DEP/DUA/1/14/20 (Normalised version)

William Malcolm

(1777)

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William Malcolm

Disease of this patient may at first sight appear somewhat peculiar.

Hold it however to be a simple & uncomplicated instance of an affection by no means rarely occurring.

Look upon it to be an instance of Hypochondria an affection of which already occasion to speak under case of John Lithgow.

The two cases indeed in many respects different from each other.

But this merely consequence of unstable nature of affection.

Well known to be a disease putting on very various appearances.

In this case principal part of affection a very peculiar palpitation felt immediately below cartilage ensiform.

That this not merely a sensation of patient but the consequence of real motion evident from being both seen & even felt by those around him

That this may proceed from various causes especially from different local affects is well ascertained by experience of every day.

And particularly consequence of disease of heart or large artery.

But that no such fixed cause any concern in present case, proved by manner of [attack]

For here not a constant affection but attacked in fits.

And these sometimes more sometimes less frequent never at time of any long continuation.

From this therefore might conclude that motion or palpitation here taking place in reality a nervous affection.

And well known that from this cause is a frequent symptom in hysteria hypochondria & all the tribe of Nervous diseases.

That with present patient a symptom of hypochondriasis might readily conclude from other affections to which patient subjected.

In hypochondria in general consider most obvious part of the disease to consist in the mental affection.

And do not know whether Mr [Samson] has not followed most proper arrangement in referring it to the Vesaniae.

That in case of the patient an error [illegible] occurred could admit of no doubt.

Patient himself even sensible of being affected with constant depression of spirits when no occasion for it.

And besides this laboured under great apprehension of sudden death whenever attacked with palpitation.

Is how particular case with hypochondriac patients to be greatly alarmed with their own danger.

In so much that term applied to [every] imaginary illness.

Here then had distinct evidence, of that state of mind which constitutes greatest part of hypochondria.

But besides this manifestly subjected also to those affects of alimentary canal by which in great measure characterised.

This disease very generally defined as being attended with Dyspepsia.

But symptoms of that affection in place of arising from weakened tone which case when Dyspepsia an idiopathic affection are in hypochondria consequence of torpor or rather perhaps of peculiar sensibility.

That here whether from this or any other cause action of alimentary canal impaired demonstrated from flatulence & eructation with which patient affected.

To proof resulting from symptoms may be added that patient at that period of life & of that temperament most disposed to the affection.

For although hold that may occur at any age & with any condition yet most common with melancholic temperaments & at advanced period of life.

While however have evident marks of former here, in dark complexion hard rough skin & large superficial veins disease occurs with a patient who has already passed 61 year of age.

From these circumstances then evidently arising from symptoms is at least corroborated.

And upon whole disposed to think that very little reason for doubting that present patient subjected to hypochondria.

And that too without any complication or peculiarity.

On this ground am far from viewing affection to be of that dangerous tendency which patient suspects.

For consider it to be of itself a [distinction] very rarely if ever proving fatal.

And many instances where patients subjected to it even to high degree have lived to great age.

With our patient though palpitation [considerable] yet in no other respect the least threatening appearance.

And even palpitation though giving great alarm to patient himself yet so little from any powerful cause that even [illegible] by pressure at part.

Although however from these circumstances consider disease as free from danger yet must add that have very little expectation of being able to cure it.

Age of patient & continuation which has already had, for space viz of 10 years may be considered as very strong circumstance against cure.

And even in most favourable situations a very obstinate affection.

Utmost therefore that here expect is to mitigate complaint.

And this hope may in some degree be able to obtain.

Yet take it for granted that from unavoidable accident patient will be subjected even to severe returns

These however may I apprehend be in some degree mitigated

And by proper management even rendered less frequent.

Respecting general principle of cure however must own that am much at loss.

Can be little doubt that as far as disease depends on [illegible] part of system is a Nervous affection.

And from many circumstances probable that connected with state of Torpor.

From which [with] diminishment of sensibility there occurs a peculiar kind of it.

And in consequence of this all inordinate & anomalous affections with which the disease remarked to be attended.

On this supposition radical cure as well as mitigation of principle symptoms to be expected only by restoring nervous energy to natural condition.

Hence probably are to explain advantage of various measures acting particularly on nervous system.

Such for example as change from cold to warmer climate, tepid bathing, camphor & in short whole tribe of medicines increasing mobility of Nervous power.

With present patient had recourse to one of these which consider as by no means the least powerful.

That is the Assafoetida.

This hold to be a very powerful nervous medicine of stimulating kind.

Besides which conjoins properties of an antispasmodic.

From first property then expected might be serviceable as mitigating palpitations.

And from last hoped that would relieve those affections more immediately dependent on wind in the bowels.

Here chose to [exhibit] the Assafoetida rather in fluid than solid state.

As by this means expected more immediate action on Nerves of stomach.

And employed Tincture Fuliginis in preference to Tincture Foetida on account of [meast.]

On this medicine our patient has continued ever since he came under our care.

And I think not without good affects.

For although still subjected to depression of spirits yet attacks of palpitation at least confessedly less frequent.

And while belly kept regular less affected by symptoms from wind.

While therefore nothing more urgent is intention to persist in use of this medicine.

And hope that may afford as much relief to patient as expect to obtain.

But if symptoms should become more distressing may perhaps subsist to assafoetida the use of camphor.

Or may conjoin camphor with course already employed.