DEP/DUA/1/36/21 (Transcript version)

Janet Davidson

1784

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Janet Davidson Decr. 18^th 1784

Respect disease of this patient have entert diff opin since came under our care.

And still far from being cert. resp nature of affect.

Can indeed be little doubt, that her disease prin if not entirely an affect of alim canal.

But this it is well known may arise from very diff causes & be of very diff. kinds.

Among other causes prod diseased affect of alim canal worms may justly be enum.

For though no doubt that these sometimes pres. without giving any inconven. yet as cert that in others prod of most serious evils.

And perhaps few causes giving rise to more numer or more anom sympt.

To this cause was I own at first inclind to suspect that sympt of pres patient were to be attrib.

For here many of those circum which at least consid as comm marks of worms.

When these pres. an almost [const] sympt is gripes.

And not unfreq. also attended with looseness.

In these however have at least most remark sympt of pres. case.

While swelling of abdom which here occurrs also a very common attend of worms.

These, it is true, while arise from this cause may also proceed from many others.

But besides these, other sympt ment in hist of pres affect. consid as more pecul the conseq of worms.

Partic uncommon keeness of app. & almost const. picking of nose.

These indeed, may it is true arise from diff irrit to alim canal.

But from none more freq. than worms

Hence always consid as giving presumpt of that cause.

But in pres case anoth circum giving still stronger presumpt than any of these.

That is actual disch of worms.

This indeed, had not it is true been a late occurr.

But upon first attack of pres affect. some months before came under our care had been subj to febrile sympt.

And during these, six or seven worms, which, as far as could learn, were of lumbr. kind, obs. to be disch.

Here I think, can be little doubt, that disch, in part at least, affect of fever.

For no doubt that by intern morbid heat, situat in body rend disag.

Hence in what gener. calld worm fevers, app of worms, rather conseq of fever, than fever conseq of worms.

Although however some here disch from this cause, yet does not follow that all evac.

And some even, may exist at time, in state not liab. to be affected by heat, that viz of ova.

Here then no unnat suppos. that remaining worms, cause of patients affect.

And this, as already said, the opin which was at first disp to adopt

Notwith. all these presumpt circum, however, now inclind to think that this opin erron

At least after empl. of med [calcul] for expuls of worms none have app.

And can hardly suppose, that if worms had existed some of them would not have been brought away.

Now therefore I own disp to enter a diff idea of pat. disease.

In sympt already enum have strong evid of pecul irritab. of intes canal.

And from many sympt arising from flatul, as well as from swellng of abdom which consider as proceeding from that cause, would app. that little resist to extric of air.

And that little force tending to [condense] or expell it.

Hence inferr that with pecul irritab of intest canal, there also occurs, a great degree of weakness.

And to these morbid condit, am now disp to ascribe, both gripes, looseness, & other sympt, to which this pat. subj.

With this idea of nature of affect, opin of termin less fav than when supp. it to arise from worms.

For under prop. manag. these, in this country at least, seldom resist the use of med.

Hence then hoped, that from expuls patient would in no long time, be freed from all his sympt.

This however, with pres. idea of affect, cannot so readily expect.

Nothing indeed either in nature of disease, or in sympt with which attended, which can give any alarm.

But restor of due tone, & prop sensib, to intest canal, not to be very suddenly affected.

Even these ends however, may in time hope to obt.

And while no sympt giving alarm youth of patient, much in her fav.

Hence hope that in end case may be brought to a fav conclus.

Cannot however say that hithert much progr. made towards recov.

This indeed in part owing to plan of cure being at first directed on mistak foundat.

For as already remarkd, began treatm on idea that worms cause of affect.

Need hardly remark observe that was with view to these that had recourse to Semen Santonic.

This hold to be one of best & safest of anthelm in comm. use.

And was partic prop, in pres case, as has unquest tend to strength alim canal.

Indeed, by some thought, that power as an anthelm, solely on this prin.

For in sensib qualit, app. nearly to absinth, abrot. & other species, belonging to same genus of Artemis.

And bitters in gener. found to act, to no very great degree, as poisons to worms.

Am however inclind to think, that in Sem Santon, something more than these.

And not improbab. that from state of powder, to which reduced, oper. in some degree, on mechan princip.

But whatever mode of operat seld of itself suff. for expuls.

Hence to employm in general necess, that cathart should be subj.

From this, though before no effect, yet after worms brought to state, in which unable to retain place readily expl.

Here then directed use of Sem Santon for six days, and on morn of 7^th of cathat.

As such had recourse to Tinct of Jallap united with simple Syr.

For introd of this catart, are indebted to the Sutton innoc.

By them first taught to employ it, even at early periods of life, as a [chartic] in small pox.

Since that extended to many other diseases.

And where a brisk cathart necess. partic with inf. with whom dare not vent. to employ jalap in powd is one of best.

Here, in obv. operat of this med, were not disapp.

But although purgat oper. briskly, & vermif powders regul. taken, yet no worms disch.

From this, notwith presumpt afforded from sympt, concl. that no worms realy were pres.

If therefore no other advant from trial might at least be consid, as of some use in diagnos.

And conclud, that sympt. to which patient subj, not affect of irritat from worms, but of diseased condit in intest itself.

Imag, as have already obs. that proceeded from pecul irritab & loss of tone, thought it necess. to have recourse to means of restor. these.

With this intent had recourse to a mixt consist of Infus. Amar & & Tinct. Aromat.

Of the former the basis is Gent., one of best of veget bitters & aromat

And partic useful where necess to brace the stom, or alim canal.

Of latter again basis Cinnam & Cadam, two of most powerful & grateful of the vegetab. aromat.

This added, both as corrigens, & likewise with view to expuls of flatul.

For can be no doubt, that from stimul, which affords to alim canal, operates powerfully as carmin.

From this however, obt. no very remark benef.

But thought at least, that gripes & flatul. somewhat dimin.

Hoped therefore, that by contin, better effect might be obt.

Hence directed that should persist in use.

Although however, in partic already ment, allev. seemd more consid, yet most urgent sympt. looseness, rather encr. in severity.

Now therefore imagined that this not to be comb. by means encr. tone of intest already empl.

But that was necess, in first place, at least, to check it by means of astring & sedat.

From first, dimin disch into intes canal.

And from last, taking off tenden. to inordin action.

As astring here, employd the Confect Japon

And as a sedative, the Theb. Tinct.

Of all the vegetab astring, to which recourse had in looseness know none better than Succus Japon.

One of most eleg. & powerful, the Infus. Japon.

Made by either simple solut in hot water or by adding prop of Cinnam or Cassia

This subst. which was long supp to be an astring earth, now ascert. to be a veget extr, from a species of the Mimosa.

And has pecul. advant, of [comb]. with consid, though mild astring, a mucil. qualit.

May be exhib in diff forms.

>+

But diffus of Confect or Elect Japon is it is calld, in water, at least one of readiest, & easiest modes of exhib.

These not only united with diff aromat, but also with a prop. of opium

Hence then in itself comb. both astring & sedat power.

But here wishd that influ of the sedative should be pushd still farther.

Hence directed an addit quantity of Theb. Tinct. influ of which as allaying inord action no one who attends to facts can deny.

From this mixt. at first derivd consid benef.

But a short time before last report looseness again returnd.

This was disp in part to ascribe to some accid circum.

And in part also to opiate from habit, losing its influ.

Directed therefore that dose should be encr.

And am hopeful, that from contin loosness may be removed.

While from having recourse to former tonics, bowels restored to form vigour.

This then plan which at pres intended to follow with this patient.

If unsuccess. future meas must be regulated by circum.