DEP/DUA/1/34/24 (Normalised version)

Robert Henderson

1784

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Robert Henderson March 24 1784

In case of this patient, have symptoms indicating different affections.

And these probably little if in any degree connected with each other.

Of these the most distressing to him when applied for our assistance frequent loose stools.

Had you will observe then watery discharge seven or eight times every day.

From appearance as well as mode of discharge could have no doubt in pronouncing this to be case of Diarrhoea.

Only other assertion indeed, to which could be considered as having any [resemblance] is Dysenteria.

And to this being his [disease] strong objections from absence of gripes, tenesmus bloody stools but above all of fever.

For though some quickness of pulse, impaired appetite & vertigo, yet without heat thirst & what still more characteristic of fever, without anxietas febrilis.

And here if even at this late period looseness had occurred would not have altered opinion of disease.

And accordingly to frequent stools, was here disposed to refer diminishment of appetite & vertigo as well as quickness & weakness of pulse

But besides these, other circumstances in the case which could not be considered as depending on this

viz frequent loose cough

In this had common characteristic of a catarrhal affection.

Or at least could only be considered as marking either Catarrh or Phthisis.

And of the latter here no grounds for entertaining any suspicions.

For vomiting as well as pain at Scrobiculus cordis with which attended were to be considered merely as indicating an irritable state of stomach.

And probably in some degree connected with irritable state in other parts of alimentary canal, giving rise to Diarrhoea.

From this view of nature of affection no grounds for giving at least an [confident] prognosis.

Diarrhoea the principal disease to which this patient subjected rather an inconvenient & distressing than a dangerous complaint.

Sometimes indeed must be allowed proves an obstinate disease.

And often when cured or at least when stopped product of inconvenience.

These however very generally the consequence only of long continuation.

But with our patient this could not be said to be case

For although, had with him continued for space of seven weeks, yet this not to be considered as a diarrhoea of long standing.

And notwithstanding this continuation had hitherto at least been product of few distressing symptoms.

For neither discharge of blood, tenesmus nor even pain at anus consequences almost uniformly resulting from abraded state.

Served therefore to show that frequency of stools more consequence of irritability or disposition to inordinate action than of anything else.

And that if increased secretion took place was at least not of that acrid & vitiated nature which can give excoriated state.

Have reason therefore to hope that in no long time may be overcome

Yet must also be observed that temporarily suspended looseness far from being evidence of entire restoration of sound state to intestinal canal.

And that till this affected patient will at least be liable to renewal of complaint from slightest causes.

With regard to catarrhal symptoms there even less grounds for alarm than Diarrhoea.

Had indeed short time before came under our care been somewhat increased in violence.

But even then by no means considerable.

And attended with such free expectoration as gave reason to hope for speedy termination.

Especially be [accurr] of mild [weather]

While neither from age of patient nor continuation of this symptom any reason to fear degeneracy into chronic state.

To all these particulars to be added that under treatment employed both affections considerably mitigated.

With regard to treatment object which first & principally claimed attention was Diarrhoea.

Though at same time in practices [employed] had in general also Catarrh in view.

This however will more particularly appear in speaking of different remedies to which had here recourse.

Began you will remark by directing for this patient the use of an Emetic.

From this in cases of Diarrhoea often very considerable advantage is obtained.

And here good affect may naturally be expected from it on different principles.

In many cases can be no doubt that diarrhoea the consequence of matter secreted or formed in stomach

And that from these passing down principal phenomena of the disease induced.

For acts as it were as purgative.

This particularly the case with respect to acid generated there.

But probably holds also with regard to many other matters.

And indeed many both secreted & formed, which probably possess much greater degree of acrimony than acid.

At least this may be inferred from pain, excoriation & even ulceration which they produce.

From these therefore being expelled before go farther than stomach, best affects may be expected.

And in this way often best affects from Emetics in Diarrhoea.

But besides this have also [unquestionably] powerful influence as giving determination to the skin.

And by this means flow to the intestinal canal is diminished.

Thus then naturally diminishment of that secretion from which fluid [illegible] constituting diarrhoea is afforded.

But besides these still a third principle on which have often been inclined to suppose that may here be serviceable.

That is from inordinate & violent action which Emetics excite.

Well known that one inordinate action in system not only for a time countered & suspended but even sometimes entirely removes another.

This particularly exemplified in sneezing stopping hiccups

And in same manner that action of stomach which takes place in vomiting may suspend or remove that in other parts of alimentary canal which occurs in diarrhoea

Thus then may be useful in cases of that kind, not only where there is an acrid matter to be evacuated or where determination to intestinal canal, but also where as suspect in present case disease principally affect of tendency to inordinate action.

But besides Diarrhoea hoped also that might here be useful with view to catarrh.

For unquestionably emetic, one of most effective means of unloading breast

And by giving determination to surface here also useful from changing balance of circulation.

All these intentions however could not expect would be completely answered by a single emetic.

Was intention therefore to have recourse to repeated employment.

But emetics when given to such extent, as to excite full [vomiting] should never be very precipitately employed.

For no doubt that by such strong action frequently repeated tone of stomach very much diminished.

Ordered therefore two only in course of week

And was intention afterwards to repeat them as circumstances might require

While directed Emetic however, had recourse also to another remedy the Infusion Japonica.

Warm water while readily [dissolving] all active parts, takes up none of impurities particularly earthy part of Succus Japonica.

Hence one of most elegant as well as efficacious modes of exhibiting it.

And especially as have at same time an opportunity of conjoining it with those grateful cordial aromatics which readily [impart] virtues to warm water.

With this view here directed an equal quantity of Cassia Bark, little inferior in virtues, to Cinnamon while much cheaper.

In this way operates as a powerful restringent in suppressing looseness.

And in many former instances have found it attended with best affects.

In consequences expected from these medicines were not disappointed.

For while vomits operated well, from time that began infusion japonica Diarrhoea very much abated.

In so much, that at succeeding report, discharge by belly little more frequent than natural state.

In this situation hardly thought it advisable to persist in use.

For if not product of inconvenience by producing opposite state of discharge, had at least some reason to apprehend bad affects from sudden suppression of evacuation to which the system had long been habitual.

On this account therefore, in place of medicine before directed, had recourse to Magnesium with Rhubarb

By former hoped that belly would be kept gently open, & that at same time tendency to looseness would be diminished from its neutral acid in stomach

While latter, produced also of same affects would tend somewhat to brace intestinal canal.

Especially when gradually thrown in by small doses so as not to operate as a purgative.

While using this powder continued free from Diarrhoea & had at same time regular discharge by belly

But during use Catarrhal symptoms were somewhat aggravated.

This led me to employment of a mucilage mixture with which combined some proportion of Tincture Thebaic.

While she took this mixture these symptoms alleviated.

But quantity given not sufficient to serve her during course of week.

And after intermission affected [again]

While repeated mixture therefore, advised that should be taken more slowly.

And to [compensate] want of former quantity directed a pill at bed time with grain s of Opium

Under these medicines am hopeful that cure may be accomplished.

And that patient may in no long time be dismissed free from affection.

If in this however disappointed future measures must be directed to appearance which may then take place & to view which shall afterwards have of the disease.