DEP/DUA/1/28/20 (Normalised version)

George Bathy

(1781-1782)

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George Bathy.

In case of this infant symptoms not numerous.

And very little doubt that all these connected together.

Most obvious & distressing part of affection [consists] in severe looseness.

And while stools to extent of 10 or 12 every day were not only accompanied with tenesmus but with prolapsed ani.

An occurrence by no means uncommon with infants.

But when taking place always very uneasy.

And tends not a little to support [other] affections particularly looseness.

Which however much more frequently the cause, than consequence of such an appearance.

And this had little doubt in considering to be case in present instance.

But viewing Diarrhoea as cause of prolapse yet still subject of inquiry whether idiopathic or merely symptom of some other affection.

Here two different circumstances to which some grounds for suspecting that might be attributed.

viz. Dentition & Worms.

Both one & other at early life well known to be cause of looseness.

In present case, besides looseness some other symptoms also, considered as indicating presence of worms.

Particularly picking of nose & grinding of teeth

These however symptoms, which although may arise from worms, often also from other causes.

Worms when present, generally induce other symptoms, particularly gripes or voracious appetite.

Seldom that product of any considerable affect, for space of month, without some being discharged.

These particulars, alone then, sufficient to lead us to conclude that were not cause of present affection.

But to all these still another objection in age of patient.

For although much more common at early than late periods of life, yet very rare occurrence in infants.

And for my own part have never met with example at early period of few months old, which age of patient when first affected with present complaint.

Hence then notwithstanding looseness combined with picking of nose, grinding of teeth etc, have little hesitation in concluding that worms no share as inducing the affection.

And would even consider this case as affording some evidence that from presence of these symptoms, existence of worms cannot with justice be inferred.

With respect to other supposition that viz of teething evidence much slighter

Well known that from this cause many dangerous symptoms induced with infants.

And these too not unfrequently prove fatal.

Among others distressing Diarrhoea one of most common

And besides occurring at time when teething most distressing during course several teeth had appeared.

From these circumstances then no doubt that teething had at least some share as inducing the affection.

And this the rather as when cough most severe there was from appearance of gums, reason to presume that teeth ready to cut them.

While farther evidence of irritation these afforded, from being frequently observed to put finger in mouth

From all these circumstances taken together was I own disposed to infer this might principal cause of affection.

At same time to be observed that from history of case had evidence of affection of alimentary canal, much earlier than teething

For are told that from time of birth till 5 months old much distressed with vomiting.

This indeed at that period of life, to some degree, a very common symptom with infants.

But when excessive as appears to have happened here, always indicates peculiar irritability of alimentary canal.

And from this circumstance was I own disposed to suspect that present affection in some degree from same cause.

And notwithstanding termination which has now had, still some doubt whether this was not in part the case.

At same time interval of health for some months, against the supposition

And still more the speedy & considerable relief, which patient had on several teeth being cut, after came under our care

Upon whole then now disposed to view it as sympathetic diarrhoea arising from worms

From same straining also would account for bloody appearance in stools

This then idea as to nature of affection

And to consider prolapsed ani as consequence of severe straining in tenesmus with tender state of bowels.

Or if to give name to affection would with Mr Sauvages term it Diarrhoea a denti

And here deserves to be remarked that in describing this species mentioned that often attended with many of those symptoms which occur from worms.

With this view of name & nature of disease prognosis more favourable than if had considered as idiopathic diarrhoea.

For on cutting of teeth as cause thus removed, had reason to hope for speedy recovery.

But as this event has already taken place farther observations on Prognosis now unnecessary.

And remains only to make few observations on practices here employed.

Considering disease as effect of teething evident that cure to be looked for only from operation of system itself.

For teething one of those processes of nature which have it not in our power to forward.

In some instances indeed as where convulsions or like occur advantage from cutting gum, above tooth.

From which however, benefit arising, perhaps more to be attributed to cutting irritated nerve, than to forwarding progress of tooth

This however unless against very urgent symptoms seldom practiced.

And as far as I know never against looseness from teething.

In this, as indeed in most cases, where dentition the cause of disease, sole objective to mitigate symptoms.

And in treatment followed with this patient aimed at nothing farther.

Prescription to which had here first recourse the Confection or Electuary Japonica dissolved in water, & sweetened with due proportion of sugar.

Need hardly observe that in this [complaint] the principle ingredient the Terra or Succus Japonica.

An article now determined with certainty to be a vegetable extract prepared from a species of the Mimosoideae.

And which very improperly esteemed earth merely from appearance which it acquires from kilns in which prepared.

In this article have a powerful astringent quality combined with mild vegetable mucilage.

In so much that where wish for gentle restrained discharge particularly from alimentary canal few more proper.

And accordingly in different forms long in use

Now perhaps even more employed than ever.

Form here directed has long had place in Pharmacopoeia¹.

And although different appellations yet no great change on principle ingredients.

These whether title of Diascordium Confection Japonica Electuary Japonica or any other much the same

With Terra Japonica as basis different aromatics as Cinnamon & Nutmeg conjoined.

And to these added a proportion of Opium

In present formula in Pharmacopoeia however besides Succus Japonica another powerful astringent the Gum Kino.

Nearly indeed to same extent as Succus Japonica.

And was on account of this conjunction that gave it here the preference to simple infusion of Succus Japonica.

From this medicine the Electuary Japonica have in former practice often found best effects particularly with infants as restoring looseness.

And from astringent & opiate conjoined may naturally expect best effects both as diminishing discharge into intestines & counteracting tendency to inordinate action.

In effects here were not disappointed.

For from commencement of use, looseness somewhat abated.

But while persisted in employment several teeth completely cut.

And to this I own, [fall] more than to medicine, was disposed to attribute mitigation of symptoms.

Notwithstanding both however, tenesmus & prolapsus ani still distressing.

From this led not only to continue medicine but to increase proportion of opiate.

Under this affection soon so far removed that reckoned farther attendance unnecessary.

And although consider medicine prescribed as having had some influence in mitigating symptoms yet look upon cure as having been consequence of cutting of teeth.

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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.