as always morbid.

And to this affection has natural tendency to degenerate when occurs as product of two former.

From consideration of these causes however [either] as simple or combined, both prognosis & practice must much depend

In case before us great reason to presume that at first arose from matter deposited in intestinal canal of uncommon fluid.

And that this proceeded from augmented watery separation in consequence of determination from surface to internal parts.

Now however has continued for long time after reason to believe that natural balance of circulation restored.

And has proceeded to such length as to induce with patient no increased debility.

May presume therefore that while [evacuation] not now [salutary] is supported also by morbid debility of intestinal canal.

Hence then although still no threatening symptoms reason to apprehend that will be both troublesome & tedious.

And this the rather as before he came under our care remedies judiciously employed insufficient for radical cure.

While again during attendance at this place after had in great [measure] [subsided] had again returned even without manifest cause

Yet although tedious hope that may at length be overcome

And that shall be able to dismiss patient free from affection.

On supposition that affection here the consequence of determination from surface to intestinal canal, practice before patient came under our care with great propriety begun by use of sudorifics.

And from these temporary recovery at least obtained.

But either from accidental neglect or from circumstances to which patient from situation naturally exposed, soon afterwards subjected to relapse.

When on this account therefore became our patient might have been expected that should again have had recourse to same measures.

But as administration of proper sweating [mentioned] with us be left entirely to patient themselves, & as often exposed to cold during the practice, wished to avoid it.

Was chiefly however with intention of giving determination to surface that directed the emetic.

And in this way few measures [illegible] more powerful.

For while from impression on stomach excited [illegible] tendency to diminishment of resistance at surface from [attacks] of vomiting have [increase] of force [propelling] blood [illegible].

Besides this evacuation of stomach often also of service as removing matters which otherwise from passing into intestinal canal would operate as stimulants increasing action

And accordingly find that from emetics good effects seem manifestly to have [arisen]

After operation stools both less frequent & of more natural consistency.

Having obtained this relief then considered it as most important objective to restore vigour to intestinal canal.

And thus hoped both to carry off remaining affection & to prevent return.

For this purpose use of astringents seemed most naturally indicated.

And here resolved upon trial of astringent from vegetable kingdom which with this intention at least but rarely I believe in use.

That was the Uva Ursi.

Of purpose to which this vegetable principally employed in medicine would here be foreign to our purpose to speak

May only observe that powder of leaves manifestly a strong & pleasant astringent.

And was solely with view of obtaining that effect that had recourse to it in present case.

Here combining it with equal proportion of powder of root of Hellebore which as conjoining aromatic & bitter hoped would act both as corrigent & [illegible].

Under this medicine continued for space of fortnight.

And apparently with good effects.

For during almost whole of that time state of discharge by belly may be said to have been in natural condition.

Had but one stool a day & that too of natural consistency.

But two days before last report looseness returned & with considerable violence.

Then also observed that powder gave some sickness at stomach.

Although consider both as affect of accident, probably of improper food creating disorder of stomach, yet led me to intermit medicine.

And have now put him [nearly] with same intention on mixture with Tincture [e] Kino.

From this, or use of former astringent, either by itself or as combined with some other aromatic hope that may soon be in condition to be dismissed.

If not, may have again recourse to Emetics or to Opiates.

And from these shall in all probability obtain temporary cure.

But [inclined] to think that radical recovery chiefly to be expected from giving strength to intestines.

And if these already suggested fail, may try [others] from vegetable kingdom as Lignum Campechense or from Mineral as Alum

But would fain hope that none of these measures will be necessary.

And that from present course patient may in no long time be in condition to be dismissed

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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.