DEP/DUA/1/34/24 (Transcript version)

Robert Henderson

1784

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Robt. Henderson March 24 1784

In case of this patient, have sympt. indic diff. affect.

And these prob. little if in any degree conn. with each other.

Of these the most distress. to him when app. for our assist. freq. loose stools.

Had you will obs. then watery disch. seven or eight times every day.

From app as well as mode of disch could have no doubt in pron. this to be case of Diarrhoea.

Only othr assert indeed, to which could be consid as having any [resemb] is Dysenteria.

And to this being his [disease] strong obj from abs. of gripes, tenesm bloody stools but above all of fever.

For though some quickness of pulse, impaird app. & vertigo, yet without heat thirst & what still more charact of fever, without anxit. febr.

And here if even at this late period looseness had occurrd would not have altered opin of disease.

And accord to freq stools, was here disp to referr. dimin of app & vertigo as well as quickness & weakness of pulse

But besides these, other circum in the case which could not be consid as dep on this

viz freq. loose cough excit vomiting.

In this had common charact of a catarrhal affect.

Or at least could only be consid as marking either Catarrh or Phthis.

And of the latter here no ground for entert any suspic.

For vomiting as well as pain at scorbic cordis with which attended were to be consid merely as indic an irritab. state of stom.

And prob. in some degree connectd with irritab. state in other parts of alim canal, giving rise to Diarrh.

From this view of nature of affect. no ground for giving at least an [conf]. prognos.

Diarrhoea the prin disease to which this pat. subj. rather an inconv & distress. than a danger. comp.

Sometimes indeed must be allowed proves an obstin disease.

And often when cured or at least when stopt prod of inconv.

These however very gener. the conseq only of long contin.

But with our patient this could not be said to be case

For although, had with him cont. for space of seven weeks, yet this not to be consid as a diarrhoea of long standing.

And notwith this contin had hitherto at least been prod of few distress sympt.

For neither disch of blood, tenesm nor even pain at anus conseq almost unif. result. from abraided state.

Served therefore to shew that freq. of stools more conseq of irritab. or dispos. to inordin action than of any thing else.

And that if encr. secret. took place was at least not of that acrid & vitiated nature which can give excor. state.

Have reason therefore to hope that in no long time may be overcom

Yet must also be obs. that temp. susp. looseness far from being evid of entire restor of sound state to intest canal.

And that till this affect. pat. will at least be liable to renewal of compl. from slightest causes.

With regard to catarrh sympt. there even less ground for alarm than Diarrhoea.

Had indeed short time before came under our care been somewhat encr. in viol.

But even then by no means consid.

And attended with such free expector. as gave reason to hope for speedy termin.

Especially be [accurr] of mild [weather]

While neither from age of patient nor contin of this sympt any reason to fear degen. into chron. state.

To all these partic to be added that under treatm empl. both affect consid mitig.

With regard to treatm. object which first & prin claimd attent was Diarrh.

Though at same time in pract [empl] had in general also Catarrh in view.

This however will more partic app. in speaking of diff remed to which had here recourse.

Began you will remark by direct for this pat. the use of an Emet.

From this in cases of Diarrhoea often very consid advant is obt.

And here good affect may naturally be expected from it on diff. prin.

In many cases can be no doubt that diarrhoea the conseq of matter secreted or formed in stomach

And that from these passing down prin phaenom of the disease induced.

For act as it were as purgat.

This partic the case with respect to acid gener there.

But prob hold also with regard to many other matters.

And indeed many both secreted & formd, which probab. possess much greater degree of acrim than acid.

At least this may be inferrd from pain, [excorriat] & even ulcerat which they prod.

From these therefore being expelld before go farther than stom, best affects may be expected.

And in this way often best affect from Emet in Diarrhoea.

But besides this have also unq. powerful influ as giving determin to the skin.

And by this means flow to the intest. canal is dimin.

Thus then naturally dimin of that secret. from which fluid [illegible] constit diarrhoea is afforded.

But besides these still a third prin. on which have often been inclind to suppose that may here be servic.

That is from inordin & violent action which Emet. excite.

Well known that one inordin action in syst. not only for a time countr. & susp. but even sometimes entirly removes anoth.

This partic exempl in sneezing stoping hiccup

And in same manner that action of stomach which takes place in vomiting may susp or remove that in other parts of alim canal which occurs in diarrhoea

Thus then may be useful in cases of that kind, not only where there is an acrid matter to be evac or where determ to intest canal, but also where as susp in pres. case disease princip affect of tend. to inordin action.

But besides Diarrh. hoped also that might here be useful with view to catarrh.

For unquest emet, one of most effect means of unloading breast

And by giving determin to surface here also useful from changing balan of circulat.

All these intent however could not expect would be compl. answ. by a single emet.

Was intent therefore to have recourse to repeated empl.

But emet when given to such extent, as to excite full [vomiting] should never be very precip empl.

For no doubt that by such strong action freq repeated tone of stom very much dimin.

Ordered therefore two only in course of week

And was intent afterwards to repeat them as circum might require

While directed Emet however, had recourse also to anoth. remed. the Infus. Japon.

Warm water while readily [dissolve] all active parts, takes up none of impur. partic earthy part of Suc. Japon.

Hence one of most elegant as well as efficac modes of exhib. it.

And espec as have at same time an opport of conj it with those grateful cordial aromat which readily [impart] virt to warm water.

With this view here directed an equal quant of Cassia Bark, not little infer in virtues, to Cinnam. while much cheaper.

In this way operates as a powerf [restring] in suppress looseness.

And in many formr inst have found it attended with best affects.

In conseq expected from these med were not disapp.

For while vomits operated well, from time that began infus jap Diarrh. very much abated.

In so much, that at succeeding report, disch by belly little more freq. than natur. state.

In this situat hardly thought it advis to persist in use.

For if not prod of inconv. by prod oppos state of disch, had at least some reason to appreh. bad affects from sudden suppr. of evac to which the syst. had long been habit.

On this acct therefore, in place of med before directed, had recourse to Magn. with Rhub

By former hoped that belly would be kept gently open, & that at same time tend to looseness would be dimin from its neutral acid in stom

While lattr, prod also of same affects would tend somewhat to brace intest canal.

Espec when grad thrown in by small doses so as not to operate as a purgat.

While using this powder contin free from Diarrh. & had at same time regul disch. by belly

But during use Catarrhal sympt were somewhat aggrav.

This led me to employm of a mucil mixt with which comb. some prop of Tinct. Theb.

While she took this mixt these sympt. allev.

But quant given not suffic to serve her during course of week.

And after intermiss affect [again]

While repeated mixt therefore, advis that should be taken more slowly.

And to [compen] want of former quantity directed a pill at bed time with gr s of Opium

Under these med am hopeful that cure may be accompl.

And that patient may in no long time be dismissd free from affect.

If in this however disapp. future meas. must be directed to app which may then take place & to view which shall afterwards have of the disease.