DEP/DUA/1/31/12 (Normalised version)

Peter Paton

(1782-1783)

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Peter Paton.

Case of this patient as described in register¹ consists of very few symptoms.

And in all probability disease might be considered as a very simple & uncomplicated affection.

State of discharge by belly excepted might be considered as in every other respect in perfect health.

Pulse indeed somewhat quicker than natural standard.

But in this respect with different individuals considerable variety

And nothing very singular if with present patient had been always this quick.

This the rather probable when consider that in other respects of natural strength & feel.

But even supposing that here a morbid change yet still evidently of no great consequence.

For when consider that not attended with anxietas febrilis or even with heat or thirst could not view it in light of febrile symptoms.

Suppose disease then to consist entirely in frequent watery stools.

In this view can have no hesitation in considering it as referred to general [term] of Diarrhoea

In this disease well known that many different modifications occur.

Of these some among practical writers distinguished even by particular names.

Such for example as Coelica, Lientery or like

In case before us from nature of the matter discharged there does not occur any of those particular [appearances] characterising such modifications.

At same time present case by no means without singularity.

Was no inconsiderable singularity that should continue for [such] long time without any affection of general health

But still more so that had such remission during night.

And that in morning discharge took place of natural consistency.

From this, reason to infer that augmented by erect posture, & action.

By these means little doubt that excremental matter more quickly brought to rectum than would otherwise be the case.

And this circumstance joined to [irresistible] propensity to frequent discharge even when little to be evacuated led me to consider affection as chiefly seated in the rectum.

As depending on peculiarly irritable state of that part of alimentary canal.

Probably also conjoined with weakened tone.

From this idea of the affection while furnished with explanation of symptoms, was [led] conclude that disease more [troublesome] than dangerous.

As had already for long time subsisted so might continue without any other inconvenience than that of obliging patient to go frequently to stool.

And as had not hitherto [resisted] any powerful remedies, particularly directed against local affection itself had more reason to hope even for expedient cure.

This the rather to be looked for if supposition well founded that depended on a local affection within reach.

And that too of such nature that had no reason to believe would be difficult to remove it.

On these grounds then expected I own what might be called speedy recovery.

At same time did not expect that would have been so soon as was really the case.

And I own was agreeably [disappointed] as to successful termination of this affection.

While at same time every reason for presuming, that was consequence of practices here employed.

On idea of local affection about extremity of rectum, became natural suggestion that cure most readily affected by injection

And on idea of increased irritability was chiefly to be expected, by a sedative allaying tendency to inordinate action.

With this however as [supporting] weakened tone to be also [conjoined] seemed advisable to employ a remedy which would have tendency to brace this part of intestines.

These views will naturally [point] out intention in practices here employed.

Remedy here employed the Thebaic Tincture thrown in under form of injection as being diffused in Decoction of Peruvian Bark.

Need hardly add that to former of these chiefly attributed cure in present case.

Here will perhaps be imagined that Laudanum employed in but small dose.

Given only to extent of thirty drops & that too in form of injection.

Opium indeed now universally allowed to act not by entering system [but] by exciting influence on sensible extremities of Nerves.

And might at first be imagined that would have equal effect to whatever part of alimentary canal applied

This however very far from being the case.

And unquestionable that as inducing sleep any quantity of Laudanum taken by mouth, more than [illegible] [illegible] [illegible]

That this the case experience I think has now fully confirmed.

For even from first injection very [considerable] mitigation of looseness produced.

And by repetition was entirely removed. In so much that after continued free from any return for near space of 8 days, & without any medicine, reckoned [farther] attendance unnecessary.

Here indeed, besides the Laudanum in the injection, as has already been observed, Decoction of Bark employed.

And to this perhaps, may be imagined, that something ought to be attributed.

That had good effect would not altogether deny.

At the same time am I own, [inclined] to consider it principally here, in light of a vehicle.

Especially from observations that affection ceased so soon.

For to derive anything from influence of bark as tonic, longer time & more frequent repetition would have been requisite.

And consider cure as chiefly if not solely affected by Thebaic Tincture.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.