DEP/DUA/1/12/19 (Normalised version)

Peggy Byers

(1776-1777)

---

Peggy Byres.

Case of this patient not altogether with difficulty

At same time symptoms of her affection such as may be considered characteristic of a particular disease

Have in history almost every symptom of that disease which in system of Dr Cullen defined under title of Dyspepsia.

And cannot help thinking that what generally called stomach complaints more properly referred to one genus, than as has been done by Mr Sauvages & others dividing into numerous genera of name vomitus, cardialgia, gastrodynia etc.

All these symptoms conjoined with bound belly a common attendant of the disease, are here present.

And except rumination, by no means a constant attendant, every symptom mentioned in definition here present.

Yet some circumstances giving room for doubt how far all symptoms to be considered as mere affects of idiopathic affection of stomach.

This chiefly from seat of pain & still more from cause supposed to induce it.

In pain in this case have not every appearance of gastrodynia attending stomach complaint.

Seems to be rather lower situated

And is besides this more constant & more severe

Patient herself disposed to assign no particular cause for her complaint.

But in history a cause fully [sufficient] mentioned.

And what at same time might give rise to different suspicion from that of pain depending on affection of stomach.

Immediately before attack of symptoms had a very considerable uterine haemorrhage.

Which if not violent while existed at least of long continuation.

For are told that was more or less affected with it for space of ten months.

Are farther told that this haemorrhage began at time when suspected herself to be pregnant

From our history however does not appear that this conjecture well founded.

For patient was not sensible of any abortion

And that she has not continued with child abundantly apparent from time that has since elapsed

Conjoined at same time with regularity of menstrual discharge.

May however remark that patient not less liable to deception in second than in first particular

Pregnancy may not have been so far advanced as she suspected.

And foetus may have been discharged unobserved with clotted blood.

But whether haemorrhage to be viewed as succeeding pregnancy as obstruction of menstrual flux perhaps immaterial

At any rate affords grounds for two conjectures respecting present pain.

May either suppose it to have operated as giving rise to dyspepsia

And thus producing pain from spasmodic affection of debilitated bowels

Or may have given rise to some local affection of uterus.

Of which also well known that profuse haemorrhage often a cause.

And which when occurs is frequently the origin of pains as in present case shooting from side to back.

Seat of pain & fixed origin somewhat in favour of this supposition.

But on other hand, regularity of menstrual discharge both as to time & quantity & evident affection of alimentary canal in other respects against it.

And as would necessarily be cause of more tedious & obstinate disease would fain hope that is not this

Willing therefore to conclude that from cause already mentioned tone of intestines as well as stomach greatly weakened.

And that from spasmodic affections in these are to account both for seat of pain & direction in which propagated.

Since this case however came under care still another circumstance claiming some attention.

And from which some would be disposed to form very different idea of the disease from that here mentioned.

That is worm which patient discharged.

Well known that from existence of worms in alimentary canal most anomalous symptoms will sometimes arise.

And wherever appears many disposed to ascribe to them every future affection.

Am however convinced that have often been supposed to operate as cause of disease when in reality appeared merely in consequence of it

And this I own disposed to conject in present case.

Notwithstanding want of diagnostic symptoms worms may in reality be cause of present affection

Or more may yet exist in bowels without being cause of disease.

Since wrote these notes find that a fresh instance of obstipation has occurred.

And that pills last prescribed have not had affect of moving belly

But reckon it of the three the more probable supposition that worm already discharged the only one.

And upon whole disposed to view the case to be an affection of alimentary canal.

On this idea should not I own be disposed to unfavourable prognosis.

Dyspepsia an affection very universally more tedious than dangerous.

And when does prove fatal is rather by inducing other affections than by itself.

Of this however notwithstanding debility of patient no appearance in present case.

Besides disease cannot be considered as of long standing

And since came under care although much has not been done, has rather gained ground as otherwise.

One circumstance however to be mentioned from which unquestionably in case of neglect some threating of danger.

That is state of patient’s belly.

In one instance already by violent constipation severe pain & much distress induced.

And from second occurrence of same nature even enteritis or ileus may be induced.

Unless from such occurrence however if conjecture right shall probably be able to dismiss patient if not cured at least relieved.

But if any truth in what threw out respecting local affection of uterus shall find it equally obstinate & more dangerous affection

In treatment of this case according to idea given of it consider cure to be aimed at on two principles.

1 By removal of causes tending to [waken] tone of stomach

And 2d. By use of such means as serve to increase it.

But at same time during course of affection have found it farther necessary to employ means for obviating particular occurrences.

Here two chief causes weakening tone were acid & constipation.

Imagined that for both intentions no remedy better suited than use of Magnesium.

While at same time thought that by combining it with small proportion of Rhubarb would both increase purgative power & serve to strengthen tone of stomach.

Was not from one or even a few doses of this that could expect much affect.

Began it therefore with intention of persisting in use for some time

And although imagined that dose very moderate when gave only ℥p of Magnesium Rhubarb grains twice a day, yet more than sufficient.

To be observed of this affection that while nothing more beneficial than to keep belly gently open purging [ever] followed by bad affects

Thought it necessary therefore at first to moderate dose

And afterwards to increase it as might seem requisite.

While on this course however vomiting eructation & other stomach complaints somewhat abated, pain of back become more [illegible]

And as from fixed seat, suspected that might in some degree be combined with muscular affection ordered friction with camphor oil

Which seemed to be so far attended with good affects.

But soon after had recurrence of severe vomiting

Which I apprehend to be ascribed to bound state of belly occurring notwithstanding continuation of Magnesium.

In this condition could not trust to any purgative taken by mouth.

As few of these from which tendency to vomiting is not even increased.

Gave merely therefore conjoined Spirit of Lavender as a gentle cordial.

And for affect moving belly ordered an injection with Glauber Salt.

Both these medicines seem to have been attended with diuretic affects

This however not it seems attended with desired affects.

For while injection produced several stools sickness considerably abated from Spirit Lavender.

Was probably also in consequence of injection that discharged worm before mentioned.

And what would indeed seem to corroborate supposition of its having some concern in inducing the affection symptoms after this much easier.

While even appearance of acid almost entirely gone

In this situation in place of having again recourse to Magnesium thought of trying the infusion amarum

And at same time of obviating constipation by use of aloetic pills.

But am in hopes may be able to put her on use of some other which may at least be means of keeping complaint tolerably easy

And if that the case shall not think it necessary for her to attend us here for much greater length of time