DEP/DUA/1/14/12 (Normalised version)

John Campbell

(1777)

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John Campbell

Case of this patient as introduced into our register¹ might be subject of many observations.

Or rather perhaps conjectures.

But these here to be given merely on style of vague suppositions.

For from patient visiting us only once had no opportunity of observing progression of affection.

Or of putting such questions respecting it as might afford satisfaction.

And must own entertain some doubt how far account was to be entirely depended on.

Was so [pathological] in description of his affection that concluded that either in reality felt much or wished that we should believe so

And his leaving so soon gave [conviction] in some measure to latter of these suppositions.

Principle affection according to his own account was a complaint of stomach.

This he described as giving same sensation as if an animal [within] constantly tearing it.

This could be described in no other manner than by [styling] it gnawing pain in opposition to [purge] & [gravity].

A sensation of this kind sometimes the affect of scirrhous.

And to such a supposition constancy & severity of pain seemed to give some countenance.

While at same time well known that scirrhous affections of stomach either at [cardia] pylorus or any other part not uncommon.

But to such a supposition many objections.

Seldom that takes place to great degree when some local hardness cannot be felt.

No such however in present case.

Besides scirrhous of this viscus almost universally attended with vomiting.

With this however not alleged that patient in any degree affected.

On contrary appetite for food little if anything impaired.

Constipation indeed to which patient subjected sometimes to violent degree the affect of scirrhous.

Especially when situation at pylorus giving rise to stricture.

But this also a symptom from various other affections of intestinal tube.

And indeed consequence of everything weakening tone or diminishing action.

May be supposed then equally to give countenance to another supposition.

That viz affection arose from wind.

Frequency of this as a cause of stomach complaints well known.

And such might have been suspected from sensation which patient described.

According to his own account felt [something] resembling wind moving about in stomach.

And by no means uncommon for distension from wind in stomach to give vertigo

This though unquestionably to be attributed to peculiar stimulation which distension gives to [nerves] yet very generally described by patient as if felt something moving to head.

Thus far then circumstances in favour of probability of such a supposition.

But to this also several strong perhaps may even add unsurmountable objections.

Were told that never any evident distension of stomach.

And not alleged to be affected either with eructation, flatus or borborigmi.

If air however present to considerable degree in alimentary canal must have appeared under [some] one perhaps all of these forms.

Naturally led therefore to think on what other possible supposition could be explained.

And if to discard supposition already mentioned know nothing more probable than opinion that might depend on peculiar morbid affection of nerves of stomach.

Was here therefore wished before proceeded on any other supposition to make some trials at least on this idea

But even allowing that such affection did exist if account to be credited was not whole of his disease.

Besides peculiar stomach complaint subjected also to affection in discharge of urine.

Told that this excretion though natural both in colour & quantity, yet in general passed with difficulty.

And at one time are told that [appeared] for 24 hours together.

When after very violent efforts [moved] out as if from discharge of stone.

This might be supposed to give some countenance to supposition that complaint wholly from calculus.

And well known that from this cause stomach affections often arise.

But when this the case not under form of pain in stomach but of sickness & vomiting

And that even affection of urine here [were] from calculus might admit of great doubt.

For unless in single circumstance of difficulty of discharging water no other symptoms of it.

No pain either in region of kidneys or bladder.

No sandy appearance of urine.

And no morbid change in any respect either in colour or quantity.

Upon whole then considered this case as exhibiting rather contradictory than uncommon [appearance]

But whether proceeded from any intention in patient to deceive, from indistinct [nature] of telling complaint or from singularity in affection cannot pretend to say.

In this uncertainty however can give no opinion as to termination

Especially as from want of attendance precluded from opportunity of making inquiry.

This also a sufficient reason why should say nothing respecting practice.

Entered on treatment of this case without having laid down any plan of cure.

Was intention for some time to watch appearance of disease & to discover affects of particular prescription on his complaint.

For by this means nature of affection often as certainly ascertained as in any other way.

Was with this intention that prescribed Aloe wine combined with paregoric elixir.

From anodyne here on supposition of Nervous affection of stomach being cause of pain expect at least temporary relief.

And from purgative expected to obviate costiveness.

But how far these intentions answered have never had opportunity of learning.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.