DEP/DUA/1/46/14 (Normalised version)

John Keith

(1789)

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N^o 13^th John Keith at 38.

In case of this patient have an evident affection of the alimentary canal.

At present is in my opinion chiefly effect of diminished tone in intestines.

And that, the consequence of violent action, to which were subjected, from accidental colic.

From loss of tone, distension from flatus, operates as stimulant, inducing inordinate action.

And from this probably, both pains & looseness.

In these affections have often disease of considerable obstinacy.

And particularly though alleviated for a time, yet apt to be renewed by slight causes.

Accordingly with present patient, after subsided, again induced, by return to work.

Probably the effect of exposure to cold giving determination from surface, to internal parts.

May however hope that by restoring tone to alimentary canal, this may be prevented.

Relief however still sooner to be expected, from diminished irritability or tendency to action.

Is with these intentions then, that have directed a mixture with bitter & aromatic tincture some of best stomach tonics

And have added proportion of Laudanum, as most effective means of allaying morbid irritability.

From these hopeful that patient may be restored to health

But if this not case, provided [no] change on symptoms, may make trial of Colombo root, or Cortex Angostura.

Of [practices] however reserve observations till again speak of case.