DEP/DUA/1/34/16 (Transcript version)

John Stark

(1783-1784)

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John Stark.

In case of this patient have an ex of an affect by no means [unfav].

And in sympt with which is attended nothing that can be [cons] as very pecul.

In very freq. stools to which subj have the disting sympt of Diarrh

While nothing of that appear of blood, which can give presumpt of Dysenteria.

And this indeed, farther rendered improbab. by absence of febrile affects even on attack of the disease.

Here freq. of disch prob in some degree depended on augm watery secret into intest.

But had reason also to suspect a partic local affect. at extrem of rectum

For was I appreh in conseq of this, that affected with severe pain about anus, by which incapacit either from walking or even sitting.

This state of rectum may possib have been conseq of secret matter possess pecul acrim. being depos. & retained there.

But however induced, after once taking place constit no inconsid part of disease.

And to uncommon sensib thus occurring, are prob. to attrib those very freq. calls to stool to which subj when first applied at Dispen.

On idea of such a local affect [had] more reason to dread that disease would prove obstin.

And [of] this also its contin with encreasing violence for space of ten weeks gave stronger presumpt

Accord when patient first app. for assist was suspic that disease would prove ted.

And although by opiates or other means, might allay sensib for the time, yet was very [appreh] that would be liab. to [recurren].

This it is not impossib may still be the case.

At same time relief which pat has already received gives ground for entert more fav. hopes.

This relief can have no hesitat in ascrib to remed here empl.

A mixt. viz the basis of which was confect Japon.

Where with the succus japon one of best vegetab astring, differ aromat & some proport of an opiate are united.

From this med have often in simil cases seen best affects.

But here from urgen of pain thought it necess to encrese a little the proport of the opiate

For to be obs. that at first [prescr] under same formula as you will find inserted into regist when case taken.

From commen of use of this med sympt very much mitig.

So that by the end of little more than week belly rather bound than otherwise

Still however had so much of pain at anus that could not supp affect to altog overcome.

And seemd necessary at once to keep belly open, & still farthr to encrease tone of intest canal

Was with this intent that had recourse to mixt of Tinct of Rhub. with mint water.

Hoped that while kept belly gently open would at same time [brace] intest

And partic operate as restor. prop mucous lining to infer. part of it.

An effect which am disp to think to very consid degree arises from Rhubarb.

And in this respect is in my opin a [contrast] as it were to aloet purgat.

For from these mucus again partic liab to be abraded.

But whether from this or any other ground as prev. return of G Diarhoea know few artic better than Rhub.

Hope therefore that will here be prod of desired affect.

And that by this means may be able to dismiss patient free from compl.

If this not case & if urgent pain at anus contin giving presumpt of contin of local affect may have recourse to topic applic in way of inject

Partic to Enema ex [illegible], with addition of Inf. Japon.

But this & other pract must be regul by situat in which shall find patient.