DEP/DUA/1/38/45 (Transcript version)

Robert Lamb

1785

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Robt Lamb. Novr 26^th 85.

History of this patient compl. does not in my opin afford cert. diagnost of any partic disease

Has indeed many of those sympt, which known to arise from pres of worms, partic of lumbri, in intest canl

Such for example as pains of belly, & picking of nose.

Of same kind also may reckon delir during sleep, starting, & grinding of teeth.

And may also rank among these, tenesm, & frothy or slimy stools.

That all these sympt. freq. arise from pres of worms in alim canal, cannot admit of doubt.

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But at same time, often arise also from other causes.

Probably may be affect of any mattr giving pecul irrit, to intest.

Perhaps even, of very irritab state of intest canal, when acted upon even merely by ordinary stimuli, to which unav. exposed.

In many cases then, from sympt alone, diagnos impossib.

For even where worms disch, may yet arise, from other causes.

At same time, where no object to use of anthelmin, these perhaps, afford most certain diagnos.

For if from use, some worms disch may concl. with at least consid prob, that these, or others still remaining, have been cause of sympt.

Where on contrary no worms app. gives at least stronger presumpt, that origin from othr causes.

On this ground, though at first supp of worms lumbrici now diff. opin of this case.

+ Am inclind to think that few asarc. obs. to be disch little or no connex with his other compl. pres disease

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And consider it as arising from weak & irritab. state of intest. canal.

To which as very gener. indeed happens in such inst a vitiated secret operat as more powerful stimul is superadded.

To this affect, unless when arises to such height as to induce Diarrhoea do not know any proper name in syst. of nosol.

For gastrodynia, an affect charact. by pain of belly princip & indeed [most] distress. sympt. which here occurs is yet a very differ. affect. as describd in nosol. syst.

But if right as not nature of the disease, name less matterial.

For is on knowledge of princip morbid affect here occurring, that successf. treatm must be founded.

And on this idea of the affect am I own disp to look for fav termin.

Not indeed that can be alledged in no inst to prove fatal.

Sometimes is merely forerunnr of incurab. diarrhoea.

Sometimes, where no disch takes place, gives rise to Tabes or Atroph proving fatal.

But of none of these termin does there seem at pres to be any threat

And in greater numb. of inst, even where sympt. worse than with pres. patient, by aid of prop. remed, due condit of intest canal may be restored.

Hope therefore that in no long time, may be able to dismiss him free from affect.

Or at least, in such a [illegible], that from prop manag. respect diet exercise & the like remaining sympt may of themselves grad disappear.

After what already said concern nature of disease almost unnecess. to add any thing, respect mode gener. plan of cure

This must consist in unload intest canal, of those matters, acting as pecul stimul.

In remov. morbid irritab, in conseq of which, more affected by irrit cause.

And in restoring to its moving fibres, due degree of tone & vigour.

These gener. intent, will abund expl pract, to which have had recourse with this patient.

Remedy indeed with which first began viz the Calomel, directed in some degree with a diff. intent as before [trusted].

Or at least, while intended that should operate, as evac of alim canal, wishd also, by this means, to determ. whether any worms lumbrici pres in intest or not.

Power of Calom as an anthelm med, long ascertaind by very extens exper.

And in manner in which here given doses viz of single grain at interv. of two days no less safe than effic.

While at same often also thus operates as powerful evac of alim canal.

But with view to both intent. to use of Calomel thought that a purgat. might with prop. & advant. be superadd.

For this purpose, had recourse to a mixt of Tinct of Jallap, & Syr Simp

A mixture for introd of which, we are indebted to the Sutton Inocul.

And which, even with youngest inf, I have found to operate, with equal certainty & ease as a cathart.

Espec. as not disagreeable to taste, & can be thrown in, by small doses in such manner as to secure operat.

not even any of ascarides

From these med, while no worms disch. +  & thus at least strong presumpt, that none existed, there took place very free disch in way of catharsis.

From this therefore concl. that intest suff. unloaded, & that what cheifly remaind to be done, for accomp cure, was the removal of morbid irritab & restor of tone.

By restorat of tone however prop condit of sensib often also restored.

Hoped therefore that here both ends might be accompl by use of Rhub.

An artic combin laxat & astring powr.

And where does not disagree with patient, often in such cases prod of best affect.

To render it more [palap.] a circum necess to be [consisted] with infant. Vin Infus of Rhub. here united with Syr. Sim

Or finally if any more ascarides discharged of which whether cause of affect or not at least desirable that should be freed, will have recourse to inject of Lime water, most powerf & safest cure with which I am acquainted

And as suspectd that swelling of belly was affect of flatul. diluted it with Syrup. Cin. Water

Adding at same time a propor of Mucil. both with view to tickling cough, & with intent of lubric intest

Under this med compl. compl though not removed, now consid allev.

And hope that from contin, patient may soon be in condit to be dismissd

If however violent return of gripes, may comb. it with small prop of Laud.

If marks of accum sordes in intest may altern it with purgat.

Or if more powerful astring shall seem requist. may subst. Infus. Japon or G. Kino.

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But in choice of these, if any necss must be directed by circum at the time