DEP/DUA/1/21/32 (Transcript version)

James Stevenson

(1779-1780)

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James Stevenson.

When came under our care subj to many diff sympt.

And these two appeard to be me to be of most threatning nature.

Was indeed inclind to consider him as lab. under complic of affect.

And some of compl with regard to which could form no very prob. conj.

This partic case with regard to some of sympt with which first attackd.

Partic pain in region of pubis, diff in voiding water & obstin costiv.

Respecting cause of these diff suppos. might be entertaind.

Might proceed from calcul in bladdr

And this not uncommon even at early period of 6 years of age

While at same time not only prod affect of disch of urine but also of faeces

More freq. however in way of tenesm. than of constipat.

But while calcul. in urin bladder will affect rectum, so also will collect of fecul matter in rectum affect the bladder.

And from bound state of belly here occurring this suppos. of the two the most probab.

But whether one or other of these suppos to be adopted consid these [sympt] as much less immed alarm than others.

In pect. compl. had here almost every sympt which could lead to [susp] of Phthisis.

Patient affected & that too for consid length of time with fixd pain of side.

And this unif attended with freq. & severe cough.

While accord to descript of matter expec reason to think that somewhat of [purul] nature.

Of this presumpt not only from colour & quantity but from state of tongue.

For here while notwith febrile sympt contin moist had also uncommon red appear.

Such a state may indeed take place from several diff causes.

But among others observd to be alm constant attend of purul. expectorat.

And here greater probab. of its arising from that circum than from any other.

But if in pain of breast cough & expectorat sympt of Phthis, [suspit] corrob. also by many concom circum.

In const. quickness of pulse had a very unfav. appear. what with the sympt above enum consid as strong mark of this affect.

Same also to be observd of alternate cold & hot fits.

And with dry state of skin the partic sense of heat in palms of his hands a sympt by no means the least charact.

Farther to be observd that although belly before loose bound yet after came under our care very cont. state of disch.

And indeed consid looseness which had now succeeded, as colliq diarrh very gener attend last stage of Phthis

Upon whole from all circum taken together very much decided in opin as to nature of affect.

And while lookd upon it to be Phthis consid it also as being in adv stage.

From this need hardly add what was opin with respect to termin.

Had little hesitat in concl. that would prove fatal & that too in short time.

In this prognos. however now app that was very much mist.

For patient if not absolutely recov from affect at least very near it.

And that too without any partic effic to be attrib to meas. which we employd.

That in prognos however was mist. proceeded from having mist nature of disease.

And probab. that diarrh. in place of being of colliq kind was merely conseq of preceeding state of constip

While pectoral sympt in place of being phthis merely catarrhal

Case then if on no other acct useful serves at least to shew how may be deceivd by sympt of Phthisis.

And that while on some occas an insid affect having made consid progress before discov. on others many & even most of sympt will occurr while yet absent.

When selected this case was with view to trial of some of these med from which think have seen good effects where high probab. if not certain evid of ulcer in lungs.

And partic to trial of Gum Myrrh.

That in many cases where have exhib this artic, it has faild readily allow.

And that in some inst ulceration of lungs have heald up without interpos of art equally unden.

That But that artic may exist which on some occas will forward healing or prom adhes inflammat is not to be doubted.

And such I think from exper I have found myrrh to be.

Notwith objects of Dr Fothergill [illegible] what he calls healing Balsams for my own part never saw any [illegible] of that kind.

And only object that have ever seen to use is in tendency to excite [loose]

To this in phthisis at latter stages often a great dispos.

And when occurrs to consid degree to be moderated rather than prom.

Although therefore was here intent to have tried Myrrh yet at first report looseness so consid as to deterr from use.

And thought it necess. first at least to endeav to palliate that sympt.

Was with this view alone that had recourse to infus. Japon.

And added Syrup Diacod that from anodyne power comb with astring might have still more consid effects.

If however conject well founded could not expect that would have any infl as remov. cause even of this sympt

And could look only at utmost for temporary allev.

Here however had evid more consid effect than looked for.

And that probab. princip arising from having been mistaken with regard to cause.

Was happy to find that after cont of med for eight days consid dimin of looseness.

As cough however still freq. was not then led to suspic that opin erron.

And even lookd upon swelling of legs as affording addit proof of Phthisis.

For in last stages freq. occurrs from mere debilit.

In this situat thought it still more advis to contin med than to [alter] course.

But I own was surprizd to find that at next report with consid allev. of all sympt swelling of legs almost entirely gone.

This could I appreh in no degree be attrib to our med.

From which utmost effect the serving in some meas. to restr. looseness.

Now therefore consid mitigat of pect compl as conseq of tendency of catarh to fav termin. in recov.

And lookd upon remov of swelling of legs as indicat of recov. of strength.

While all these changes however undr use of infus japon consid as most advis still to persist in employm.

But at last report recov. so far effected that consid farther employm as totally unnecess.

And while had formerly been of serv. as restr. looseness was now unwilling that should have any inconv. to [comb] from it as binding belly.

Have now therefore entirely omittd med.

And disp to hope that will here be no farther necess. unless in conseq of future occurr.

And if such should take place must be accom to these.