DEP/DUA/1/37/23 (Transcript version)

Thomas Davie

1785

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Thos. Davie March 5^th 85

To disease of this patient am I own at a loss what name to be affixd.

Chief sympt with which affected when came under our care, such as occurr in many diff. diseases.

This partic the case with respect to vertigo nausea & sickness at stom.

These well known to be insepar. attend of greater part of febrile affect.

And indeed also told that besides these other febr. sympt here also likewise occurrd.

Such for ex as want of app. encreased heat & quickness of pulse.

These often it is true take place where cannot be certain from what cause origin.

But in others can be distinct traced to some partic cause.

And here I think could be little doubt respect it.

Are not unfreq. affect of irritat in alim canal, proceeding from costiv.

And here no hesitat in attrib them to that cause.

For bound state of belly, had taken place to very consid degree.

In so much that at time when came under our care, informd that one disch only in space of forthnight.

This indeed, with some, hardly perhaps to be reckond morbid.

For inst of indiv to be met with to whom not usual to have disch oftener than once in eight days.

And with whom this length of retent, not prod of any inconv.

With one however, like our patient, in health habit to daily disch this be no means [case]

And accord little doubt in attrib to it all sympt with which affected.

Here therefore may have consid patient as lab. under high degree of obstip.

And that disease well entit to this appellat. when came under our care, can hardly I think be matter of doubt.

But [to] this, perhaps may be imagind, that some obj from progr of affect.

For began you will obs. with very oppos. state.

When patient first taken ill disea app. under form of viol diarrh.

A compl. which may by way remark, has of late been extremely common.

Or at least this has been very remark the case with regard to affect of alim canal.

And these app. princip under form of diarrhoea.

But by no means univ in this way.

May therefore be quest. whether was not rather to be consid, as pecul modif of the prev. epidem. than as strictly speaking an inst of obstip.

That this, may have been in some degree the case, would not deny.

But at same time well known, that in every inst, unless when morb. condit of intest, affect of excess. loosnss is, to give tend to opp. state of disch.

This even the case, where purging excited by med, as for ex. Glaub. Salts.

Hence then suppos him at first subj to epidem diarrh, still prop. obstip may have here occurrd as conseq.

And at any rate the bound state of belly, the morb. condit from remov of which reason to expect allev of sympt.

With this idea of nature of disease had no reason to entert unfav hopes of termin.

For obstin espec when merely an occas occurr. one of these affect. which have it perhaps more in our power to comb. than any other.

And here neither habit, nor smallest reason for susp. any fixd cause.

Concl therefore that should soon be able to comb. it.

But even these remarks on progn now unnecss. since fav termin has already taken place.

And this am inclind to think, not a little to be attrib, to pract to which had here recourse.

When came first under our care, seemd to be first obj. to obt. thorough evac of intest canal & to support regul. disch.

This however did not think, was to be aimd at by brisk or viol cathart.

For from these, as from diarrh at commen of affect, might have expected even, more obstin obstip.

But was obj, by gentle stimul, to encrease peristal. motion through whole course.

But espec to encr. stimul to it, at the rectum.

Was with these intent, that had here recourse to aloet purgat.

And was espec with view to last that empl. aloes under form of pills.

These pills to extent of about five grains, have in gener. effect of prod one or two easy stools.

Here however from very bound state of belly, could hardly expect operat, from so small a dose.

Ordered therefore, that till regul disch could be obt. should be taken to extent of ten grains in day.

And from this quant. even alth no obstip had occurrd nothing to be feared.

For by no means an overdose.

And indeed remarkd, that operat of aloes, in point of degree, not propor to quant. to which taken.

Accord. [the] having prescr. aloes to this extent in pills, did not prev. me, from having recourse to anoth purgat.

For directed at same time, Elx. of aloes & Rhub. conj with Pepp. mint water.

In this diluted state however, intended rather as stom than purgat.

And with this, intent as strength tone of stom, & giving vigour action to alim canal in gener. has often best affect.

Probab. however more from Rhub. than aloes.

Under these med, disch by belly, soon returnd to natur stand.

Had easy stool every day.

And with this, consid allev of affect.

Still however some remains of former sympt.

Partic those depend on affect of stomach.

For to this, would attrib not only nausea & sickness, but also vertigo & headach.

These at least sympt often result from affect of stom.

And viewing affect in this light, imagind that affect might be comb. by contin of formr stom med.

Now however saw no occas for persist in use of aloet. pills.

Directed therefore the contin of her mxt alone.

And although, in state in which given, to be consid as but very slightly purgat, yet as obstip removed, imag that would now be suff. to keep belly gently open.

In this way, some reason even to presume, that had more affect than could have wishd for.

At succeeding report at least, were informd, that had now five or six stools in course of day.

This indeed I susp. rather, to be consid as some return of former looseness than as affect of med.

But at any rate under such state of disch. seemd imprud to persist in use.

And this now the less necess as all other sympt. were gone.

Ordered therefore that elix should be omitted.

Still however, both with view to pres looseness, & to prev of recurr of formr affect, some pract. seemd necess.

As means of destroying acid, by which thought that might perhaps be supp, had recourse to Magnes.

And with view of strength bowels added small prop of Rhub.

While as corrigens, & espec for prev of flatul, comb. with these, a small quant of powder of Cassia.

Under this med, whether in any degree the affect of operat or not, sympt entirely left him.

And accord. dismissd free from his affect.