DEP/DUA/1/21/02 (Normalised version)

James Burton

(1779-1780)

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James Burton.

Disease few symptoms distinctly marked.

Yet as to name at least some doubt.

But more from diversity of names to same affection than any other circumstance

Is affected with gripes tenesmus & bloody stools

And although neither quickness of pulse thirst, nor heat, yet can hardly assert that has been or is now without fever.

Though absent when history taken may [occur] at other time

And in such complaints frequent at particular times of day.

Besides might be present at beginning although now absent.

Cannot therefore from thence infer that [not] dysenteric

And with many wherever gripes tenesmus & bloody stools, even although no fever name of Dysentery employed.

Certainly however not with propriety.

At least very different from febrile diseases where same symptoms from peculiar contagion.

+ Or at least if has been product of peculiar fomes would consider influence as now over.

And if originating contagion Dysentery now look on patient as subjected to Sequel of that affection only.

At this state Diarrhoea & Dysentery not unfrequently the same.

That is leave similar topical affection of intestines particularly about rectum

To that alone would appropriate term Dysentery

And to present therefore would be inclined to give name of Diarrhoea.

Must however allow that Diarrhoea often in [different] state.

And not unfrequently rather [salutary] than morbid.

Not only cures self but even prevents other affections to which system would be subjected.

This however can by no means consider as being case in present instance.

For has now subsisted for six months.

And during that period has induced great debility & exhaustion.

May conclude therefore that whatever origin now supported even by local affection.

With regard to cause Patient no conjecture

And nothing to be learned from history which can throw light upon it.

May however observe that dysentery affection more disease of warm than cold climates.

And that both these & diarrhoea observed most frequently in this country after warm & dry summer.

This observation [confirmed] by last summer

Need not observe that there has never been in my [remembering] a warmer or dryer.

And never met with more instances of these affections

How connected hard indeed to say.

For certain that free discharge by surface tends to bind belly.

Heat indeed by evaporation from marshes may give rise to peculiar miasma.

And thus induce contagion.

Perhaps also may offer an explanation of induction of Diarrhoea where no contagion supported.

Probably from free discharge to great extent greater disposition to be suddenly checked.

And when does occur attended with more considerable consequences.

But whether this any share in induction of disease of our patient or not, now little doubt that at considerable height.

And not without apprehensions as to termination.

If as suspect intestines at extremities not merely morbid laxity or sensibility but [topical] disease cure always difficult.

And in many instances notwithstanding every remedy fatal termination

In present instance from long continuation system already debilitated.

And although no symptoms fever yet should not be surprised at occurrence.

May observe also that some anomalous & distressing symptoms.

Particularly pain about pubis affecting discharge of urine.

This do not consider as of itself threatening danger.

For look upon it as merely depending on spasmodic action propelled from rectum to neck of bladder.

Yet additional evidence of local disease

And of morbid sensibility in parts here principal seat of disease.

From all these particulars then cannot look for sudden cure.

And even not without doubts as to termination

Yet still at least no appearance threatening immediate danger.

And hope even that cure may be obtained.

If not, opportunity at least for trial of different remedies.

And although may not be able to remove shall yet be much disappointed if cannot give temporary alleviation of complaint.

This however not case with measures already taken

And that too notwithstanding use of medicine from which frequent benefits.

Although has failed yet on some general principles benefit from others.

Here have already said that suspect actual topical affection.

That is that part of intestinal canal probably near rectum actually in excoriated or ulcerated state.

And that such frequently occurs abundantly confirmed by dissection.

But healing of this as indeed in cases of superficial & external sores [must] in great measure be work of nature.

And great objective at which we are here to aim may be referred to two heads.

1 The restraining inordinate action arising from augmented sensibility.

2. The restoring tone to those parts of the intestinal canal in relaxed or irritated state.

As answering former intention no article with [which] I am acquainted sedative powers of which to be compared with Opium.

Of late indeed contended that Opium not to be ranked among class of Sedatives but Stimulants.

But he who denies that in general at least diminishes pain, produces sleep, & allays inordinate actions must contradict facts.

And by sedative every writer hitherto at least has understanding medicines possessing [such] power.

Was then with view to last of these effects that have had here recourse to it.

And if affection continues shall afterwards use it to greater extent.

For consider it at least as most certain means of palliating.

Neither of these articles products of this country

Nor do I know any we possess which can be considered as of equal efficacy

But hitherto used only to small extent.

And in treatment had principally in view not so much the immediate palliation, as producing more permanent relief from restoring tone.

This again as well as restraining discharge chiefly to be expected from different astringents.

And as such have already had recourse to two articles of both of which entertain high opinion.

Viz. Gum Kino & Succus Japonica.

First of these Gum Kino a new article of Pharmacopoeia¹ Edinburgh.

And has not I believe place in any other.

Has now however for several years been in practice at London.

And for introduction to public notice are indebted to Dr Fothergill.

On this subject paper in first Volume London Medical Observations.

Described it as a substance which had at different times met with under title of [illegible] Sang. Dracon. or fine Gum Senegal.

But is of opinion that as has no connection with either would more properly be named G. Rub. Astringent Gambiense

Recommend it as a remedy in all diseases proceeding from laxity & acrimony.

And particularly in Diarrhoea.

Since Dr Fothergills publication has been brought from Africa in considerable quantities

And not unfrequently employed at least by some practitioners particularly in this City.

Although name of Gum so far of Resinous nature that completely dissolved by spirit.

To this menstruum imparts fully its astringency

And accordingly place given to Tincture e Kino.

Began with it in this form as thus most certainly freed from impurities.

Here united with mint water in order to give proper form.

