DEP/DUA/1/45/34 (Transcript version)

David Phin

(1789)

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N^o25 David Phin. at 23.

Formerly pron disease of this pat to be a long cont. dist. markd & obst inst of Diarrhoea.

And from any thing which had afterw [opp] of obs. with respect to case no reason to alter opin with resp to it.

Is indeed true that term diarrh taken in very diff senses.

By some consid as compr every affect in which there occurr freq loose stools.

While others again divid this into sever diff gener. from pecul. nature of matter disch.

Thus where consists of bilious matter & supp. derivd from liver has name of [hepaturrhoea].

Where again disch takes place of alim matter undigest. has name of Lienteria.

And where disch of white coloured fluid supp. to consist of alim matter conv into chyle, has name of Coeliaca

That for each of these diff [affectn] some distinct in nature is unquest.

But at same time many circum in common to all.

In all these occurr freq. & thin stools. And in all, prob an uncomm depos of watery matter into intest canal furn from circul syst.

This however the great charact of Diarrhoea.

Hence other app. rather to be consid as superadded affect.

And indeed compl. with some rarely fails to taken place to greater or less degree.

This partic holds, with respect to indicat of Lienteria.

For but very rare inst, where freq. loose stools for any length of time in which, alim matters are not disch before compl. digest.

Hence then name of Lienter. appl. only where takes place to very great degree.

And where even without consid looseness.

But these circum, consist in variety in degree only, no suff ground for constit distinct genus of disease.

May [make] same remark with respect to that app. supp to charact coeliaca.

For with freq. disch very rarely that app is not changed.

And indeed must necess be so while consid separ of mucus.

For this in no case the colour of ordin excrem matters.

And well known capab of underg many diff changes.

Indeed reason to believe that white app much more freq from vit secret of mucus than from chyle.

But besides this, where such app. in stools takes place, rarely perm.

And as in case before us, disch sometimes of white app. sometime of natur colour.

These circum then suff. object to consid, this app. as charact pecul genus.

To be consid merely where occurs to remark extent & with uncomm perman. as induc pecul. in the diseas

And as such consid it in pres inst where sometimes occured sometim absent.

But not only circum in case of pres pat, indic severe & obst. disease.

Besides long contin of affect great emaciat which had induced, very unfav.

And perhaps might also view in same light, remark coldn of feet.

With regard to this symp, some doubt perhaps, whether to be consid as conseq of or cause of the disease.

At least well known, that cold app. to feet, very apt with some, prob from checking [cutic] disch to give diarrh.

And this prob. conseq of encr. [disch] by other parts of alim canal.

Nay from large evac, presumpt that seros drained off, even from circul mass.

And accord that thirst conn. with demand necess for suppl. want in syst.

Here however relief which gratif of appet would have prod, precl. by state of alim canal.

For from watery fluids taken in, looseness as might natur be supp. unif augm.

And perman mitig to be expected only be restr. looseness, that is by [cure] or at least allev the disease.

Here however after so long contin would have been by no means prud to empl such remed, as would at once check it.

For well known that often worst conseq, from sudden stop to habit disch

And this perhaps, even more case with diarrh, than most others.

For is often means by which offending causes, thrown off from [sys].

And accord in slighter cases, in place of attempt to check disch. best means of cure, is by encour. it.

For evac the natur cure. This indeed could not be consid as case, after disease already of eight years contin, & had alr prod very [exhaust] habit.

Still however in every point of view, was more advis to aim to aim at [restr] in grad, than sudden manner.

As means of effect this had here recourse to combin of [an] astring & an opiate.

These indeed means most powerf in giving sudden check to disch.

The first as giving [constric] of [vessel] the second as allaying inord action

Degree of operat however very much depend on kind of astring empl & quant to which opiate used.

As an astring had here recourse to Terra or Succus Japon, or catechu as now more prop. called.

A vegetab extract prep. from a species of Mimosa.

And which pecul adapt to encr. secret from intest, from quant of mucil matter it cont.

This as united with some aromat & a small prop of opium the basis of Conf Jap

A formula readily diffus in water & easily united with any farther prop of opium under form of liq. Laud.

Here added to extent of ℥i. to six ounces of mixt.

That is in quant of about gr. XII to ℥i.

This mixt as moder. checking loosenss. in very comm use with many pract.

And often found prod of best effect.

Accord soon after begun use, looseness became very moder.

In this situat natur thought of persist in empl.

But afterwards, on an aggrav of disease, prob conseq of some accid circum, of himself had recourse to Peruv Bark.

And although formerly tried without effect, at that time now thought it prod of some benef.

Should I own have wishd rather that patient had persist for some time longer in use of mixt.

But from Peruv Bark, provided could be born without inconv. had also reason to hope for benef.

For unquest a powerful tonic to syst. in gener, & that chiefly by acting on alim canal.

Hence then thought it best to direct that should persist in use.

But since that have seen nothing more of patient in this place.

And perhaps unnecess to form any conj with regard to situat.

But own inclind to believe that this patient nearly in same situat as before.

Or at least that not matterially benef by any thing we have done for him in this place.

This however I consid as in part at least owing to himself.

For seems to want [steadiness] [either] to give due attend, or proper trial to any med.