DEP/DUA/1/31/04 (Normalised version)

Jean Stuart

(1782-1783)

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Jean Stuart.

In history of this patients case a variety of different symptoms.

Some as cough, pain of breast & affection of breathing indicate a pectoral complaint.

Others again as pains of belly grinding of teeth, picking of nose and lips, symptoms of an affection of alimentary canal

Often indeed more especially considered as indication of worms.

But although may certainly proceed from worms as cause yet no doubt that may be effect of any irritation in alimentary canal.

When reflect however that affection now of two years standing & that no worms passed can hardly suspect these to have here any influence.

Would rather therefore view this part of affection as consequence of peculiar irritation of intestines

But while thus evidence of affections both of lungs & alimentary canal in present as well as last case have also [marks] of affection of bones.

From distortion of bones & enlargement particularly at joints can have little doubt in considering this affection as being Rachitis.

And with this patients age, in place of affording any objection tends to corroborate the supposition.

For is at that period of life when rachitis most common.

Disease also took origin from a cause to which that affection not unfrequently traced viz Measles.

Must indeed be admitted that some even of most common symptoms in Rachitis here wanting.

Particularly no [increase] of head no distortion of chest.

And although abdomen swelled yet neither appeared that this dropsical nor any marks of Anasarca swellings of legs.

But although dropsical affections as well as affections of head & chest common in this affection yet not necessary.

And in different cases has commenced in different ways.

Particularly where occurs not in most simple state but with any complaint.

And here when consider origin of affection, as well as other symptoms to which subjected can have no doubt in considering this to be the case.

When consider that glandular swellings have [appeared] externally reason to conclude that an affection of this kind still subsists in Lymphatic glands both of mesenteric & lungs.

And therefore consider her complaint as an example of Rachitis [illegible].

From this view of affection must be doubtful as to termination.

And would not be surprised if should fall a victim either to Phthisis or to Tabes Mesenterica.

Must however observe that affection although of a dangerous nature has made no great progress.

That many cases where even without the aid of remedies patients have gradual recovery.

And that since treatment of present case begun whether from operation of system or remedies which have been employed affection apparently diminished.

This however shall have occasion more particularly to mention in speaking of practices which have here been used.

First prescription for this patient [then] use of two vomits at short intervals.

These chiefly intended with view to affection of breast.

And while not disappointed in operation that had in this way good effects, may be inferred from relief of cough which soon followed.

No doubt that emetics the most immediate & most powerful expectorants which we possess.

And here probably good effects principally to be attributed to mucus discharged by means of them.

But besides cough had here also in view the unloading stomach.

For no doubt that sordes collected there, a very common & uneasy occurrence in Rachitis.

And therefore that Emetics a necessary prelude to any other practice.

But while expected these consequences from Emetics still more immediately with view to affection of alimentary canal had recourse to another remedy

Combination viz of Magnesium with Rhubarb.

This naturally indicated by marks of acidity.

As destroying this removes a cause by which tone of alimentary canal very much weakened.

While at the same time the Rhubarb both tends to prevent constipation & to brace intestinal canal.

Hence look upon it as one of best remedies with which am acquainted against such affections of alimentary canal as are the attendants of Rachitis.

In present case appears to have had good effects.

For since she began use these very considerably diminished.

With regard to affection of bones could not expect so sudden a change

This as observed with regard to case of former patient chiefly to be brought about by operation of system itself.

By absorption of watery & [incoherr.] matter & by fresh deposits of earth in more firm & compact state.

With a view however to forwarding this process have here also directed friction with camphor oil.

Imagine that both from friction itself & from the Camphor something may be expected.

And that has had good effects is at least presumed from diminishment of affection since began use.

If therefore matters continue to go on as have hitherto done shall not think of altering course.

Under medicine at present employed with operation of system itself, may I think hope for recovery.

And indeed patient at present in such a situation that more to be expected, from air, exercise & regimen than anything else

With these would probably indeed [form] recovery if cold bathing could be conveniently conjoined.

But both situation of patient & season of year at present objections to this.

Besides till farther evidence that no danger of return of affection of lungs, would even be inadvisable

Hence then if no new appearance or change of affection to the worse shall probably persist in present course till patient in condition to be dismissed.

But if these shall take place future practices must be accommodated to occurrences.