DEP/DUA/1/38/51 (Transcript version)

Barbara Orrock

(1785-1786)

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Barbara Orrock.

Respecting disease of this patien am I own not without doubts.

Can however have no hesitat in consid her as subj to a compl of affect.

And perhaps not an easy matter to determine which to be consid as most danger or most import.

Compl. however at least most urgent when came under our care were diff stom ailm.

Partic was affected to very consid degree with pain both in stom & bowels.

And this pain accompan with freq eruct & flatus.

From which as well as from [trans] nature, might inferr that affect merely of wind in alim canal not of any fixd cause.

Besides this affected also with [want] of app. disagr. taste in mouth & headach.

In all these cannot indeed by pret. that have charact of Dysp. as defind by nosol. writers.

But often where for months togeth fewer sympt take place, [in] no long time there occurr nausea vomit rumin, cardialg. & all other sympt. which attend. of that affect.

And will not at least be denied that in sympt here enum have unquest evid of morbid state of dig.

Hence in strict lang. entitled to appelat of dyspep.

One partic indeed which may seem obj to that suppos.

That is loose state of belly.

Must be allowed that with Dysp. if not univ at least very gener. constip occurrs.

But this neither a const. nor necess sympt of the dis.

Accord. Dr Cullen in his definit, has only said, alvus [pleurunque] astricta.

But although might consider obstip, as almost univ attend of the diseas in ordin cases, yet no reason to doubt, that in partic inst, may be compl. with diarrhoea.

And this I own from what have seen of progr of disease consider as being case in pres inst.

For when patient last attend us Diarrhoea one of most urgent sympt.

And can at least conceive, that with that morbid affect of stom giving sympt of dysp. there may at same time occur in infer part of intest condit giving diarrhoea

That is augm depos of watery [secrt] & encr. of peristal. motion.

But besides these here also symp of anoth disease & that too of more alarm nature

In cough pain of breast & dyspn. have common attend of Phth. Pulm.

And these the rather alarm as were ushered in by consid Haemopt.

From this circum am I own not without appreh.

At same time sever partic which now at least againt supp of Phthis.

Neith has at pres. nor as far as we can learn, has she had during course of affect, any marks of hectic fever.

And neither that progr. which might have expected during course of disease, nor any sympt apn of haemopt for many months past.

While pulse, in point of numb, even below natur. stand.

Am therefore disp. to concl, that affect of lungs, which accompan rupt, has entirely ceased.

And this the rather to be imag. as haemopt. occurrd at a time, when menst disch wanting.

Well known however that haem vicarious to menst disch, seld attended with any dang.

Accord. both Haemopt & [Haematem] to great degree happ. in Ammen. at period when menses should flow, seldom consid as ground of alarm.

As therefore haem. in pres case, occurrd during obst. – As has now for long time entirely ceased. – And as menst. evac now regul, have I think, ground for presum, that all dang. from this source over.

And am I own inclind to hope, that pect. compl, merely catarrh.

But whether Phthis or catarhal, at least add to compl. here occurr.

And besides what already pointed out, have some susp. that may also add to dis of this pat, anoth affect.

Have not indeed, in any of compl enum in case, what can be consid as in any degree app. in app to the hyster. parox.

But sever of her compl, are what more freq. occurr, as hyst. sympt, than from any other cause.

Partic flying pains in diff parts of body, fitts of sickness, faintness, & the like.

And indeed with hyster. females, both stom compl, & cough very freq. occurs.

Hence not imposs. that may have very consid share, as induc affect.

Whether however has in this way any influ or not, from after what already said respect diff affect here occuring, need hardly add, that can say very little, with any degree of confid resp. prognos.

If however as we are inclined to hope disp to believe be really free from Phthis, though sympt num, yet affect cannot be consid as immed danger.

And am inclind to hope that if attend regul contin may in no long time, be able, if not to remov, at least to allev, most of compl.

This however it must be allowed, the more diff. as in comb. Dysp. Diarrh., & Pector compl, diff. modes of treatm may be requird.

And in such cases, cannot pretend to lay down any gener. plan of cure.

Or at least, though may form [such] yet pract must be very much regul. by urgen of sympt which occurr.

And this I own, has hitherto been ground for diff. pract directed to pres patient.

Before selected her as subj of case lect. prescr. for her, a mixt of Peruv Bark & Valer.

From first of these had in view the strength tone of stom, & thus allev. sympt of dysp.

From last, the counteract pecul irritab of habit, which consid as cause of pains.

Partic of those flying pains when consid viewed as being of hyster kind.

And from Valer. as a nerv. med have in many inst since remark. benef.

This med however from state of pat. stom attended with very diff operat from what wishd.

For not only, always excited [sickn], but in gener. also vomiting.

While this the case, in place of any benef. had reason to think that would be attend with bad conseq.

From even from sickness, while always highly distress to pat, reason to believe, that tone of stom weakn.

And this certainly case, from freq. action of vomiting.

Such therefore being obvious oper of med, could have no hesit in laying aside use.

But upon this, had recourse you will obs, to anoth with same intent

A mixt viz of the Aromat & bitter Tinct.

Is at least general opin. that is as cont. & comb. those princip. vzr bitterness & aroma, that Peruv. bark oper.

And whether any other found for opin action or not, cert. at least, that does possess these to consid degree.

And also certain, that for Per. B. artic possess. these powers, useful subs.

But partic in stom compl. where when bark not retained, these not only sit easily on stom, but prod even of cordial affects.

