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

Jean Small

(1783)

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Jean Small.

In case of this patient a distinctly marked instance, of an affection of which treated at some length in first case lecture.

That viz of John More.

Here therefore very few observations now necessary.

May only observe that in copious [illegible] eruption in numerous vibices, & in manifest tendency to haemorrhage without what can properly be considered as febrile symptoms have all the characteristics of what described under title of Petechanosos.

Here although affection had in few days, arisen to considerable height, no evident cause to which could be traced.

Symptoms themselves however sufficient to indicate nature of complaint.

And at time when case taken was not without apprehensions as to conclusion of it.

These however soon entirely removed

And from patient, being already dismissed free from affection any observations on prognosis entirely superseded.

May only observe that from present case [appears] that although symptoms may put on alarming appearance yet may in short time have favourable termination

[How] far this termination forwarded by medicines here employed will not pretend to say.

At same time seems to me most probable supposition that had share in the cure.

As in case of More imagined that affection most readily to be overcome by counteracting putrescent tendency.

And although measures there employed had not the success that could have wished yet here also had [recourse] to those powerful antiseptics the Elixir of Vitriol & Peruvian Bark.

These medicines taken as directed without any inconvenience.

And during use affection had manifestly a speedy decline.

In so much that in few days no more tendency to haemorrhage little remains of vibices & petechial very considerably diminished.

After continuing for another week symptoms entirely gone & patient free from any other affections.

In this situation then reckoned continuation of medicine or farther attendance of patient unnecessary.

And accordingly dismissed.

May here therefore with confidence venture to say that did not retard cure

And in as far as can presume between cause & effect probable even that forwarded it

At same time but fair to observe that between 13^th of June when case taken & fifteenth when medicines [ordered] symptoms rather declined as [otherwise]

And must also add that by means of them were not able to effect cure in case of John More.

Since last spoke of that patient several reports with respect to case introduced into register¹.

And as will observe by report on Friday last still under care for some [remaining] or rather for threat of return, of former affection.

On 15^th of May when last spoke of case from urgency of symptoms particularly sickness vomiting & headache Bark & vitriol intermitted.

And had recourse to Electuary Japonica & Pulveris stypticus.

From these some temporary good effects seemed to be obtained.

And particularly from application of [latter] to cut in lip haemorrhage from that part entirely stopped & has never since returned

From subsequent reports however will observe that on 17^th bleeding again began from nostril.

But of itself spontaneously ceased after considerable discharge.

Showed however evident tendency to return.

And as topical astringents formerly product of so good effects led to think of employing astringents to act on system in general.

With this view had recourse to succus Japonica.

But combined it with Cream of Tartar both countering tendency to bind belly & to obviate costiveness to which patient naturally disposed.

Under this medicine continued till 2^d of June.

During all that time no return of haemorrhage & livid blotches had almost entirely disappeared.

Principle remaining complaints weakening & tendency to vomiting although appetite somewhat mended.

Imagined therefore that would now be better to omit all medicines & to trust entirely to such [nutritious] diet as patient capable of taking.

Accordingly under this course gradually recovered strength for near space of month.

And was again in situation to enjoy [unsupervised] [amusement] out of doors.

But about beginning of July some fresh livid blotches again appeared upon legs.

On this appearance had immediate recourse to mixture of Bark as formerly.

But although readily taken did not prevent some return of haemorrhage as well as farther appearance of vibices.

In this situation, as some reason to think that bark inadequate to cure have had recourse to another measure suggested by natural indication or longing.

Patients mother has observed that when affection formerly at worst & since again aggravated that has shown a particular inclination to eat lime earth & several other substances.

On this uncommon desire two suppositions may be entertained.

Not impossible that indulgence of such cravings arise from some peculiar state of stomach has given rise even to affection of mass of fluids constituting present disease.

For can easily suppose that this appetite may have taken [place] before ailment & that may have indulged it unobserved to considerable extent.

At same time has only been remarked during severity of affection.

And therefore no less probable supposition that is a natural craving the indulgence of which will prove cure

Is almost inconceivable how extraordinary the salutary longings of patients frequently are.

In so much that some disposed to think is safe general rule to [indulge] [depends] of patient in every case.

On this subject cannot help thinking that a rule laid down by late Dr Monro in Clinical lectures one of best I have heard.

When patient made any urgent [desires] either in way of food or medicine asked the reason for it.

If they assigned reason gave it or not as his own judgement led him to think proper.

But if they knew not why they asked it, never failed to alleviate it even although would have been disposed to think it very improper.

And after long course of practice found that following this rule attended with best effects.

In case before us then, viewing article longed for as of tribe of absorbents have, by way of experiment directed a medicine of that kind viz Magnesium Alba.

How far any good effect will appear from trial.

And what to be after treatment must be determined by circumstances in which shall then find patient.

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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.