DEP/DUA/1/39/02 (Normalised version)

Katherine Hutton

1785

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Katherine Hutton February 4^th 1785

Of case of this patient perhaps hardly necessary to make many observations.

For since last spoke of her have seen nothing more of her at this place.

And thus no opportunity either of altering opinion of disease or of being more confirmed in it.

May only observe that diarrhoea of an alarming nature.

And that too not merely from obstinacy & long continuation but from symptoms which had induced.

With woman only in 26^th year before she came under care, had been subjected to complaint for near one half of that time.

During that time at least great chance that even some local disease of intestinal canal might have taken place.

But even supposing this not case, had in other respects very considerable affect of system.

For not only distressed with pain & sickness, but also with extreme debility.

And would not I own be surprised to find that at last sunk under affection.

This as already observed often happens where local disease of intestinal canal, in consequence of inducement of hectic fever.

But here I own yet presumption seemed to me to be rather against that supposition.

For in these cases while much pain in belly yet very generally more remarkably severe at some particular part.

This however as far as could learn never case with our patient.

Pain on contrary seemed to be equally extended through every part of intestinal canal.

And even in stomach itself as might be inferred from sickness & unease [there]

But besides this still another circumstance perhaps against local affection.

That is that with our patient somewhat of hereditary disease

For in history of case told that father subjected to bowel complaint for many years.

This as far as I have observed not a common occurrence.

And do not recollect that hereditary disposition mentioned among causes of diarrhoea by practical authors.

At same time nothing absurd at least in supposing that peculiar [fab] in bowels transmitted from parent to child as well as resemblance in other parts

And if this the case it at least in favour rather of general than local affection.

This then at least somewhat more favourable with respect to prognosis.

For of all instances of diarrhoea those unquestionably most dangerous where local affection takes place.

But here other circumstances not a little against patient.

And besides what already remarked of obstinacy & symptoms induced, may add that even some doubt how far cure would be safe.

For well known that from restoring accustomed discharge often great inconvenience.

And that even when morbid, & tendency to weaken.

For by this means very considerable change cannot fail to be induced in mode of circulation.

And thus, even greater distress than these intended to be obviated.

Hence then attempts to cure here required caution.

Particularly in use of those practices giving sudden check to discharge.

From this then, appears to me, that moderation required with respect to use of opium.

For of all medicines immediately restoring such discharge this unquestionably the most powerful

Has immediate effect as allaying increased action of vessels on which discharge depends

Here therefore though somewhat afraid of employment did not wish to lose entirely benefit to be derived from it.

Particularly as tending to retain for longer time in intestinal canal medicine gradually restoring to those due tone & vigour.

Was with this intention then that here directed Pill Thebaic to extent of grain V every night at bed time.

That is Opium to quantity of grain s.

While at same time directed for patient use of Succus Japonica.

Here however in place of usual form, watery infusion, employed it in substance.

This perhaps neither so elegant nor in general so convenient a mode as other.

But here induced to give preference from two circumstances.

In substance from sufficiently slow solution in alimentary canal has both more gradual & longer continued action.

And these in present case were certainly desirable circumstances.

While at same thus also action more extended through whole tract of intestines

A circumstance particularly to be wished [where] affection extended through whole

Even this astringent however did not wish to employ to any very great extent

And was chiefly with view of limiting & moderating dose that here given in conjunction with Pulveris Cretacea.

While however served purpose of giving convenient & easily divisible form, imagined also that might here be useful in other respects.

Need hardly observe that basis an absorbent earth, with addition of some aromatic.

From first, might expect affect of destroying acid in stomach & intestines.

And in this manner removing [cause] by which looseness often supported & [aggravated]

While from last, benefit as alleviating some of most distressing symptoms of patient

Particularly flatus & borborygmi.

From these medicines then expected that in this case might obtain at least some advantage.

And by influence on disease should have been directed as to continue, augmentation of dose or future measures.

But since first directed have seen nothing more of patient.

What circumstance has led to this desertion cannot pretend to say.

Here however no grounds for imagining that is consequence of having no farther occasion for assistance.

For from measures here employed, with disease of such obstinacy, could hardly expect even considerable temporary mitigation.

From desertion however may I think infer another circumstance.

viz That obstinacy of disease in some degree effect of never having employed proper means for removal.