DEP/DUA/1/13/05 (Normalised version)

James Ritchie

(1777)

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James Ritchie.

As to nature of this patients disease little room for doubt.

May however be some question what name to be properly affixed to it.

Can have no hesitation in considering alimentary canal to be here great source of affection.

And in viewing morbid state of this as source of all symptoms.

May however be matter of doubt whether can with strict propriety be styled a stomach complaint.

Or as is now very generally termed an instance of Dyspepsia

Here indeed very manifestly greater part of symptoms of that disease.

Of idiopathic affection of stomach have evidence in various symptoms here present.

Particularly in want of appetite, vomiting of acid matter, pain at stomach, eructation

Evident however that affection here by no means confined to stomach.

Although at same time uneasiness of patient immediately after taking food, would even argue that this principal seat of the affection.

Yet even some of first & most urgent symptoms of this affection indicate that disease of greater extent.

And appears that pain often originated from flatus in bowels

From thence told that propagated upwards to region of stomach where afterwards source of greatest uneasiness.

From this together with bound belly have I think sufficient evidence of a debilitated state, or what may be called chronic weakness of alimentary canal in general.

And perhaps more proper that practice should proceed on this idea without pretending to give it any particular name than on affixing to it particular appellation not strictly applicable.

With regard to termination here can see no circumstance from which any reason for being alarmed.

Stomach complaints in general far from being of dangerous tendency.

Especially when no particular local affection as scirrhous, ulceration, or like.

And even then is usually a very tedious affection

This however often also the case where even of slightest nature.

In such complaints therefore a prudent practitioner will never perhaps promise very speedy cure

And the longer the affection has already continued less chance of this.

For admits of cure principally if not only by artificial means.

And this chiefly to be expected when but of short standing.

This circumstance would in some measure lead to favourable judgement in case before us.

For when patient came under our care was only of five or six weeks standing.

Which with an affection of this nature at least comparatively speaking may be considered as but recent date.

If however this circumstance in favour of patient leads us to mention another perhaps as much against him.

That is rapidity with which symptoms of patient had augmented.

Will rarely find instances of Dyspepsia or atonic state of bowels where in so short space symptoms have gone to so great height

For not only very considerable vomiting want of appetite etc but also high degree of pain returning at intervals.

And affording evident mark that with atonic state there takes place considerable disposition to spasmodic affection.

To all this may add that treatment hitherto followed does not seem to have had great influence.

Although patient in some respects relieved, particularly with regard to vomiting, yet in other circumstances complaint very much in same state.

From all circumstances taken together then cannot give very favourable opinion as to termination of case.

And besides measures already tried shall probably be obliged to have recourse to several others, before can be obtained for patient tolerably easy condition.

And after all presumption is that will be dismissed with complaint rather alleviated than removed.

With regards to treatment may here remark that principle part of remedy hitherto used directed with intention of alleviating symptoms

Particularly as counteracting influence of flatulence constipation & acidity.

On idea given of disease indeed radical cure of affection, must be supposed to depend on restoring due tone of alimentary canal.

But this not more to be effected by medicine augmenting tone than by avoiding such causes as serve to weaken it.

When these fully counteracted restoration often more readily affected by natural powers of system than by any medical aid.

These general principles will sufficiently explain intention which have had in view by medicine already used.

Had here recourse to pil Gum. for removal of spasmodic stricture, retaining wind in bowel

And for giving such stimulation as would serve for farther expulsion.

Used Magnesia chiefly with view to destruction of acid.

And that might not have tendency to farther generation of wind ordered it in calcined state.

After continued it for some time alone united it with a proportion of Rhubarb.

From which hoped by astringent quality to strengthen tone of intestines & by purgative property to obviate costiveness.

As notwithstanding Pil. Gum flatulence continued very distressing, had recourse to Tincture Fuliginis.

And as this also proved abortive had recourse with same intention to Tincture Aromatic.

Which although possessing nothing of antispasmodic quality of other yet to be considered as stronger & more immediate stimulant.

With intermission of Magnesia which given up when acid left him became more costive.

By this led to employment of the Pilulae Aloeticae

Under these different measures complaints have in several respects been somewhat mitigated.

And while continues in present situation shall not think of immediately altering course.

Persisting in use of Tincture aromatic in morning & aloetic pills at bed time.

At same time however regulating quantity by effect observed to be produced.

And with these enjoined as much exercise out of doors as patients situation will allow him to take.

Do not however pretend to assert that these measures will be found effective.

And if this the case shall conclude that something farther requisite than merely obviating symptoms & counteracting causes diminishing tone.

Shall then think of having recourse to such measures as have tendency to increase tone

With this view besides employing means acting on system in general may have recourse to bitters astringents & tonics strictly so called acting immediately on stomach.

And if shall be found necessary may employ in succession Peruvian Bark. Columbo Root Tincture Japonica & Tincture e Kino.

At same time obviating effects of any farther constipation which may have tendency to produce.

But before employing any of these is intention to make this patient subject of trial with another medicine as a tonic to stomach

That is cold water.

Of tonic powers of this as applied to system in general need say nothing.

Can be no question that will excite similar influence on an organ so sensible as the stomach.

Is a medicine however rather too simple to be taken with any regularity merely by itself.

Is with this intention that shall employ it as it were in medical state.

Using it as vehicle for Elixir Vitriol dulce or Tincture Martis.

At same time exhibiting these in such small quantities that whatever effect obtained may justly be attributed to the water or rather to action of cold upon stomach than to any other circumstance.