DEP/DUA/1/21/32 (Normalised version)

James Stevenson

(1779-1780)

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James Stevenson.

When came under our care subjected to many different symptoms.

And these two appeared to be me to be of most threatening nature.

Was indeed inclined to consider him as labouring under complication of affections.

And some of complaints with regard to which could form no very probable conjecture.

This particularly case with regard to some of symptoms with which first attacked.

Particularly pain in region of pubis, difficulty in voiding water & obstinate costiveness.

Respecting cause of these different suppositions might be entertained.

Might proceed from calculus in bladder

And this not uncommon even at early period of 6 years of age

While at same time not only producing affection of discharge of urine but also of faeces

More frequently however in way of tenesmus than of constipation.

But while calculus in urine bladder will affect rectum, so also will collection of feculent matter in rectum affect the bladder.

And from bound state of belly here occurring this supposition of the two the most probable.

But whether one or other of these suppositions to be adopted consider these [symptoms] as much less immediately alarming than others.

In pectoral complaint had here almost every symptom which could lead to [suspicion] of Phthisis.

Patient affected & that too for considerable length of time with fixed pain of side.

And this uniformly attended with frequent & severe cough.

While according to description of matter expectorated reason to think that somewhat of purulent nature.

Of this presumption not only from colour & quantity but from state of tongue.

For here while notwithstanding febrile symptoms continued moist had also uncommon red appearance.

Such a state may indeed take place from several different causes.

But among others observed to be almost constant attendant of purulent expectoration.

And here greater probability of its arising from that circumstance than from any other.

But if in pain of breast cough & expectoration symptoms of Phthisis, [suspicion] corroborated also by many concomitant circumstances.

In constant quickness of pulse had what with the symptoms above enumerated consider as strong mark of this affection.

Same also to be observed of alternate cold & hot fits.

And with dry state of skin the particular sense of heat in palms of his hands a symptom by no means the least characteristic.

Farther to be observed that although belly before bound yet after came under our care very [continual] state of discharge.

And indeed consider looseness which had now succeeded, as colliquative diarrhoea very generally attending last stage of Phthisis

Upon whole from all circumstances taken together very much decided in opinion as to nature of affection.

And while looked upon it to be Phthisis considered it also as being in advanced stage.

From this need hardly add what was opinion with respect to termination.

Had little hesitation in concluding that would prove fatal & that too in short time.

In this prognosis however now appears that was very much mistaken.

For patient if not absolutely recovered from affection at least very near it.

And that too without any particular efficacy to be attributed to measures which we employed.

That in prognosis however was mistaken proceeded from having mistaken nature of disease.

And probable that diarrhoea in place of being of colliquative kind was merely consequence of preceding state of constipation

While pectoral symptoms in place of being phthisis merely catarrhal

Case then if on no other account useful serves at least to show how may be deceived by symptoms of Phthisis.

And that while on some occasions an insidious affection having made considerable progress before discovery on others many & even most of symptoms will occur while yet absent.

When selected this case was with view to trial of some of these medicines from which think have seen good effects where high probability if not certain evidence of ulceration in lungs.

And particularly to trial of Gum Myrrh.

That in many cases where have exhibited this article, it has failed readily allow.

And that in some instances ulceration of lungs have healed up without interposition of art equally undeniable.

But that article may exist which on some occasions will forward healing or promote adhesive inflammation is not to be doubted.

And such I think from experience I have found myrrh to be.

Notwithstanding objects of Dr Fothergill [illegible] what he calls healing Balsams for my own part never saw any [illegible] of that kind.

And only object that have ever seen to use is in tendency to excite looseness

To this in phthisis at latter stages often a great disposition.

And when occurs to considerable degree to be moderated rather than promoted.

Although therefore was here intention to have tried Myrrh yet at first report looseness so considerable as to deter from use.

And thought it necessary first at least to endeavour to palliate that symptom.

Was with this view alone that had recourse to infusion Japonica.

And added Syrup Diacodium that from anodyne power combined with astringent might have still more considerable effects.

If however conjecture well founded could not expect that would have any influence as removing cause even of this symptom

And could look only at utmost for temporary alleviation.

Here however had evidently more considerable effects than looked for.

And that probably principally arising from having been mistaken with regard to cause.

Was happy to find that after continuation of medicine for eight days considerable diminution of looseness.

As cough however still frequent was not then led to suspicion that opinion erroneous.

And even looked upon swelling of legs as affording additional proof of Phthisis.

For in last stages frequently occurs from mere debility.

In this situation thought it still more advisable to continue medicine than to [alter] course.

But I own was surprised to find that at next report with considerable alleviation of all symptoms swelling of legs almost entirely gone.

This could I apprehend in no degree be attributed to our medicine.

From which utmost effect the serving in some measure to [restrain] looseness.

Now therefore considerable mitigation of pectoral complaint as consequence of tendency of catarrh to favourable termination in recovery.

And looked upon removal of swelling of legs as indication of recovery of strength.

While all these changes however under use of infusion japonica considered as most advisable still to persist in employment.

But at last report recovery so far effected that consider farther employment as totally unnecessary.

And while had formerly been of service as restraining looseness was now unwilling that should have any inconvenience to [combat] from it as binding belly.

Have now therefore entirely omitted medicine.

And disposed to hope that will here be no farther necessity unless in consequence of future occurrences.

And if such should take place must be accommodated to these.