DEP/DUA/1/23/02 (Transcript version)

Janet Kennedy

(1780)

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Janet Kennedy.

Though sympt. distressing yet dis not very distinctly marked.

Might at first be susp that symp to which princip subj. dep on disease of urin organs.

Pain of which compl. cheifly in region of loins.

Hence some reason for concl. that referr to kidneys.

And diffic with which affected in passing water may be ment. as a circum corrob this suppos.

While at same time, such change also descrbd to have occurrd in appear of urine as to indic morb. state.

For is remarkd often thick & muddy.

Although however sever sympt thus indicating affect of kidneys yet by no means amount even to prob. proof.

If suppose this to be the case will most naturally concl. that disease depends on calcul & gravel in kid.

Of such an affect however many sympt. here wanting.

Pain not observd partic seated in region of kidneys.

Nor observd propag in direct in which nephrit pains in gen. are.

Not attended with same sickness at stomach or vomiting.

No remark aggrav of pain or bloody tinge to urine on vomiting motion.

Nor as far at least as patient, able to observe, has sand been ever disch with urine.

A circum which when consid contin of patients disease, alone suffic to invalid suppos of calcul or gravel.

To all this farther to be added that such sympt. as here take place freq. arise from affect of other parts.

And partic are prod of affect of alim canal.

Such a cause however when attend to hist of affect should be inclind to susp. in inst. before us.

Is ignor indeed of any partic cause accident to which affect. to be referrd.

But have first commen to severe colic, with which first affected about six years ago.

Since that has been subj to freq returns of same ailment.

And besides these const. affected to consid degree with borborygmi flatus & sour [crustat].

In all these evid affect of alim canal

From this also pain of loins may readily arise.

While at same time expl. to us, why pain should at times, affect diff parts of abdom.

For such pains of intest canal partic where flatus or borborygm & where reason to concl. dep on spasm readil prop from one part to [anoth]

Yet in gener. most freq. at some partic part as there princip dis. state.

In this manner would expl. its being princip remark in loins.

Prob as cheifly seated in colon

And from distent of this part of alim canal giving compress to urin passag. would readily acct both for diffic in disch & morbid appear in urine

Upon whole then consider affection disease to which this patient subj, as being an affect of alim canal, but princip of larger intest.

With this idea of nature however still at loss what name should assign to it.

Nor do I know any genus describd by nosol. to definit of which can be consid as corresp.

If exam those in syst of Dr Cullen should find that has more of sympt of Dysp than of any other.

Yet when consid that affect of stom by much least consid part. term unquest in some meas improp.

Nor does it corresp to defin or descr of colica gastrodynia Flatul &e.

Yet upon whole more exact corresp with defin of latter disease than of any other.

And Were it necess to give it any name, should be inclind to bestow upon it that appellat.

And of all species which Mr Sauv. has referrd to that genus [case] of our patient most nearly resemb. what describd under title of Flatul. acidae.

But if conject as to nature of affect well founded name immatter.

For is too [see] [true] on nature of compl. that progn must be founded & to this the cure to be directed.

From what have said of nature opin entert of event in pres inst can not be very fav.

No reason indeed to consid patient as in any immin danger.

Under sympt. from alim canal much more distress. patients will cont. for great length of time.

And often even if not perfect recov. at least very consid relief.

Yet more freq. happens that pat. once subj to such [ailing] cont. distr. during whole remainder of life.

And when consider that patient already six years subj to ailm, of this some presumpt.

Especially when consid cause from which had its comm. viz viol cholic.

This it is well known even where sup to be entirely of spasm kind, yet accomp with some degree of inflam.

Thus often even [illegible] foundation not merely for weakness but for local affect.

And by this means tumours, [strict] or [like] which at length fatal.

That this therefore may yet be conclus of pres case is not I think cert.

Yet am rather disp. to fear that will prove a tedious than danger affect.

With view however to removal several meas which may be taken with at least some prob of success.

And although these should not answer to wishes may still at least be conj with pract. from which reasn to expect allev.

Here in as far as idea of nature of affect is well founded radic cure must dep. on restor of vig to alim canal.

While again relief of sympt as also pain, borborigm, flatus & eruct. to be cheifly expectd by obv. costiveness & spasm.

Besides this meas it is true may also be requis for counteract acid.

