DEP/DUA/1/37/23 (Normalised version)

Thomas Davie

1785

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Thomas Davie March 5^th 1785

To disease of this patient am I own at a loss what name to be affixed.

Chief symptoms with which affected when came under our care, such as occur in many different diseases.

This particularly the case with respect to vertigo nausea & sickness at stomach.

These well known to be inseparable attendants of greater part of febrile affections.

And indeed also told that besides these other febrile symptoms here likewise occurred.

Such for example as want of appetite increased heat & quickness of pulse.

These often it is true take place where cannot be certain from what cause originate.

But in others can be distinctly traced to some particular cause.

And here I think could be little doubt respecting it.

Are not unfrequently affect of irritation in alimentary canal, proceeding from costiveness.

And here no hesitation in attributing them to that cause.

For bound state of belly, had taken place to very considerable degree.

In so much that at time when came under our care, informed that one discharged only in space of fortnight.

This indeed, with some, hardly perhaps to be reckoned morbid.

For instances of individuals to be met with to whom not usual to have discharge oftener than once in eight days.

And with whom this length of retention, not product of any inconvenience.

With one however, like our patient, in health habitual to daily discharge this be no means [case]

And accordingly little doubt in attributing to it all symptoms with which affected.

Here therefore may have considered patient as labouring under high degree of obstipation.

And that disease well entitled to this appellation when came under our care, can hardly I think be matter of doubt.

But [to] this, perhaps may be imagined, that some objection from progression of affection.

For began you will observe with very opposite state.

When patient first taken ill disease appeared under form of violent diarrhoea.

A complaint which may by way remark, has of late been extremely common.

Or at least this has been very remarkably the case with regard to affections of alimentary canal.

And these appear principally under form of diarrhoea.

But by no means universally in this way.

May therefore be questioned whether was not rather to be considered, as peculiar modification of the prevailing epidemic than as strictly speaking an instance of obstipation.

That this, may have been in some degree the case, would not deny.

But at same time well known, that in every instance, unless when morbid condition of intestines, affect of excessive looseness is, to give tendency to opposite state of discharge.

This even the case, where purging excited by medicine, as for example Glauber Salts.

Hence then supposing him at first subjected to epidemic diarrhoea, still [proper] obstipation may have here occurred as consequence.

And at any rate the bound state of belly, the morbid condition from removal of which reason to expect alleviation of symptoms.

With this idea of nature of disease had no reason to entertain unfavourable hopes of termination.

For obstinacy especially when merely an occasional occurrence one of these affections which have it perhaps more in our power to combat than any other.

And here neither habitual, nor smallest reason for suspecting any fixed cause.

Conclude therefore that should soon be able to combat it.

But even these remarks on prognosis now unnecessary since favourable termination has already taken place.

And this am inclined to think, not a little to be attributed, to practice to which had here recourse.

When came first under our care, seemed to be first objective to obtain thorough evacuation of intestinal canal & to support regular discharge.

This however did not think, was to be aimed at by brisk or violent cathartic.

For from these, as from diarrhoea at commencement of affection, might have expected even, more obstinate obstipation.

But was objective, by gentle stimulation, to increase peristaltic motion through whole course.

But especially to increase stimulation to it, at the rectum.

Was with these intentions, that had here recourse to aloetic purgative.

And was especially with view to last that employed aloes under form of pills.

These pills to extent of about five grains, have in general effect of producing one or two easy stools.

Here however from very bound state of belly, could hardly expect operation, from so small a dose.

Ordered therefore, that till regular discharge could be obtained should be taken to extent of ten grains in day.

And from this quantity even although no obstipation had occurred nothing to be feared.

For by no means an overdose.

And indeed remarked, that operation of aloes, in point of degree, not proportional to quantity to which taken.

Accordingly [the] having prescribed aloes to this extent in pills, did not prevent me, from having recourse to another purgative.

For directed at same time, Elixir of aloes & Rhubarb conjoined with Peppermint water.

In this diluted state however, intended rather as stomachic than purgative.

And with this, intention as strengthening tone of stomach, & giving vigorous action to alimentary canal in general has often best affect.

Probably however more from Rhubarb than aloes.

Under these medicines, discharge by belly, soon returned to natural standing.

Had easy stool every day.

And with this, considerable alleviation of affection.

Still however some remains of former symptoms.

Particularly those depending on affection of stomach.

For to this, would attribute not only nausea & sickness, but also vertigo & headache.

These at least symptoms often resulting from affection of stomach.

And viewing affection in this light, imagined that might be combated by continuation of former stomachic medicine.

Now however saw no occasion for persisting in use of aloetic pills.

Directed therefore the continuation of her mixture alone.

And although, in state in which given, to be considered as but very slightly purgative, yet as obstipation removed, imagined that would now be sufficient to keep belly gently open.

In this way, some reason even to presume, that had more affect than could have wished for.

At succeeding report at least, were informed, that had now five or six stools in course of day.

This indeed I suspect rather, to be considered as some return of former looseness than as affect of medicine.

But at any rate under such state of discharge seemed imprudent to persist in use.

And this now the less necessary as all other symptoms were gone.

Ordered therefore that elixir should be omitted.

Still however, both with view to present looseness, & to prevent of recurrence of former affection, some practice seemed necessary.

As means of destroying acid, by which thought that might perhaps be supported, had recourse to Magnesium.

And with view of strengthening bowels added small proportion of Rhubarb.

While as corrigents, & especially for prevention of flatulence, combined with these, a small quantity of powder of Cassia.

Under this medicine, whether in any degree the affect of operation or not, symptoms entirely left him.

And accordingly dismissed free from his affection.