Basis of first artic here used, the aromat Tinct, are Cinnam, & Cardam, two of most active, & most agr. of Arom.

While chief basis of latter, the Gent. one of purest & strong of Veg. bitter.

And in state of combin here empl. that viz of Tinct Amar, has been so much used in stom ailm, that formerly when med named from supp. virtues had title of Elix. Stomach

From these therefore, expected that might derive same benef. as from Peruv. Bark, without inconv. found to result from it.

But as in both Tinct, a spirit menst. empl. consid farther dilut as necess.

And with this view added a propor of Pepp. mint water which without any thing of intox qualit, has affect of oper. as a carmin.

And in this way highly useful in many dyspept cases.

But besides this directed also you will obs anoth addit.

A proport viz of Theb. Tinct.

To this not so much led, from hopes of dimin tend to vomiting, as with view to othr partic in case.

The cough viz & looseness to which was subj.

While from both of themselves very consid distress, could be no doubt also that augm. pres affect.

Both cough vomiting often excitd a circum on many acct. to be avoid.

And well known that while bound state of belly very distress to dysp. patients, if to obv. this, purgat emp. oper. briskly compl. never fail to be afterwards aggrav.

And this conseq. we may readily expect, will result from spon. loosenss as well as from that artif. ind.

Indeed may be consid as conseq of every praeternat evac.

Hence then indep. of distress, when these sympt. of themselves occas. the obviat cough, & at least gently restr. looseness, were very desir obj.

And in answ. both intent no med from which could expect more [thn] opium.

Whatever diff opin pract may entert as to mode of action, no one can deny, that influence as allayin inordin action in gener, both very great immed & also very consid.

And in this way, benef in partic daily felt from it both as allaying cough, & as restr. loosness.

Hence then here expected some [benf] from pres. directed, both as tend to remove dysp. to mitig cough & to restr. loosness.

From use of this med however expect. hardly more answ. than by formr.

Seemed indeed to have some effect in mitig of cough.

Or at least during use that sympt became easier.

But while stom compl. contin much in same state as before loosness upon whole aggrav.

And often partic distr., during the night.

In this situat, to contin of mixt, thought it prop to superad a larger proport of opium.

And this directed to be taken at bed time under form of Theb. Pills.

From this however though loosness prev. during night, no other matter advant was derived.

For still cont. to have freq. loose stools through the day.

And while other compl. nothing mitig was more than ever affected with sickness at stom

While as might naturally be expected from contin of disease strength cont. to be dimin.

In this situat thought that little to be expected from persist any longer in use of med.

And indeed now consid mitig or rather remov. of loosness, as a necess condit, before could expect to do any thing with advant as countr. dyspep. compl.

With view then espec. to Diarrh have you will obs. at last report, put pat. on use of Infus. Japon.

This artic which often pres. undr title of Julap sistens, a name [impr] as being derivd from supp. virtu.

For no doubt that much greatr advant. & less chance of error, when med derive name princip constit.

And accord Ednr College in last edit of Pharm. have almost univ followed this rule.

But whether pres under title of Julap. Sist. or Infus. Japon, has for its basis, has for basis, the succus or as very improp stilled in our Pharm the Terra Japon.

For what formerly supposed to be an earth now well known to be a vegetab. extr. of or [illegible] juice.

Obt. from a spec of the Mimosa growing abund in many parts of Ind partic in Bengal.

From kilns dug in ground in which is prep by evap of water [plan] acquires earthy app. often discov. on extern surf.

And which indeed has led to belief of its being an earth.

But earth thus adher. to it merely to be consid as an extran impur.

Accord. is a desir. obj to free it from this.

And in some Pharm as Succie a succus japon [depur]. with great prop introd.

Formd by first dissolv in warm water & again evap to dryness the clear liquor

By this means vegetab part of it obt in pure state

For earthy sedim matters, not solub in water almost imm falls to bottom.

Nearly same end obt. by empl. it under form here directed that viz of Infus Japon.

For thus also, although no future evap, by throwing away sedim, get rid of all earthy impur.

And in this respect consid. Infus Japon. as pref. to mixt made by diffus in water the Elect. Japon.

For in that case, as sever artic insolub in water, mixt directed to be shaken before use.

And by this means earthy impur. swallowd as much as when taken in subst.

To infus Japon. here added you will obs. a proport. both of Cinnam Water & Mucil of G. Arab.

First chiefly with a view to action on stom & to forward expuls of flat.

Last again, with a view to demul affects, as lubric fauces, & for mitig of cough.

And both as a means of allaying cough, & of rest. loosness here also added a proport of Theb. Tinct.

This where astring I have ment is empl. a very common adjuv.

And often with best affects.

Nay obs. that much more obt from two togeth than from either separ.

And not improb. that as opium gives tempor. susp. of inord. action, astring has thus full opport of action.

Whereas otherwise would be [hurried] through intest canal before could prod affects.

While again by astring, tempor adv obt from opiate are contin.

But whether this reasoning well founded or not, cannot be quest. that from med here empl. very great benef often obt.

And am hopeful that in pres. case may find such an affect result from use.

But at same time after trials alr. made without success, cannot speak with great confid.

If however as at pres. directed has not affect of remov. looseness, shall prob empl it to greatr extent & with larger propor. of [Laud].

And if this also fails may have recourse to more powerful astring or to astring & sedat. topically applied to rectum.

But as already obs. need hardly offer any suggest as to future pract.

For from complic nature must be very much regul by circum.