DEP/DUA/1/34/16 (Normalised version)

John Stark

(1783-1784)

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John Stark.

In case of this patient have an example of an affection by no means [unfavourable].

And in symptoms with which is attended nothing that can be [considered] as very peculiar.

In very frequent stools to which subjected have the distinguishing symptom of Diarrhoea

While nothing of that appearance of blood, which can give presumption of Dysenteria.

And this indeed, farther rendered improbable by absence of febrile affects even on attack of the disease.

Here frequency of discharge probably in some degree depended on augmented watery secretion into intestines.

But had reason also to suspect a particular local affection at extremity of rectum

For was I apprehend in consequence of this, that affected with severe pain about anus, by which incapacitated either from walking or even sitting.

This state of rectum may possibly have been consequence of secreted matter possessing peculiar acrimony being deposited & retained there.

But however induced, after once taking place constitutes no inconsiderable part of disease.

And to uncommon sensibility thus occurring, are probably to attribute those very frequent calls to stool to which subjected when first applied at Dispensary.

On idea of such a local affection [had] more reason to dread that disease would prove obstinate.

And [of] this also its continuation with increasing violence for space of ten weeks gave stronger presumption

Accordingly when patient first applied for assistance was suspicious that disease would prove tedious.

And although by opiates or other means, might allay sensibility for the time, yet was very [apprehensive] that would be liable to [recurrence].

This it is not impossible may still be the case.

At same time relief which patient has already received gives grounds for entertaining more favourable hopes.

This relief can have no hesitation in ascribing to remedies here employed.

A mixture viz the basis of which was confection Japonica.

Where with the succus japonica one of best vegetable astringents, different aromatics & some proportion of an opiate are united.

From this medicine have often in similar cases seen best affects.

But here from urgency of pain thought it necessary to increase a little the proportion of the opiate

For to be observed that at first [prescribed] under same formula as you will find inserted into register¹ when case taken.

From commencement of use of this medicine symptoms very much mitigated.

So that by the end of little more than week belly rather bound than otherwise

Still however had so much of pain at anus that could not suppose affection to altogether overcome.

And seemed necessary at once to keep belly open, & still farther to increase tone of intestinal canal

Was with this intention that had recourse to mixture of Tincture of Rhubarb with mint water.

Hoped that while kept belly gently open would at same time [brace] intestines

And particularly operate as restoring proper mucous lining to inferior part of it.

An effect which am disposed to think to very considerable degree arises from Rhubarb.

And in this respect is in my opinion a [contrast] as it were to aloetic purgative.

For from these mucus again particularly liable to be abraded.

But whether from this or any other grounds as preventing return of Diarrhoea know few articles better than Rhubarb.

Hope therefore that will here be product of desired affect.

And that by this means may be able to dismiss patient free from complaint.

If this not case & if urgent pain at anus continues giving presumption of continuation of local affection may have recourse to topical application in way of injection

Particularly to Enema [ex] [illegible], with addition of Infusion Japonica.

But this & other practices must be regulated by situation in which shall 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.