DEP/DUA/1/43/18 (Normalised version)

Agnes Sead

(1787-1788)

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N^o20 Agnes Sead at 18.

When formerly spoke of this patients case observed that considered her as subjected to complication of affections.

What most distressing to her however was the Diarrhoea.

And to severity with which had subsisted for considerable length of time was inclined to refer state to which reduced.

At same time however observed that not without some [appearance] of Phthisis

For besides pain of breast, cough & dyspnoea several other circumstances also render it probable.

Particularly quickness of pulse, intense thirst, impeded appetite & failure of menstrual discharge.

And to all these to be added that patient at a period of life when Phthisis most common.

But notwithstanding all these circumstances [could] not be said to be a decided example of Phthisis.

That is had not those regular accessions of hectic fever & colliquative sweats which chiefly observed to characterise the disease.

From these considerations led to think that Diarrhoea not here to be considered as symptom of Phthisis.

And to entertain more favourable hopes than, as now apparent from events, were well founded.

Now little doubt that though no proper hectic accession patient, had yet been subjected to Phthisis from commencement of cough, that is for period of nine months

And that diarrhoea though of no less than four months continuation was yet symptom of Phthisis & of colliquative [sweats].

In this then, as in many other cases, have evidence of insidious nature of this affection.

In some instances apparent alarm where yet the affection merely catarrhal.

In others & that much more frequent progression of Phthisis very great before distinctly marked.

Although however in present instance had been fully aware of danger of patient, would have made no alteration in treatment.

For when Phthisis occurs & is even in incipient state very little can be done with advantage.

And in advanced states of disease know no practice on which least dependency can be put.

Then if recovery happens which indeed very rare occurrence is entirely operation of nature.

And art can do nothing more than alleviate symptoms.

In this case as have already observed symptom most urgent was the diarrhoea.

And was with view to mitigation of this that had recourse to two medicines here ordered.

viz Pill Thebaic & Mixture with Confection Japonica.

Efficacy of first of these need hardly remark depends on Opium which contains.

Nor need I add that this most powerful article as allaying inordinate action with which are yet acquainted.

In this way a very effective means of [restraining] increased discharge in general.

And every day in use in cases of violent diarrhoea.

Where operates no less as preventing augmented action of intestinal canal, than increasing deposit into intestines.

In same manner as [restraining] looseness also allays cough.

And in this way then, might have been imagined that also serviceable in present case.

Where however cough with much expectoration & dyspnoea the [restraining] it not always desirable

For cough means of relieving dyspnoea in consequence of expectoration.

Is indeed true, that by frequent efforts in way of coughing secretion at lungs augmented.

And thus by diminishing cough a lesser quantity of matter to be discharged.

But from [restraining] it very much still worse consequences.

This then necessarily led to caution in administration of opium.

And accordingly seemed advisable to begin at least with small quantity.

Here directed opium under form of Pill Thebaic.

In that form as united with Aromatic the Jamaica pepper often sits more easily on stomach, & gives less affection of head than when taken pure.

While at same time nothing in article added of such active nature as in least degree to give [restriction] in employing opium to any dose required.

In most cases for an adult unaccustomed to opium a grain may be considered as full dose.

Here however as our patient a delicate female, unaccustomed to use, & as uncertain of effects of checking cough, [ordered] it in smaller quantity.

To extent viz of half a grain only, quantity contained in grain V of pill.

While however this taken at bed time directed mixture of Confection Japonica through the day.

Of basis of this article the Succus Japonica have already oftener than once had occasion to speak.

And may only repeat that consider it as one of best vegetable astringents particularly in cases of Diarrhoea.

Would indeed in my opinion be improvement of formula if prepared with Succus Japonica depurative.

And if quantity of Gum Kino which enters composition either diminished or even entirely thrown out.

For this much more an acrid & resinous substance. But even as it is a very useful article. And when diffused to quantity of ℥ ii in ℥VI of watery menstruum often highly advantageous in diarrhoea. Cannot however say that from either medicine our patient have either reaped considerable advantage or much alleviation of symptoms.

Both looseness & cough indeed [here] at times somewhat diminished

But still suffered a very rapid diminution of strength.

And in no long time, as is case with by much greater part of Phthisic patients fell a victim to her disease.