DEP/DUA/1/45/34 (Normalised version)

David Phin

(1789)

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N^o25 David Phin. at 23.

Formerly pronounced disease of this patient to be a long continuing distinctly marked & obstinate instance of Diarrhoea.

And from any thing which had afterwards [opportunity] of observing with respect to case no reason to alter opinion with respect to it.

Is indeed true that term diarrhoea taken in very different senses.

By some considered as comprising every affection in which there occurs frequent loose stools.

While others again divide this into several different genera from peculiar nature of matter discharged.

Thus where consists of bilious matter & suppuration derived from liver has name of [ hepaturrhoea].

Where again discharge takes place of alimentary matter undigested has name of Lienteria.

And where discharge of white coloured fluid supposed to consist of alimentary matter converted into chyle, has name of Coeliaca

That for each of these different [affections] some distinction in nature is unquestionable.

But at same time many circumstances in common to all.

In all these occurrences frequent & thin stools.

And in all, probably an uncommon deposit of watery matter into intestinal canal furnished from circulatory system.

This however the great characteristic of Diarrhoea.

Hence other [appearances] rather to be considered as superadded [affects].

And indeed complaint with some rarely fails to take place to greater or lesser degree.

This particularly holds, with respect to indication of Lienteria.

For but very rare instances, where frequent loose stools for any length of time in which, alimentary matters are not discharged before completely digested.

Hence then name of Lienteria applied only where takes place to very great degree.

And where even without considerable looseness.

But these circumstances, consist in variety in degree only, no sufficient grounds for constituting distinct genus of disease.

May [make] same remark with respect to that [appearance] supposed to characterise coeliaca.

For with frequent discharge very rarely that [appearance] is not changed.

And indeed must necessarily be so while considerable separation of mucus.

For this in no case the colour of ordinary excremental matters.

And well known capable of undergoing many different changes.

Indeed reason to believe that white appearance much more frequent from vital secretion of mucus than from chyle.

But besides this, where such appearance in stools takes place, rarely permanent.

And as in case before us, discharge sometimes of white appearance sometime of natural colour.

These circumstances then sufficient objections to considering, this appearance as characterising peculiar genus.

To be considered merely where occurs to remarkable extent & with uncommon permanence as inducing peculiarity in the disease

And as such consider it in present instance where sometimes occurred sometimes absent.

But not only circumstance in case of present patient, indicating severe & obstinate disease.

Besides long continuation of affection great emaciation which had induced, very unfavourable.

And perhaps might also view in same light, remarkable coldness of feet.

With regard to this symptom, some doubt perhaps, whether to be considered as consequence or cause of the disease.

At least well known, that cold [appearance] to feet, very apt with some, probably from checking cuticle discharge to give diarrhoea.

And this probably consequence of increased [discharge] by other parts of alimentary canal.

Nay from large evacuation, presumption that serous drained off, even from circulating mass.

And accordingly that thirst connected with demand necessary for supplementing want in system.

Here however relief which gratification of appetite would have produced, precluded by state of alimentary canal.

For from watery fluids taken in, looseness as might naturally be supposed uniformly augmented.

And permanent mitigation to be expected only by restoring looseness, that is by [curing] or at least alleviating the disease.

Here however after so long continuation would have been by no means prudent to employ such remedies, as would at once check it.

For well known that often worst consequences, from sudden stop to habitual discharge

And this perhaps, even more case with diarrhoea, than most others.

For is often means by which offending causes, thrown off from [system].

And accordingly in slighter cases, in place of attempting to check discharge best means of cure, is by encouraging it.

For evacuation the natural cure. This indeed could not be considered as case, after disease already of eight years continuation, & had produced very [exhausting] habit.

Still however in every point of view, was more advisable to aim at [restoration] in gradual, than sudden manner.

As means of effecting this had here recourse to combination of [an] astringent & an opiate.

These indeed means most powerful in giving sudden check to discharge.

The first as giving [constriction] of [vessel] the second as allaying inordinate action

Degree of operation however very much dependent on kind of astringent employed & quantity to which opiate used.

As an astringent had here recourse to Terra or Succus Japonica, or catechu as now more properly called.

A vegetable extract prepared from a species of Mimosoideae.

And which peculiarly adapted to increase secretion from intestines, from quantity of mucilaginous matter it contains.

This as united with some aromatic & a small proportion of opium the basis of Confection Japonica

A formula readily diffused in water & easily united with any farther proportion of opium under form of liquid Laudanum.

Here added to extent of ℥i. to six ounces of mixture.

That is in quantity of about grain XII to ℥i.

This mixture as moderately checking looseness in very common use with many practitioners.

And often found product of best effects.

Accordingly soon after begun use, looseness became very moderate.

In this situation naturally thought of persisting in employment.

But afterwards, on an aggravation of disease, probably consequence of some accidental circumstance, of himself had recourse to Peruvian Bark.

And although formerly tried without effect, now thought it product of some benefit.

Should I own have wished rather that patient had persisted for some time longer in use of mixture.

But from Peruvian Bark, provided could be borne without inconvenience had also reason to hope for benefit.

For unquestionably a powerful tonic to system in general, & that chiefly by acting on alimentary canal.

Hence then thought it best to direct that should persist in use.

But since that have seen nothing more of patient in this place.

And perhaps unnecessary to form any conjecture with regard to situation.

But own inclined to believe that this patient nearly in same situation as before.

Or at least that not materially benefited by anything we have done for him in this place.

This however I consider as in part at least owing to himself.

For seems to want [steadiness] [either] to give due attendance, or proper trial to any medicine.