DEP/DUA/1/13/10 (Normalised version)

John Lithgow

(1777)

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John Lithgow.

In affection of this patient a pretty numerous assembly of symptoms.

By no means such however as indicates complication of diseases.

Consider affection to which this patient is subjected to be both simple & distinctly marked.

And have little hesitation in pronouncing it an instance of pure hypochondria.

May however observe respecting this disease in general that is one of those unstable affections in different cases putting on various appearances.

Hence in many instances will find that several symptoms with which present patient is affected are wanting.

Among this list may enumerate Nausea yawning & partial sweats.

And indeed method of attack in format fits to which this patient is subjected.

Instances indeed by no means rare where accession in hypochondria still more distressing to patient than what here mentioned.

Particularly in those instances where occurs under form of palpitation.

These with hypochondria patients often occur even to great extent.

And while they continue give degree of distress to patient which can hardly be conceived.

To this even would appear that some tendency in present case.

For apprehend that may consider as of this nature, that fluttering on slightest accident with which patient affected.

Though here indeed format spontaneous fits consisted more in sickness partial sweats & even tendency to fainting.

But whatever may be more accidental symptoms of the affection when present always characterised by two great marks.

A diseased condition in functions of alimentary canal

And a diseased state of mental faculty.

This last perhaps to be considered as most essential part of the disease.

In so much that reckoned by Mr Sauvages among [illegible] or those affections the most distinguishing mark of which is an [illegible]

And that such occurred with present patient could I apprehend admit of no doubt.

And if from no other circumstance sufficiently evident from method in which patient related the history of his case.

That was by no means free from corporal symptoms would readily allow.

But from simple attention in relating them evident that mind dwelt upon affection.

And in description showed particular disposition to employ terms of art.

Though sphere of life no higher than that of journeyman shoemaker had taken opinion not only of different practitioners respecting his disease but consulted also various practical authors

To these particulars may farther add, great apprehension respecting his disease.

Which of all other imaginings of hypochondriac patients is that most generally present.

With this state of mind here also evident conjunction of affections of alimentary canal.

Particularly appearing under forms of acid, eructation & constipation.

Symptoms which the common attendants of Dyspepsia whether occurring as an idiopathic disease or as a constituent of part of Hypochondria.

And which in latter case probably arise from a very different cause from what do in former.

From all these particulars taken together then little room left for hesitation respecting this case.

And may farther add that as far as external marks go have here also evidence of existence of the melancholic temperament.

Patient evidently of that dark complexion black hair spare habit and hard rough skin which considered as external evidence of this state.

Some have considered hypochondria to be a disease entirely confined to this temperament.

This opinion however must own can by no means adopt.

Yet not to be refused that with such habits hypochondria most frequent

And with those even considered as an essential part of the affection such a requisite not here wanting.

Hence farther characteristics of this affection in accident by which is aggravated.

For particularly remarked that accession with which patient affected especially induced by close application of mind.

May then upon whole consider present to be a case in which hypochondria pointed out on every ground.

On this supposition then next to speak of prognosis & plan of cure.

In present affection notwithstanding apprehensions which patient has at different times entertained nothing which can in any degree be considered as alarming.

In most other affections indeed partial sweats, with tendency to fainting might be considered as threatening imminent danger.

But in nervous affections in general by no means to be considered objects of very great terror.

Must therefore own that entertain no apprehension as to life of patient.

And indeed remarked that those affected with hypochondria often rather long lived as otherwise.

But while pronounce case free from danger am far from considering it as of little importance.

On contrary disposed to fear that shall find it both an obstinate & troublesome complaint.

Entertain little expectations that shall be able to eradicate affection.

At least consider disease to be so much interwoven with constitution that doubt much of being able to prevent renewal on action of exciting causes

Particularly such as lead to thought & anxiety.

Although however can hardly expect to remove may yet be able to alleviate patients complaint.

And to mitigate some of most urgent symptoms

Hope therefore to dismiss patient if not cured at least considerably relieved.

And continuation of that relief must in great measure depend upon himself, especially as observing proper regimen.

Particularly with regard to what respects general heads of diet, exercise & temperature

May even farther remark that on these suppose greatest part of cure to depend.

As to general principles of cure in this affection must own am much in the dark.

Which indeed must be case with regard to every affection in which mental faculties have much concern.

Or where there occurs even diseased state of what consider as connecting medicine between sentient & corporal parts of system viz Nervous fluid

And no doubt that what frequently consider as diseased states of mind are consequences of morbid affection of this part of system.

As far as know anything respecting this affection consider it to depend on state of torpor of Nervous system.

At least with evident marks of such a state is manifestly connected.

And removal of this consider to be great objective at which are to aim in attempting to obtain radical cure.

Chiefly however to be brought about by medicine which here have it not in our power to employ.

Such for example as change to steady & warm climate

Benefit also might be perhaps reaped from long continual use of tepid bath.

A practice which want convention for [exhibiting] in proper manner.

From effects of Camphor on constitution have often been disposed to believe that from this good consequences might be reaped in present affection.

And if present patient found subjected to frequent returns of his affection have thoughts of trying it.

Wished first however to see how far good affects to be obtained from mere mitigation of symptoms

Trusting merely restoration of due state of nervous [influence] to natural powers of system aided by proper exercise

Is then with view of mitigating symptoms that medicines hitherto used have chiefly been intended.

From relief obtained by patient on discharge of wind concluded that this to be considered as source of greatest complaint.

And was even disposed to ascribe to it those fits of Nausea, sickness & fainting with which complains of being often affected.

Was with intention of expelling wind by action as antispasmodic & stimulant that had recourse to Pill Gummos & Tinctura Fuliginis.

As however complained much of being affected with acid at stomach, & as pills had not effect of moving belly had recourse to Magnesia.

From these medicines has derived at least temporary relief.

And if continues in same easy condition shall not probably think of any farther measures at present.

If however should be subjected to recurrence of urgent symptoms may be led to measures of which cannot at present be aware.

And if subjected to frequent returns in present form shall as already hinted try what may be obtained from use of Camphor.