DEP/DUA/1/23/02 (Normalised version)

Janet Kennedy

(1780)

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Janet Kennedy.

Though symptoms distressing yet disease not very distinctly marked.

Might at first be suspected that symptoms to which principally subjected depend on disease of urinary organs.

Pain of which complains chiefly in region of loins.

Hence some reason for concluding that referred to kidneys.

And difficulty with which affected in passing water may be mentioned as a circumstance corroborating this supposition.

While at same time, such change also described to have occurred in appearance of urine as to indicate morbid state.

For is remarked often thick & muddy.

Although however several symptoms thus indicating affection of kidneys yet by no means amount even to probable proof.

If suppose this to be the case will most naturally conclude that disease depends on calculus & gravel in kidneys.

Of such an affection however many symptoms here wanting.

Pain not observed particularly seated in region of kidneys.

Nor propagated in direction in which nephritic pains in general are.

Not attended with same sickness at stomach or vomiting.

No remarkable aggravation of pain or bloody tinge to urine on motion.

Nor as far at least as patient, able to observe, has sand been ever discharged with urine.

A circumstance which when consider continuation of patients disease, alone sufficient to invalidate supposition of calculus or gravel.

To all this farther to be added that such symptoms as here take place frequently arise from affections of other parts.

And particularly are product of affections of alimentary canal.

Such a cause however when attend to history of affection should be inclined to suspect in instance before us.

Is ignorant indeed of any particular accident to which affection to be referred.

But have first commenced to severe colic, with which first affected about six years ago.

Since that has been subjected to frequent returns of same ailment.

And besides these constantly affected to considerable degree with borborygmi flatus & sour [crustation].

In all these evident affection of alimentary canal

From this also pain of loins may readily arise.

While at same time explains to us, why pain should at times, affect different parts of abdomen.

For such pains of intestinal canal particularly where flatus or borborygmi & where reason to conclude dependent on spasms readily [propelled] from one part to [another]

Yet in general most frequent at some particular part as there principally diseased state.

In this manner would explain its being principally remarked in loins.

Probably as chiefly seated in colon

And from distention of this part of alimentary canal giving compression to urinary passage would readily account both for difficulty in discharge & morbid appearance in urine

Upon whole then consider disease to which this patient subjected, as being an affection of alimentary canal, but principally of larger intestine.

With this idea of nature however still at loss what name should assign to it.

Nor do I know any genus described by nosologists¹ to definition of which can be considered as corresponding.

If examine those in system of Dr Cullen should find that has more of symptoms of Dyspepsia than of any other.

Yet when consider that affection of stomach by much least considerable part term unquestionably in some measure improper.

Nor does it correspond to definition or description of colica gastrodynia Flatulence etc.

Yet upon whole more exact correspondence with definition of latter disease than of any other.

Were it necessary to give it any name, should be inclined to bestow upon it that appellation.

And of all species which Mr Sauvages has referred to that genus [case] of our patient most nearly resembles what described under title of Flatulence acidae.

But if conjectures as to nature of affection well founded name immaterial.

For is on nature of complaint that prognosis must be founded & to this the cure to be directed.

From what have said of nature opinion entertained of event in present instance cannot be very favourable.

No reason indeed to consider patient as in any imminent danger.

Under symptoms from alimentary canal much more distressing patients will continue for great length of time.

And often even if not perfect recovery at least very considerable relief.

Yet more frequently happens that patient once subjected to such [ailing] continues distressed during whole remainder of life.

And when consider that patient already six years subjected to ailment, of this some presumption.

Especially when consider cause from which had its commencement viz violent colic.

This it is well known even where suspected to be entirely of spasmodic kind, yet accompanied with some degree of inflammation.

Thus often even [illegible] foundation not merely for weakness but for local affection.

And by this means tumours, strictures or [like] which at length fatal.

That this therefore may yet be conclusion of present case is not I think certain.

Yet am rather disposed to fear that will prove a tedious than dangerous affection.

With view however to removal several measures which may be taken with at least some probability of success.

And although these should not answer to wishes may still at least be conjoined with practices from which reason to expect alleviation.

Here in as far as idea of nature of affection is well founded radical cure must depend on restoration of vigour to alimentary canal.

While again relief of symptoms as pain, borborygmi, flatus & eructation to be chiefly expected by obviating costiveness & spasms.

Besides this measures it is true may also be requisite for counteracting acidity.

But this probably may follow as consequence of due tone of intestines being restored.

