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Mr Purves

I have received your concerning Mr. Purves and
answer you in course but not without fully & attentively
considering your distinct and judicious account of the
case.

However it may have arisen or may be ac¬
counted for I consider the case as purely Dysenteric and
I think you have treated it with great propriety &
I suspect that the patient did not allow you to be
constant enough at the beginning in the use of the
Glauber salt otherways you would have prevented
the so long continuance of the disease. Though cir¬
cumstances are not now so favourable as they were
some time ago I am still of opinion that the means
of Cure must be the obviating all stagnation in the
Colon and both with a view to this and to the fever
which is now risen I would propose the use of

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Tartar Emetic which I think can be managed so
as to operate almost only by stool. You must make a
weak solution of it as of two grains in six or Eight
ounces of water & giving a spoonful of this for a dose
repeating it every half hour till some sickness or
Nausea comes on but upon the first appearance
of this you must stop your exhibition & trust
to its going downward. If upon the first trial the
Nausea comes on before enough has been given
to move the belly you must on a second trial after
the sickness comes on stop for an hour before you
give another dose and thus I expect that by the
management of doses & intervals you may bring
the medicine to operate as I wish & by repeating
it at first every Evening & afterwards every second
or third you may at length change the habit of
the bowels very entirely.

✍see former page✍

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If the use of the Tartar Emetic in the evening
produces a fœtulent stool of tolerable consistence I
expect the griping & tenesmus will be so much re¬
lieved that you need not give ↑any↑ Laudanum for that
night and I must tell you that I would wish
to avoid the Laudanum as much as possible as I
think it has always a tendency to renew the stag¬
nation of the Colon & thereby continue the disease
but I dare not insist on this as the violence and
constancy of pain may absolutely require the
Anodyne and I know the difficulty a Practitioner
may have to resist the importunity of pain or
to get a patient to quit a medicine from which,
he has been in use to receive even a temporary
relief. I give you therefore my opinion I truly
leave the matter to your discretion. But I shall

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observe that one of the best & safest methods of em¬
ploying the Opiate is to join it with the Emetic but in
that way you may give the Emetic in much larger doses
than above proposed. For example you may give a grain
of the Tartar with forty drops of Laudanum & repeat
such a dose in 2, 3, or 4 hours afterwards as the cir¬
cumstances of the patient's stomach & bowels may
direct you & the same circumstances must direct
you to adapt the above doses better than I can. I
have thus given you my method of Cure to be mana¬
ged & varied by your direction. I have only to say
further that for relieving the tenesmus &c. instead
of the Mutton Broth you may try an Ounce of Gum
Arabic dissolved in four Ounces of water with a
small proportion of Laudanum if you are at the same
time giving it very largely by the mouth. I expect
nothing from the Bark & Astringents. His Diet
has ✍
October 4th 1782