DEP/DUA/1/33/24 (Normalised version)

Nelly Grant

1783

---

Nelly Grant January 17. 1783.

In case of this patient nothing either peculiar or alarming.

But exhibits example of affection very frequent in this climate & at this season

viz Diarrhoea.

Of this sufficient evidence from frequency of stools.

While at same time without either fever to give suspicion of Dysenteria

Or any uncommon appearance in smaller discharge as takes place in Coeliaca, Lientery etc

Besides frequency of stools indeed when patient came under care affected also with other symptoms

Particularly pains in belly breast & head.

These however to be considered merely as symptomatic

And indeed some of them particularly gripes are almost constant attendants of this affection.

While headache again well known to occur as symptom of many different diseases.

But particularly of affection of alimentary canal.

Hence then to be viewed not only as example of Diarrhoea, but that too in simple & uncomplicated state

This disease often consequence of obvious accident.

Particularly from improper articles employed in diet & from action of cold on [surface].

First operates as giving peculiar stimulation to intestines second as occasioning uncommon determination of blood there.

But still more frequently as happened with present patient takes place without any obvious cause.

Then chiefly arising from peculiar state of secretion taking place into intestines.

Whatever cause in most instances at least not a dangerous disease.

And unless when allowed to run to great length seldom obstinate.

Then indeed disease has not only become habitual but such local affections have taken place as with difficulty removed.

But in case before us, symptoms neither severe nor of long continuation.

Had reason therefore to hope for that recovery which has now taken place

But of prognosis after favourable termination which has already occurred now unnecessary to make any observations.

This termination however I am inclined to think principally to be attributed to practices here employed.

For before came under our care disease had continually increased in violence for space of fourteen days.

But from time that began practices directed, symptoms began also to decline.

In treatment of this case you will observe, first prescribed for patient an Emetic.

From this had in part at least in view the giving determination to surface of body.

And thus by restoring equable [balance] diminishing flow to intestinal canal.

But still more intention to produce full evacuation of stomach.

By this means hoped to discharge sordes which collected there from passing downwards, would augment looseness.

While by emptying stomach, expected still farther advantage as paving way for other remedies directed at same time.

As an Emetic here, had recourse to Ipecacuanha.

Which where action of full vomiting required, is in my opinion, most certain means we can employ for obtaining it.

In this respect unquestionably preferable to emetic Tartar, the operation of which as an Emetic at least with respect to degree of action, much more [uncertain]

Some indeed inclined to consider this latter article as possessing great diaphoretic powers.

But as far as my own observation goes, have never been able to see anything confirming this opinion.

Indeed diaphoretic powers of either very much proportionate to preceding sickness & to degree of action, which induced.

These however, even from trifling circumstances, very various.

When additionally employed for determining [influence] to surface, no article more powerful as a Diaphoretic than Ipecacuanha.

As every day exemplified in combination with Opium when employed under form of Dovers powder.

Here therefore, besides certain prospect of obtaining thorough evacuation of stomach, as far as diaphoretic powers either proper or necessary, had reason to hope that should obtain them.

For degree of operation when employed in substance by no means proportional to quantity taken

As soon as operation begins, greater part of what lodged in stomach, discharged even in active state

Thus what may be considered even as overdose, has more the effect of securing & quickening operation, than of producing it to excessive degree.

Here neither disappointed in effects expected, nor did it do too much.

How far, to full & free operation of emetic, good effects which followed were to be attributed, cannot pretend to say

Of this, from another medicine, being at same time employed had no certain opportunity of judging.

But while reason to presume that had some influence in this way, little doubt that from stomach being previously emptied, articles afterwards used had more influence.

This article you will observe a simple water infusion of the Succus or as has long been improperly called of Terra Japonica.

The active astringent & mucilaginous parts of this vegetable substance admit of ready solution in warm water.

While at same time all earthy impurities derived from kilns in which prepared fall to bottom.

Hence then such watery infusion one of most elegant modes of exhibiting it.

To quantity of ℥i with from four to ℥VIII of water gives active medicine.

Merely by itself however tastes rather unpleasant & sometimes does not sit easily on stomach.

Hence though no adjuvant employed in Rx. yet corrigents sometimes necessary.

As such here you will observe employed to equal extent with Succus Japonica the Cortex Cassia.

Unquestionably one of most grateful of vegetable aromatics.

Is product of species of same genus of tree with that which furnishes the Cinnamon.

And excepting in circumstance of price very little if anything inferior to it.

Our being able to purchase it however at much easier rate an additional [inducement] to employment in Dispensary practice.

And even in private practice [where] Cinnamon ordered this frequently substituted by Apothecaries probably without any material injury to prescription.

With this corrigent especially when sweetened with due proportion of sugar of syrup forms a very agreeable medicine.

Accordingly though patient at that period of life when more apt to consult taste than [interest] taken without inconvenience.

From this astringent medicine had reason to hope that increased discharge into intestinal canal would be restrained.

While at same time from [increased] tone of muscle fibres, less liable to be affected by slight stimulation

In these expectations, probably [were] not disappointed.

For from time that began cure looseness gradually diminished.

And in space of two weeks, state of discharge from belly, entirely in natural state

While also, free from all other symptoms.

In this situation, reckoned farther attendance unnecessary.

And consider it as example of cure of Diarrhoea by means of Infusion Japonica