DEP/DUA/1/39/02 (Transcript version)

Katherine Hutton

1785

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Kath Hutton Febr. 4^th 1785

Of case of this patient perhaps hardly necess. to make many obs.

For since last spoke of her have seen nothing more of her at this place.

And thus no opport. either of altering opin of disease or of being more conf. in it.

May only obs. that diarrhoea of an alarm nature.

And that too not merely from obstin & long contin but from sympt. which had induced.

With woman only in 26^th year before she cam under care, had been subj to compl for near one half of that time.

During that time at least great chance that even some local disease of intest canal might have taken place.

But even supposing this not case, had in other respects very consid affect of syst.

For not only distressd with pain & sickness, but also with extreme debil.

And would not I own be surp. to find that at last sunk under aff.

This as already obs. often happen where local disease of intest canal, in conseq of induc of hect. fever.

But here I own yet presumpt seemd to me to be rather against that suppos.

For in these cases while much pain in belly yet very gener. more remark severe at some partic part.

This however as far as could learn never case with our pat.

Pain on contrary seemd to be equally extended through every part of intest canal.

And even in stom itself as might be inferrd from sickness & uneas. [there]

But besides this still anoth circum perhaps against local affect.

That is that with our pat somewhat of hered disease

For in hist of case told that father subj to bowel compl for many years.

This as far as I have obs not a comm occur.

And do not recollect that hered. dispos. ment among causes of diarrh. by pract. auth.

At same time nothing absurd at least in suppos. that pecul [fab] in bowels transm from par. to child as well as resemb. in other part

And if this the case it at least in fav rather of gener. than local affect.

This then at least somewhat more fav. with respect to prognos.

For of all inst of diarrh. those unquest. most danger. where local affect takes place.

But here other circum not a little against pat.

And besides what already rem of obstin & sympt induced, may add that even some doubt how far cure would be safe.

For well known that from restr. morbid accust disch often great inconv.

And that even when morbid, & tend to weaken.

For by this means very consid change cannot fail to be induced in mode of circul.

And thus, even greater distress than these intended to be obv.

Hence then attempts to cure here requird caut.

Partic in use of those pract giving sudden check to disch.

From this then, app. to me, that moderat requird with respect to use of opium.

For of all med immed restr. such disch. this unquest the most powerfu

Has immed effect as allaying encr. action of vessels on which disch depends

Here therefore though somewhat affraid of empl. did not wish to lose entirely benef. to be derivd from it.

Partic as tend to retain for longer time in intest canal med grad restor to those due tone & vigour.

Was with this intent then that here directed Pil. Theb. to extent of grV every night at bed time.

That is Op. to quant of gr s.

While at same time directed for pat. use of Succus Japon.

Here however in place of usual form, watery infus, empl it in subs.

This perhaps in genr. neither so eleg. nor in gener. so conv. a mode as other.

But here induced to give prefer. from two circum.

In subst. from suff. slow solut in alim canal has both more grad & longer cont. action.

And these in pres. case were certainly desir circum.

While at same thus also action more extended through whole tract of [intes]

A circum partic to be wishd [where] affect extended through whole

Even this astring howevr did not wish to empl. to any very great exten

And was chiefly with view of limi & moder. dose that here given in conj with Pulv. Cretac.

While however served purp. of giving conven & easily divis form, imag. also that might here be useful in other resp.

Need hardly obs. that basis an absorb. earth, with addit of some aromat.

From first, might exp. affect of destr. acid in stom & intest.

And in this manner remov. [cau] by which looseness often supp & [aggr]

While from last, benef. as allev. some of most distr. sympt of pat

Partic flatus & borborygmi.

From these med then expected that in this case might obt at least some advant.

And by influ on disease should have been directed as to contin, augm of dose or future meas.

But since first directed have seen nothing more of pat.

What circum has led to this dissert. cannot pret. to say.

Here however no ground for imag. that is conseq. of having no farther occas for assist.

For from meas here empl, with disease of such obst, could hardly expect even consid temp mitig.

From desert however may I think inferr anoth circum.

viz That obstin of disease in some degree effect of never having empl. prop. means for remov.