DEP/DUA/1/13/14 (Normalised version)

Peter McDairmid

(1777)

---

Peter McDairmid

Of this patient since applied for aid have seen very little.

And must own that am able to form no very certain judgement respecting nature of his disease.

Symptoms of affection to which subjected but few in number.

These however of such nature that might be explained on different grounds.

Evident that in case before us the stomach to be considered as chief seat of disease.

And affection principally characterised by pain attacking that viscus.

Particularly after taking food.

This pain at same time attended with gripes & flatulence.

And as is very generally the case in Dyspepsia with a bound state of belly.

From these circumstances then led to suspect affection to be of this nature.

Although must at same time be allowed that several of more common symptoms here wanting.

Particularly want of appetite, sourness of stomach, cardialgia, nausea etc.

And these also symptoms usually apparent in earliest stages of the disease.

Must however own that do not consider any one of these to be constant or essential symptoms of this affection.

Yet occur at least so frequently that when absent room for suspicion.

And this suspicion still farther corroborated by description which patient gave of his pain

Represented it as entirely attacking in form of fits.

And these fits at same time of greater severity

Would naturally lead us therefore to refer pain to some accidental & violent affection.

And to such well known that stomach not unfrequently subjected.

This viscus as well as other muscular organs of body, liable to be attacked with fixed tonic spasm or cramp.

A disease while subsists even of greater severity

And even from short continuation produces most remarkable affection of system.

In so much that even from single attack greatest prostration of strength will be induced.

This therefore affords at least some objection to supposition of being of this nature.

For notwithstanding account which patient gave of severity of his pain was not followed by those consequences commonly resulting from cramp of stomach.

To this may be added as farther objection the frequency of the return.

For at least not common that patient should be liable to such affections several times in the day.

Notwithstanding these circumstances however consider this opinion as of the two the most probable.

And although would not perhaps assert that patient subjected to that very severe affection known by title of Cramp of stomach yet disposed to consider principal part of his disease as consisting in spasmodic affection of that viscus

This suppose to depend on peculiar sensation of that viscus.

And thus would account both for connection with bound state of belly & for its occurrence more especially after taking food.

For both one & other to be considered as causes affording irritation.

This then opinion which was disposed to adopt respecting nature of affection.

And on this founded judgement both respecting termination & plan of cure.

When this patient first admitted on list must own that not entirely without apprehension

Principally from being doubtful as to nature of affection to which he was subjected.

And in some measure also from idea that at least partook of nature of Cramp.

An affection by no means without danger.

And that too both from immediate affects & from consequences.

While therefore could not say what turns the disease might take, evident that some grounds at least for apprehension.

At same time had hitherto at least shown no bad effect on system.

And from recent date grounds at least for hoping that in no respect rooted in constitution.

Besides considered it as an affection which by medical aid might entertain hopes of being able to alleviate.

Especially as could at least in great measure remove some of exciting causes.

And where could not be entirely removed, might at least be able to diminish that peculiar tendency to contraction in stomach on which action depended.

Thus though remaining would yet cease to have former affects.

On these grounds then although not free from doubts was yet disposed to hope for favourable & speedy termination.

How far event of disease has verified this prediction cannot positively say.

For from patient having discontinued attendance have not of late had opportunity of examining him

And have never seen him but on street

There however at least apparently in good health.

Which some grounds for presumption that if disease has not already had termination which could have wished for, is at least on mending [hand].

And not even of such severity that thinks it necessary to apply for farther aid.

Must however acknowledge that even supposing this to be case cannot ascribe very much to practices employed while under our care.

In treatment of this case, consider cure as in great measure hinging on two particulars.

Considering as have already said what might be reckoned proximate cause of the disease to be spasmodic affection of stomach.

This however after short continuation had evident tendency to resolution.

Became much less therefore an objective of practitioner care to remove it when present than to prevent return.

On removal of causes therefore inducing return, cure must entirely depend.

Of this cause first to be mentioned & perhaps principal a peculiar state of stomach giving disposition to spasmodic affection on slightest irritation.

This condition may suppose to be perhaps in some measure connected with state of simple solids.

More immediately depends however on condition of nerves.

And without pretending to enter into any inquiry respecting nature of these to be considered as removed by those agents found from experience to possess power of diminishing disposition to spasm.

Of this kind however are various articles known by title of antispasmodic.

These therefore naturally suggested as principle part of indication in case before us.

But even where greatest disposition to action will yet not be induced without some exciting cause.

On removal of such therefore or at least on guarding against action much in cure must depend.

And if be not means of radical cure will at least be most effective method of preventing future returns.

Under this general principle of avoiding exciting causes several particulars comprehended.

But must especially have in view all irritation either immediately acting on stomach or affects of which communicated to that viscus.

Of articles immediately acting on stomach are all ingesta whether in way of food or drink.

On proper regulation of diet therefore must consider prevention of frequent returns of fits as in great measure depending.

But [aliment] even in nature the [least] stimulating, in consequence of [remora] in bowels acquires stimulating quality.

Especially when united with excremental parts of fluids intended to be thrown off by [faeculatory] discharge as bile etc.

Irritation to any part of intestinal canal however readily communicated to stomach.

Hence obviating bound state of belly to be considered as one of most powerful means of removing & avoiding exciting causes.

These then general principles on which apprehend that cure of present case to be conducted.

And on these principles treatment as long as patient remained under our care proceeded.

Was with view to operating as an antispasmodic that resolved to try this patient with use of the pill Gummos.

From which hoped that might obtain removal of that state of stomach giving disposition to action.

At same time had some expectation that might serve also to move belly.

For this not unfrequently the effect of stimulus from foetid Gums which [enter] composition.

In this expectation however were disappointed

And while remained for several days without stool not strange that notwithstanding use of this medicine pains both more frequent & more violent.

While therefore afforded no reason for discontinuing course begun was strong argument for having recourse to most immediate means of moving belly.

Was with intention of obtaining discharge most suddenly that here directed use of an injection.

And to secure regular discharge afterwards directed use of Pill ex Colocynthide.

From these then with continuation of the antispasmodic hoped both for removal of predisposing & exciting causes

How far however intention answered have not been able to learn.

For patient has not of late visited us.

But from circumstances already mentioned am disposed to conjecture that has rather had favourable termination as otherwise.