And particularly of use of bitters with that intention

For by this means may both destroy present acid & remove cause.

Well known that bitters as well as absorbing possess power of neutralising acid.

With different intentions now mentioned then various measures may be taken

Before however attempt anything with view to radical cure thought it first necessary to obviate symptoms

But particularly costiveness.

For while this continues great reason to presume that every measure taken with view to radical cure ineffective.

And that even many of these as augmenting this symptom might aggravate affection.

For no doubt that in consequence of distension & obstruction of alimentary canal by retained faeces, such complaints more aggravated than perhaps from any other cause.

While however here employed measures for obviating costiveness wished also to counteract inconvenience from flatulence.

Not so much indeed by preventing generation of flatus as by affording ready escape to what already generated from removal of spasms by which retained.

Was with these particular views then, that had here recourse to first & indeed only prescription yet directed for this patient.

With intention of obviating costiveness may here observe that in such cases often very great difficulty.

For while never fails to have very great distress from bound state of belly so on other hand complaint uniformly aggravated by severe purging.

And often happens that purgative answering with one will by no means succeed with another.

Hence most proper purgatives in such cases to be determined rather by trial than by reasoning

With one belly most easily kept gently open by aid of saline purgative

Such for example as Cream of Tartar. soluble Tartar or Salt Polychrest.

With another intention best answered by oily or lubricating purgative as Oil Ricini, olive oil with Mamma or Tincture of Jalap, Lenitive electuary consisting principally of mucilage fruits or like.

While in third case nothing better suited than sulphur.

Yet although all these accommodated to particular cases have found aloetic purgatives more generally useful in such instances than any of them.

And particularly as given in solid state under form of pills.

For this purpose have often observed best effects from pill aloetic of Edinburgh Pharmacopoeia² where aloes conjoined with Extract of Gentian principally with intention of giving form.

To these therefore, where merely intention to obviate costiveness have in general recourse in first instance in [preference] to any other.

While aloetic pill thus useful in obviating costiveness so among different carminatives none more generally successful than pill Gummos.

Although into these various articles enter, yet consider efficacy as principally dependent on Assafoetida.

And principally from effects of operating as stimulant & at same time obviating [spasms]

But as answering these purposes effects nothing counteracted from being conjoined with aloes.

Accordingly am of opinion that might with propriety introduce as fixed formula in Pharmacopoeia, a pill in which aloes & Assafoetida conjoined.

Such often of late used in practice at the Dispensary both by Dr Webster & myself.

And in many instances attended with best effects as conjoin advantage of Pill Aloetic & Pill Gummos.

These we often prescribe under title of Pill Foetid cum Aloe.

In which case consists of equal parts of Aloes Assafoetida & [illegible] Soap intended with view of giving form.

Where however circumstances require, proportion of each may be altered.

And particularly either quantity of Aloe or of Assafoetida may be increased accordingly as have in view the obviating costiveness or flatulence.

From this prescription then in present case hope that most urgent complaints of patient may be obviated.

And if this end thus obtained will next be endeavour to conjoin it with [such] measures as may operate in producing radical cure.

That is such as will serve to restore due tone to alimentary canal.

With this intention more to be expected from those articles having immediate action than operating on system in general.

And few more successful than the vegetable bitters.

To many of which indeed whether as acted upon by watery vinous or spirit menstruum from properties as particularly acting on stomach, general title of Stomachicus medicine given.

To such then mean here to have first recourse.

And for this purpose mean to employ the Infusion Amarum of Edinburgh Pharmacopoeia conjoined with a preparation of Tincture Rhei.

In former one of purest vegetable bitters & what I reckon very useful tonic viz the Gentian.

While at same time more remarkable power of destroying & neutralising acid than perhaps any other of the Vegetables.

To present case then according to ideas of disease consider it as particularly adapted.

But from conjunction with astringent of Rhubarb imagine that quality may be improved.

Hope then that under these [indeed] may in time be able so far to counteract morbid state & to obviate symptoms that patient may be dismissed from farther attendance.

If however this not the case & if continue to hold same opinion of disease as at present, may yet have recourse to other purgatives, carminatives, antacids & tonics.

And if from future appearance any ground to change sentiments [measures] must then be accommodated to opinion which shall afterwards adopt.

But whether shall then have reason to suppose symptoms to proceed from calculus or other local disease in kidney, intestines, or any other of Viscera, or cavity of abdomen at present [cannot] [suggest] what may then be [thought] [necessary]

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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.

2) 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.