And added proportion of Laudanum that from [conflation] as restraining inordinate action, effects of astringent might be better obtained.

In this way have often before employed it.

And in some cases with very remarkable success.

Cannot however say that in present instance this was the case.

For during use for week symptoms rather aggravated.

And looseness in particular in no degree diminished

Could not however look upon it as having had any tendency to aggravate affection.

Nor inclined at once to desert it as [despairing] of advantage expected.

Hoped that by increasing quantity might still obtain good effects.

But when wished to augment dose [thought] it proper also to change form.

As quantity of Spirit in tincture objection to introduction to extent that wished.

From this led to use in solid form.

And with view of correcting flatulence [which] in some measure expected from Spirit add small proportion of powder of Cinnamon

That might better judge of effects also opium entirely omitted.

But thus given even to extent of scruple² without desired effect.

In these circumstances then thought it advisable to desist from farther trials.

And although want of success does not alter opinion of medicine yet consider as [unique] to circumstances of present case.

Now therefore have substituted to it the Succus Japonica.

This also another astringent on which in such cases great confidence.

This article with great impropriety has [described] in Edinburgh Pharmacopoeia the name of Terra Japonica.

Now universally allowed that entirely Vegetable.

That extract of species of the Mimosoideae.

And that all those earthy matters adhering to it entirely impurities.

Account of tree, as well as method of preparation, accurately described in London Medical observations by Dr Kerr of Bengal.

And authors of Pharmacopoeia [illegible] have accordingly changed name to that of Succus Japonica.

Have with propriety also introduced preparation under title of Succus Japonica depurative.

In [this] from solution in water [straining] & evaporating is freed from earthy matter.

And wherever to be exhibited in solid state unquestionably proper.

Here however employed it in state of watery solution.

And thus also get rid of impurities

For while all active parts readily dissolved in warm water earthy matter falls to bottom

Have thus then one of most elegant as well as most convenient forms of exhibition

For while water will dissolve the succus japonica to great extent not [restrained] as to dose by active quality of menstruum.

And water also menstruum for vegetable aromatic as well as for Succus Japonica.

Hence can readily give impregnation by addition during infusion.

For this purpose none perhaps better suited than Cinnamon.

And accordingly Infusion Japonica which we employ made with equal parts of each.

In general dram of each to ℥ VIII of water

But according to circumstances may be varied

Of this strength directed to present patient.

And with same intention as had formerly employed Laudanum with Kino, used here also

This I hold to be less active astringent than former.

To this conclusion should be led from sensible [qualities]

But still more inclined to infer it from what have seen in practice.

If however thus inferior from another quality better suited in some instances of looseness.

Particularly those where reason to suspect an [abraded] excoriated or ulcerated state.

Has less of resinous & more of mucilage quality than the Kino.

And from this circumstance better fitted for affording gentle [definition] to parts.

Is chiefly on this account that led to employ it after Kino used without effect

And hope that by proper continuation may overcome affection.

If this case may yet be [proposed] to put patient for some time on use of Peruvian Bark.

And by this means reason to expect that tone of viscera may be completely recovered

If not thus successful from Infusion Japonica in present state, shall yet push it farther

And before deserting use will give both astringent & opiate to greater extent.

From this practice, have I must own greater confidence than from any other that can at present suggest.

Yet should it prove ineffective various other measures which in such circumstances recommend

And is particularly in such cases that Simarouba & Radix Indica advised.

Latter of these however though highly extolled not yet introduced into Pharmacopoeia & not to be met with in shops.

Is chiefly product of Portuguese settlement in South America & principally used in Lisbon.

And from circumstances of being difficultly obtained rarely employed here.

For my own part have used it only in one case

And there without any good effect for soon after begun disease proved fatal.

Not however in any degree to be ascribed to the medicine but to symptomatic fever which occurred before begun.

And on dissection intestines & neighbouring parts found in highly ulcerated state.

From this therefore could form no opinion either for or against this medicine.

And have been prevented from future trials by not being able to procure it.

As Radix Indica difficult to be had so also is the Simarouba.

At least of such quality as to be depended on.

In shops barks very manifestly different from each other sold under this name.

Nor wonderful when consider that tree from whence obtained unknown even to most able Botanists.

Dr Wright however [an] ingenious Physician from Jamaica has now ascertained beyond [doubt]

And has given in paper on subject to Philosophical Society

If therefore can procure it good & genuine shall be disposed to give it trial here should Succus Japonica fail.

And to this the rather from [reputation] which has had not only abroad but in Europe also in circumstances nearly similar to those of our patient.

According to account by [Mr] Jussius [Member] of Royal Academy in flux which in France succeeded very hot summer used with great advantage

And represented by Degnerus as having had equal success in epidemic of same nature in Germany.

How far this as well as former, acts on any other principle than as astringent has with many been matter of doubt.

This however may at least observe that what represented as genuine not very remarkable for astringent.

And when given in large doses efficacy very different from what would expect from astringent

Would by no means however from this at once infer specific power.

On contrary consider trial as rather necessary both for determining effects & ascertaining mode of Operation

These then trials which at present have principally in view for combating affection of this [patient]

And which unless in as far as [counter] attended by future occurrences mean to put in practice.

If reduced entirely to plan of [palliation] shall chiefly attempt this by opium.

And in place of Liquid Laudanum will exhibit it in solid state.

Unless perhaps when shall think it advisable to have recourse to it in form of injection as well as taken by mouth.

Would fain however hope that case may soon put on more favourable appearance.

And that in place of being necessary to have recourse to any practice suggested may yield to measures already begun.

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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.

2) A unit of weight equal to 20 grains, used by apothecaries and physicians.