DEP/DUA/1/41/40 (Normalised version)

Alision Denham

(1786-1787)

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Alision Denham.

When this patient came under our care was in situation truly distressing.

And although affection of complex nature yet no doubt that at time most important part of it the tenesmus to which subjected.

This in all probability effect of state of increased sensibility at extremity of rectum

And that probably arising from natural covering being abraded.

A consequence often resulting from previous constipation.

And to this in present instance disposed to refer it.

Though at same time may have been in some degree connected with condition of menstrual discharge.

Of this however less presumption from not being a common occurrence in such instances.

For with frequent [examination] of Menorrhagia have not at least for my own part before met with any instance of tenesmus.

Where at least had any reason to suspect that connected as cause & effect.

But whatever might be circumstance inducing it, could have little doubt that immediately depends on state of sensibility at rectum.

And that therefore most readily remedied by counteracting effects of that sensibility.

In accomplishing this however no article in point of efficacy to be compared with Opium.

Influence of which, as diminishing [effects] of uncommon sensibility, whatever difference of opinion may be entertained, with regard to class of medicine to which referred no dispute.

And accordingly not disappointed in obtaining wished for effect in instance before us.

For even from first dose of opium tenesmus entirely removed.

And that too although taken only to extent of single grain.

For that the proportion of Opium in grain x of Thebaic Pill the dose here ordered.

From this sufficient evidence that by no means from large doses of opium only that good effects obtained.

On contrary am for my own part persuaded that by these even disappointed

And particularly as giving confusion of head which might otherwise be avoided.

But whatever requisite in [cases] here a grain sufficient.

When directed Opium however at same time advised also a small proportion of Cream of Tartar.

To this led from two circumstances both view to belly & urine.

For while urine scarce, [illegible] frequent inclination to stool, belly bound.

And had reason to think that this would be still more the case on use of Opium.

Accordingly though urine restored [with] Cream of Tartar yet bound state of belly continued.

Hoped however that even [same] quantity might be product of desired effect after [omission] of opium.

And this as perfect relief [from] tenesmus seemed now no longer requisite.

[Advised] therefore Cream of Tartar alone.

But what has since been effect do not know.

For have seen nothing more of patient here.

This however am I own inclined to attribute to having no farther occasion for assistance.

And to look upon case as example of benefits to be reaped even from moderate dose of Opium in removal of very obstinate & distressing Tenesmus