DEP/DUA/1/21/08 (Normalised version)

Euphan Preston

(1779-1780)

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Euphan Preston.

Symptoms in many respects similar to those of a patient already treated of G. Burton¹

Hence less necessary to be said with regard to it

Here also complaint consists of frequent bloody & slimy stools with tenesmus.

And to these may refer all other symptoms palpitation. dyspnoea & pain in back

Can have no doubt then in considering it as one of numerous instances of looseness which have succeeded very warm summer.

Considering however dysentery as a name [which] ought to be appropriate to a disease depending on peculiar contagion, would give this appellation of Diarrhoea.

And that notwithstanding tenesmus with discharge of slime or blood to considerable extent.

For these hold to be merely accidental circumstances which may occur in both diseases.

And to be totally unconnected with cause from which the affection may arise.

Whether then diarrhoea or Dysentery to be determined by other circumstances.

And here to be observed that patient has mentioned no circumstances which can lead to suspicion that derived disease from contagion.

That no reason to think this affection in her has produced it in any other.

And lastly that has neither now nor formerly been attended with any fever.

All these circumstances however commonly to be remarked with regard to Dysentery.

And concomitant fever in particular during earlier stages very considerable.

While then name of Diarrhoea, must also remark that far from same severity as in last case, that of Burton

Not only of shorter duration but without those violent & fixed pains from under part of alimentary canal.

Here then less reason I think to suspect local affection.

Or at least in way of ulceration, scirrhous contraction or like.

Here only morbid condition probably is peculiar morbid laxity of parts.

And in consequence of this an [abraded] & irritated state

While again from mere exhaustion all other symptoms to be explained.

While however thus explain symptoms not perhaps so easy to account for another circumstance.

Relief viz which patient has obtained from a different disease since this commenced.

Was before we are told subjected to affections of Dyspeptic kind.

And these at least since commencement of present disease not so severe.

Perhaps principally to be ascribed to their being less object of attention during more serious complaint.

For certain that no affection more than stomach complaints aggravated by thought.

But probably also in some measure [relieved] from open state of belly.

For from this very generally some alleviation of stomach complaints.

At same time however must be observed that from violent purgatives always aggravated.

And therefore at least doubtful in present case whether relief from this circumstance.

But here though frequent not considerable discharge.

Gives therefore greater presumption that may have arisen from this circumstance.

And not improbable that on being freed from present affection will again be subjected to it

Thus far then prognosis unfavourable.

For in any situation but especially with such a patient as present these complaints very difficult to be overcome.

But if thus apprehensive of return of former complaints proceed on hopes that present affection unquestionably more dangerous may be overcome.

This am still in expectation may be soon accomplished.

Although must at same time observe that has already continued with greater [obstinacy] than at first imagined.

Or rather has again returned after once in great measure gone.

Remission once obtained for this patient am inclined in good measure to ascribe to remedies employed.

Here imagine that cure to be effected by restoring vigour to intestinal canal as simple solution.

By restoring tendency to increased discharge from giving constriction of vessels.

And by diminishing disposition to action.

Was with these views that had here recourse to an astringent combined with an Sedative.

And here as in former case employed succus Japonica in form of [simple] infusion combined with a small proportion of Laudanum.

My opinions of this medicine already stated & some length when spoke of case of Burton.

And if these expectations from it disappointed has here I think [supplied] [characteristics] which [gave]

From time that patient began use some of most urgent symptoms considerably diminished.

Looseness in particular became less frequent.

And discharge of blood almost entirely disappeared.

Was not surprised that should still complain of pain of loins.

For this consider as principle effect of debility

And removal of that in every case work of time.

Nor did I think it strange that tenesmus also should continue.

For this consider as only affect of rectum being still in abraded state & without [illegible] [covering]

And when once thus laid bare restoration can never be suddenly effected.

Hoped however that by short continuation these symptoms also might be overcome

And with view of more readily obtaining this affect directed dose to be increased.

After continuing in this manner for week longer progress to recovery still went [on]

And considered her as entirely rid of disease.

For now no more in general than one stool in space of day.

And that too of natural consistency & without tenesmus.

Hoped therefore that now both strength of intestines & state of disposition to action in natural state.

Considered it therefore as more advisable to omit astringent than to persist in use.

For apprehensive that might now be product of inconvenience as [inducing] opposite state.

And from retention of indurated faeces [reason] even to imagine that former disease might be renewed.

Should have wished therefore that patient had continued for week without any medicine.

But as still complained of pain in back was desired of [application] not altogether inactive.

With this intention therefore ordered [illegible] of Bark with Camphor oil.

And besides [illegible] patient imagined that if pain in any degree a muscular affection might be of some service.

But was in hopes that with regard to looseness nothing farther necessary.

In this however now appears that was mistaken.

For almost as soon as medicine omitted patient subjected to return of all former complaints.

But whether this affect of any accident to which exposed, or of state of alimentary canal being still such as to require astringent is perhaps matter of doubt.

On either supposition however same reason which formerly led to use of Succus Japonica induced me to repetition.

Now however have somewhat varied form.

And with same proportion of other article have introduced double proportion of Succus Japonica.

As now inclined to think that [intention] requires greater astringent than once imagined.

Am in hopes that by repetition of medicine disease soon again overcome

But should temporary alleviation be obtained will not again be disposed to give up use so soon as formerly.

To secure effect will continue it for some time although perhaps in smaller doses.

And if again product of desired effect shall persist till product of some inconvenience or till consider disease as cured.

And this hope may in no long time be affected.

If however should be disappointed consider present also as case in which may make trial of Simarouba.

Nor do I consider want of success in instance in which have seen me lately [despair] it as any object.

For besides that case very bad one, Simarouba employed although [generally] Bark, not of good quality.

Trial therefore, if necessary, must depend on obtaining it in more recent state.

Should I not be able to procure it may here have recourse to other medicine of Tonic or astringent tribe.

Particularly Peruvian Bark or Cortex Salix Alba.

But in hopes that none of these will be requisite.

And that by medicines on which patient already put disease may be completely cured.

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Explanatory notes:

1) G Burton is most likely James Burton.