DEP/DUA/1/39/10 (Normalised version)

James Goodall

1786

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James Goodall February 18. 1786.

When this patient came under our care was subjected to complication of affections.

But these by no means of equal importance.

In Cough Dyspnoea & viscid expectoration to which then subjected, have common symptoms of catarrh.

And what here took place, seem to have been affect of accidental cold.

Imagine that as had been, but of short standing, would soon even of [itself] cease.

And accordingly, this event has already taken place, without any medicine being directed for that purpose.

But if this part of affection slight same observation cannot be applied to other

To the looseness which principally led him to apply for our assistance had been more or less subjected for upwards of 30 years.

And during that period a variety of remedies employed utmost affect of which to produce temporary intermission.

While disease thus obstinate was also at time when came under our care very severe.

For had not only several loose stools every day but these also with considerable gripes.

To same cause also are probably to refer sickness at stomach, flatus & borborygmi.

Seemed also to have had considerable influence on constitution in general.

For could have no doubt in referring to this both unhealthy appearance & debility.

Another circumstance also probably connected with looseness here was intermittence of pulse.

This indeed a symptom which it must be allowed occurs in other cases.

And some even with whom may be considered as it were natural state.

That is intermittence obvious even in health

But where occurs in disease none with which more frequently connected than Diarrhoea.

Nay as taking place in fevers has even been considered as forerunner of critical diarrhoea.

And with view to explanation of it several ridiculous theories have been offered.

But that for these, little foundation, abundantly apparent from being often attendant of Diarrhoea in other cases.

And has been very remarkable in case of present patient

In general one beat lost in every 15 or 20.

But besides these circumstances still another to be pointed out perhaps more particular.

As being a circumstance distinguishing one modification of Diarrhoea from others.

State viz in which feculent matter discharged.

In general came away with appearance of being very little digested.

That is with almost no farther [solution] than obtained in mouth by masticating.

This circumstance discharge of food in indigested state has been supposed to characterise even particular genus of disease.

And distinguished by title of Lienteria.

For my own part however cannot see in what essential difference from Diarrhoea.

Nay sometimes reason to believe that merely affect of quickness, with which matter hurried through alimentary canal.

Though at same time, am I own disposed to think that in general there takes place also, a morbid condition in [menstruum] furnished by stomach for solution.

But at any rate, even thus, no essential difference from Diarrhoea.

For still principal part of affection, in frequent & watery discharge.

And thus general exhaustion general loss of strength & debilitation of intestinal canal in particular.

Considering disease however as Diarrhoea prognosis could not in present instance be very favourable.

For after continuation for 30 years had become as it were habitual.

During that time had resisted use of many powerful remedies.

And not to be expected that would now be easily [checked].

Nay to be doubted if that could with safety be done.

For from such change in balance of circulation reason to apprehend bad consequences.

Hence then great reason at least to conclude obstinacy of disease.

And when considerable debility condition not even without danger.

For from very severe attack might even have sank under [illegible]

But at least somewhat in favour of patient, that no evidence, of being supported by any local affect in intestinal canal.

No fixed pain, or sense of heat at any particular part.

No marks in quickness of pulse of [illegible] [fit] of any hectic fever.

And when consider relief which patient had once before obtained reason to hope that might again obtain some alleviation.

This chiefly to be looked for, by diminishing deposit of watery fluid into alimentary canal.

By diminishing irritated state in consequence of which peristaltic motion accelerated.

But above all, by restoring due tone & vigour to muscle fibres by [which] considerable affect in both ways.

This chiefly to be expected, by use of gentle astringent & tonic.

For here as already observed danger of suddenly checking discharge such, that could not with safety employ very strong ones.

Began practice by Emetic.

In this had somewhat in view Catarrh.

Thought might be of service as unloading breast & determination to surface.

But used also with view to looseness as means of evacuating stomach.

And thus at least rendered operation of other remedies more affective.

In obvious operation of vomit not disappointed.

But had no influence on looseness.

And with view to this now resolved on use of an astringent

As such made choice of the Tincture e Kino.

A formula which has only of late had place in our Pharmacopoeia¹.

And not yet introduced into many others.

But unquestionably a remedy of very considerable activity

Basis a Gummi – resin substance imported from Africa.

And product of a tree hitherto [illegible]

First recommended to attention of practitioners by late Dr Fothergill.

And in passage of his in London Medical Observations where treats of it under title of Gum Resin Astringent Gamboge will find best account of it yet published.

In sensible qualities possesses considerable degree of pleasant astringent.

And has been chiefly found useful in instances of obstinate diarrhoea.

Especially those of Lientary kind.

With some such have formerly employed it with advantage.

And indeed, with this very patient had formerly affect of giving at least considerable remission.

All more active parts of Kino readily soluble in spirit menstruum.

And this hold to be one of best forms of exhibiting it.

For does not then require [solution] but introduced as it were in active state.

From fear however of sudden [check] to looseness unwilling to use it to great extent.

Hence as [exception] here had recourse to Vinum Rhei, which while first operation that of gentle purgative, has [ultimately] also an astringent affect.

And accordingly even by itself often very useful in such cases.

First affect of this mixture seemed to be that of augmenting looseness.

But from continuation seemed to be somewhat abated.

And what still more favourable faecal matter discharged a more digested appearance.

From this led to think of [pursuing] use somewhat farther.

And accordingly with mixture conjoined [use] of Rhubarb & Gum Kino in [substance] each grain X indies.

During first week under these medicines considerable benefit.

But in following one very great aggravation of looseness.

From what cause proceeded not clear.

But he himself suspected the [powder]

And not impossible that Rhubarb may have had this affect though did not purge at first.

But at same time think it more probable that from some other cause.

And indeed formerly often aggravation of looseness when could not tell to what to be ascribed.

Here however his own suspicions sufficient to induce to lay aside at least present formula.

But still willing to give farther trial to Kino.

In place however of Rhubarb now directed it with equal parts of Tincture Absinthe, one of strongest of vegetable bitters.

And often useful in affections of alimentary canal.

To these added also small proportion of Tincture Thebaic as means of [allaying] tendency to inordinate action.

Under this medicine has now [continued] for three weeks.

And upon whole complaint considerably relieved.

Is [therefore] [intention] even although there should be accidental return to [persist] in use.

But if in end fails, may have recourse to Succus Japonica Cortex Peruvian or such other remedy as circumstances at time shall indicate

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.