But this probab. may follow as conseq of due tone of intest being restored.

And partic of use of bitters with that intent

For by this means may both destroy pres acid & remove cause.

Well known that bitters as well as absorb. possess power of neutr. acid.

With differ. intent now mentiond then various meas may be taken

Before however attempt any thing with view to radic cure thought it first necess to obviate sympt

But partic costiv.

For while this contin great reason to presume that every meas. taken with view to radic cure ineffect.

And that even many of these as augm this sympt might aggrav affect.

For no doubt that in conseq. of disten & obstruct of alim canal by retaind [faeces], such compl. more aggrav. than perhaps from any other cause.

While however here employd meas for obv. costiv wishd also to counteract inconv. from flat.

Not so much indeed by prev gener of flatus as by afford ready escape to what already gener. from remov. of spasm by which retaind.

Was with these partic view then, that had here recourse to first & indeed only prescript yet directed for this patient.

With intent of obviating costiv. may here observe that in such cases often very great diffic.

For while never fail to have very great distress from bound state of belly so on other hand compl. unif aggrav. by severe purging.

And often happens that purgat answering with one will by no means succeed with anoth.

Hence most prop purgat in such cases to be determ rather by trial than by experim. reasoning

With one belly most easily kept gently open by aid of saline purgat

Such for example as Cream of Tart. solub Tart or Sal Polych.

With another intent best answerd by oily or lubric purgat. as Oil Ricini, olive oil with Mamma or Tinct of Jallap, Lenit elect consit princip of mucil fruits or like.

While in third case nothing better suited than sulphur.

Yet although all these accom to partic cases yet have found aloet purgat more gener useful in such inst than any of them.

And partic as united given in solid state under form of pills.

For this purp. have often observd best effects from pil aloet of Ednr Pharmac. where aloes conj with Extr of Gentian prin with intent of giving form.

To these therefore, where merely intent to obv costiv have in gener. recourse in first inst in [perf] to any other.

While aloet pill thus useful in obviating costiv. so among diff [carmin] none more gener success. than pil Gummos.

Although into these various artic enter, yet consid effic as prin dep on Assafoetid.

And prin from effects of oper. as stimul & at same time obv. [spasm]

But as answ. these purposes effects nothing counteracted from being conj with aloes.

Accord am of opin that might with prop. introd as fixd formul. in Pharm, a pill in which aloes & Assafoetid conj.

Such often of late used in pract at the Disp pract. both by Dr Webst & myself.

And in many inst attended with best effects as conj advant of Pil. Aloet & Pil. Gummos.

These we often prescrb under title of Pil. Foetid cum Aloe.

In which case consist of equal parts of Aloes Assafoetid & [illegible] [Soap] intended with view of giving form.

Where however circum require, proport of each may be altered.

And partic either quantity of Aloe or of Assafoet. may be encreased accord as have in view the obv. cost or flatul.

From this prescript then in pres. case hope that most urg. compl. of patient may be obv.

And if this end thus obt. will next be endav to conj it with [such] meas. as may operate in prod radic cure.

That is such as will serve to restore due tone to alim canal.

With this intent more to be expectd from those artic having immed action than operating on syst in gener.

And few more success. than the veget bitters.

To many of which indeed whether as acted upon by watery [vinous] or spirit menst. from prop as partic acting on stomach, gener title of stomach med given.

To such then mean here to have first recourse.

And for this purp mean to employ the Infus Amar. of Edr Pharm conj with a prep of Tinct. Rhei.

In former one of purest veget bitters & what I reckon very useful tonic viz the Gentian.

While at same time more remark power of destroying & neutral acid than perhaps any other of the Veget.

To pres case then accord to ideas of disease consid it as partic adapted.

But from conj with astring of Rhubarb imagine that qualit may be improved.

Hope then that under these [ind] may in time be able so far to counteract morbid state & to obv. sym that patient may be dism from farther attend.

If howevr this not the case & if contin to hold same opin of disease as at pres, may yet have recourse to other purgat, carmin, [illegible] antacids & tonics.

And if from future appear any ground to change sentim [meas] must then be accom to opin which shall afterwards adopt.

But whether shall then have reason to supp sympt to proceed from calcul. or other local disease in kidney, intest, or any other of Viser, or cavit of abdomn at pres. [cannot] [sugg] what may then be [thought] [necess]