DEP/DUA/1/13/22 (Normalised version)

Alexander Orrock

(1777)

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Alexander Orrock

Case of this patient very soon favourably terminated under our care.

Or at least patient received such intermittence from affection that judged it unnecessary for him to continue any longer his attendance.

Would however be by no means astonished if should again be affected with return of former ailments.

And must own that relief he obtained from his complaint much sooner than should have expected.

For consider his case as by no means without singularity.

Easier I apprehend to form probable guess as to nature of this affection than to affix either proper name to it or to explain all phenomena

Evident that essential part of disease consists in pain beginning in abdomen.

And these while last, subsists with very great violence.

Among nosological¹ writers all pains of intestines not from any fixed case referred only to general head of colica

To bestowing this denomination on present affection however some objections.

From transitory nature as well as from frequency of returns different in appearance at least from what generally known by title of colica.

And that even when arises from flatulence which manifestly appears to be cause in instance before us.

But besides this several other peculiarities in present case.

Particularly symptoms preceding attack viz uncommon flow of saliva into mouth.

In what manner this connected with other parts of affection must own am totally at loss to say.

Observable however that increased separation of fluid by salivatory glands is effect of [different] peculiar sensation.

Thus for example not infrequently arises even from particular sounds.

May at least conject therefore that produced in present instance by a cause somewhat similar

And that depends on peculiar sensation arising from bowels which proceeds violent pain.

May here observe that this not only instance in which have known such an appearance to occur.

Have met with two instances of Epilepsy of which flow of insipid watery fluid into mouth was forerunner.

And these was disposed to imagine that might be explained on supposition now thrown out.

But whether in one case or other the supposition well founded will not pretend to assert

As singular here in circumstance preceding pain so also in consequence of it.

Or at least in direction in which [illegible].

Are told that in every attack here begins at under part of belly.

And that there in pained part manifest swelling & distension.

Soon however propagated from part in which originated through trunk of body in general.

But that terminated as it were under arm pits in which is particularly severe.

From what cause determined in this particular direction must own cannot pretend to say.

Some would be disposed to refer it to continuous membranes.

While at same time would refer several under arm pit to termination & interruption there.

To this reasoning must own that [know] no very strong objection.

At same time can hardly consider it as confirmed by phenomenon.

For although in particular cases, pain as in present may always follow certain course, yet when compared together different cases course much varied.

While at same time in all connections of membrane the same.

Am therefore more disposed to consider direction in which propagated to be in each case effect of particular condition of parts which seem more especially affected.

But at same time probably more from condition of nerves than of simple solids.

Yet on whatever footing are to explain appearances which are either forerunner or consequence of present attacks can I apprehend be little doubt in ascribing these principal parts of complaint to an affection of spasmodic kind.

And such complaints induced by distension from wind.

This equally evident from swelling belly & from relief on discharge of wind.

On this idea of nature of affection did not despair of being able to effect cure

Or at least of alleviating severity of pains & of diminishing frequency of attacks

When however considered violence of attacks was disposed to think that would not be easily affected.

And when reflected that had now subsisted for space of 12 years, imagined that would not be brought about in short space of time.

While therefore looked for favourable termination yet dreaded that case would be tedious.

In this however from facts appeared that apprehensions groundless.

Considered cure of this affection as turning on two circumstances.

First on frequent expulsion of wind by which cause inducing spasmodic affection would be taken off.

And secondly on removal of disposition to spasms from which although irritating cause in some degree remained yet would soon cease to be product of former affection

Was with view of answering both intentions that had here recourse to use of Pill Gummosa.

In which trusted chiefly to stimulation & antispasmodic powers of the Assafoetida.

Little reason to doubt that this medicine fully answered intention which had in view.

From time that began this medicine had free discharge of wind downwards.

And seemed to have farther effect of obtaining regular evacuation of feculent matter.

For during use belly natural.

With these changes patient at same time freed from any return of pain.

And after suffering no relapse for space of month thought it unnecessary to persist longer in use.

Dismissed him therefore at least for the time cured.

Would not however say that will continue free from any returns.

But if this should be case will probably hear of patient again.

And by use of same medicine may I hope be removed.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.