DEP/DUA/1/42/29 (Transcript version)

James Ritchie

(1787-1788)

---

James Ritchie at 8.

Formerly observed that case of this patient not without doubt.

That sympt such as occurr in comm of sever diff. disease.

While could not be consid as char of any one.

Chief affect a compl. of febrile kind.

But of irregul type.

And at same time chiefly charact by distress. headach.

These well known to be app. with which acute hydroceph often attend.

And often for some time no other appear.

But here may be thought that susp. corrob by other partic.

Partic by state of sleep during night.

For while sleeps little that sleep also disturb by freq. start.

If therefore should in end turn out to be that affect, could not be said that appear at comm uncom or anom.

And certain that often subs. for some time where even less ground for suspic.

But if some circum in fav of supos others against it.

Partic wants one of most comm sympt the vomiting.

This as may concl. from variety of circum a common sympt of [opp.] brain.

And unquest one of most freq. at commen of Episp. Hydroceph

Partic as returning at intervals of two or three days

If vomiting a comm sympt of Hydr. bound state of belly no less so.

This however you will obs. also absent here.

To these obj to supp. a third also to be added drawn from progr.

Here more slow than in much greater numb of inst of acute Hydr.

Before came under our care had subs. for forthnight.

Ere then however might have expected comm of 2^d stage.

Partic slowness of pulse.

These partic then consid as rendng suppos rather improb.

And besides to be remarkd as already said, that while sympt of pat such as often occur in hydroceph take place also in other diseases.

Partic such febrile affects often conseq. of worms in alim canal.

And with many would be consid as not a little in fav of presumpt of these that pat. affected with grinding of teeth during sleep.

That this a very freq. sympt from worms not to be denied.

But at same time judgm. would be very erron if to inferr these pres. where ever this sympt occurr.

Well known to take place even in disease last ment.

And among other partic to encr. diffic in disting in some cases betwen sympt from worms & hydroceph.

But besides that not diagnos here some suppos many of princip marks of worms here wanting.

When these pres very gener. prin part of affect severe gripes.

And in place of app. being impaird common even voracious.

While with worms in gener disch of glairy stools.

And seldom that sympt from worm of long contin without some of them being disch.

On these grounds then conclude that still stronger obj to suppos of worms than of hydroceph.

But worms & hydroceph by no means only affect giving rise to such febrile affect as that occurring in pres case

[These] not unfreq arise from even very triffling irritat in alim canal

And then partic attended with dimin appetite & with grinding of teeth

Then also fever partic markd by headach as leading sympt.

And then especially slow & lingering suffering exacerb. & remiss.

Of these there suppos. then concl. this to be most probab.

And accordingly on this suppos. treatm of patient has hitherto proceeded.

Begun you will observe by direct use of an Emet.

In this had chiefly in view unloading the stomach.

A means of remov. irritat from one & indeed most essent part of alim canal.

For unquest most sensib as giving affect of syst in gener.

But besides matters accum in stom pass downwards

And thus exert as it were action on whole tract of intest canal.

Hence from evac of stom benef. here to be expected on diff. prin.

And indeed indic by want of app.

But even suppos conject as to nature of case not well founded, yet still might here expect some benef from use.

For without pretend to say how happ. certain that in many febrile affect from concuss of Emet best effects may be obt.

Strong reason to presume that in commen of fevers from contag. even in [plague] itself. Emet have sometimes cut short the disease.

And not unfreq. same effect even at after periods.

Some indeed consider these affects as following only from use of Antim Emet.

And look on James Powder. Tart Antimon. as like as possess. pecul. & as it were specif. power.

This opin however as far at least as can judge from my own observ. am inclind to consider as ill found.

And am persuaded that no other effect results from them, than conseq of obv. operat. partic as Emet.

And this effect of prod full vom may with greater cert. & with more safety be obt. from Ipecac.

Need hardly remark that this Emet very rarely fails, very rarely prod more effect than wanted.

Both one & other however freq. conseq of the Antim Emet.

Partic those which in state like Jas Powder not solub. in water

And which for solut in alim canal require acid or liquor of stom.

Accord with one condit of stom, alth taken to great extent, prod of no effect.

With anoth even in small doses prod of very viol effects.

In so much that in some inst, espec. at early periods of life, have seen very viol effects from use.

And on this acct. am I own disp very gener. to give prefer. to Ipecac over antim emet.

Ipecac. though more slow in oper. will yet have effect when exhib even in small doses.

And taken even to great extent seldom if ever prod of excess. vomit

For operates from being subj to infus, or rather perhaps warm diges in stom.

And as soon as infus suffic active for exert action of vomiting is prod, the superf quant. it may be allowed express. expelld by action of vomit.

In this manner would acct for moderat & regul. as may be calld of operat.

But whethr this conj. well founded or not certain that effects, by no means proport to quant. taken

That while from small dose seldom disap in operat. large one almost never obs. to do too much.

And from these circum look upon it as being upon whole much prefer to any other Emet with which yet acquainted

While directed emet. prescribd also a combin of Magnes. & Rhub.

Of these artic neither can be consid as possess. any great degree of activ.

Yet both separ & conj. often of very great service.

Partic in affect of alim canal of infants.

No doubt that many of these affect the conseq of superab. acid.

And in Magnes. have a most powe agent for destr. of acid.

In many cases has advant over almost every other [from] tend to open belly.

A conseq. prob. of its rather neutr. than destroying acid.

This laxative power not a little encreased by addit of Rhub.

Which while operates as purgat in first inst. tends afterwards to strength tone of intest.

Accord from this combin in [varie] of affect of inf. depend on condit of alim canal have I think seen best effects.

With pres. patient Emet. prod of wishd for effect in induce full vomit.

And after this sever of sympt, partic distress. headach consid relivd.

While in every other respect app much better.

A circum in some degree at least corrob. opin, that conj as to nature of disease well found.

Still however some sympts [remn].

And while slight febrile [exacerb] at night, Magnes. had no effect in mov. belly.

Directed therefore its contin in encr. dose.

But whether in this operates accord to intent or not, am hopeful, that will be necss. to do little more for this pat.

If however in this disapp. future meas. must be accom to state in which shall find him.