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

Jean Small

(1783)

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Jean Small.

In case of this patient a distinct markd inst, of an affect of which treated at some length in first case lect.

That viz of John More.

Here therefore very few obs. now necess.

May only obs. that in cop. [illegible] erupt. in num vibices, & in manif tend to haemmor. without what can prop be consid as febrile sympt. have all the charact of what descr. under title of [Petechanosos].

Here although affect had in few days, arisen to consid height, no evid cause to which could be traced.

Sympt themselves however suff to indic nature of compl.

And at time when case taken was not without appreh as to concl. of it.

These however soon entirely remove

And from patient, being already dismissed free from affect. any obs. on prognos. entirely superseded.

May only obs. that from pres case app. that although sympt may put on alarm appear. yet may in short time have fav term

Have far this termin affected forwarded by med here empl. will not pretend to say.

At same time seems to me most probab suppos. that had share in the cure.

As in case of More imagind that affect most readily to be overcom by counteract putres tenden.

And although meas there empl. had not the success that could have wishd yet here also had [recour] to those powerful antisep. the Elx. of Vitriol & Peruv. Bark.

These med taken as directed without any inconven.

And during use affect had manif a speedy decline.

In so much that in few days no more tend to haemorh. little remains of vibic & petech very consid dimin.

After contin for anoth week sympt entirely gone & patient free from any other affect.

In this situat then reckond contn of med or farther attend of patient unnecss.

And accord. dismissd.

May here therefore with confid vent to say that did not retard cure

And in as far as can presume between cause & effect probab even that forwarded it

At same time but fair to obs. that between 13^th of June when med ordered case taken & fifteenth when med [ordered] sympt rather decl as [otherwise]

And must also add that by mean of them were not able to effect cure in case of John More.

Since last spoke of that patient sever reports with respect to case introd into regist.

And as will obs. by report on frid last still under care for some rem. or rather for threat of return, of form affect.

On 15^th of May when last spoke of case from urgen of sympt partic sickness vomiting & headach Bark & vitriol interm.

And had recourse to Elect Jap. & Pulv stypt.

From these some temp good effect seemed to be obt.

And partic from applic of [latter] to cut in lip haemorr from that part entirely stop. & has never since returned

From subseq. reports howev will obs that on 17^th bleeding again began from nostril.

But of itself spont ceased after consid disch.

Shewed however evid tend to return.

And as topic astring formerly prod of so good effect led to think of empl astring to act on syst in gener.

With this view had recourse to succus Japon.

But comb it with Crem of Tart both counter tend to bind belly & to obv. cost. to which pat natur disp.

Under this med contin till 2^d of June.

During all that time no return of haemorrh. & livid blotches had almost entirely disapp.

Princip remain compl. weakng & tend to vomiting although appetit somewhat mended.

Imag. therefore that would now be better to omit all med & to trust entirely to such [nutrit] diet as patient capab of taking.

Accordingly under this course grad recov. strength for near space of month.

And was again in situat to enjoy uns. [amus] out of doors.

But about begining of July some fresh livid blotches again app upon legs.

On this app had immed recour to mixt of Bark as formerly.

But although readily taken did not prev some return of haemorrh. as well as farther app of vibices.

In this situat, as some reason to think that bark inad to cure have had recourse to anoth meas. suggest by natur indic or longing.

Patient mother has obs. that when affect formerly at worst & since again aggrav that has shewn a partic inclin to eat lime earth & sever other subst.

On this uncommon desire two suppos may be entert.

Not impossib that indulg of such crav. aris from some pecul state of stom has given rise even to affect of mass of fluids constit pres. disease.

For can easily suppose that this appet may have taken [plac] before ailm. & that may have indulg it unobs to consid extent.

At same time has only been remarkd during sever of affect.

And therefore no less prob suppos that is a natur crav. the indulg of which will prove cure

Is almost inconcev. how extraord the salut longings of patient freq are.

In so much that some disp to think is safe gener rule to [indulg] depends of patient in every case.

On this subj cannot help thinkin that a rule laid down by late Dr Monro in case Clin lect one of best I have heard.

When pat made any urgent [desir] either in way of food or med asked the reason for it.

If they assignd reason gave it or not as his own judgem led him to think prop.

But if they knew not why they asked it, never faild to direct allev it even although would have been disp to think it very improp.

And after long course of pract found that following this rule attend with best effects.

In case before us then, viewing artic longd for as of tribe of [absorb] have, by way of exper directed a med of that kind viz Magnes Alb.

How far any good effect will app from trial.

And what to be after treatm must be determ by circum in which shall then find patient.