DEP/DUA/1/14/21 (Normalised version)

Robert Mitchel

(1777)

---

Robert Mitchel.

With regard to name of disease some difficulty.

But as to nature I apprehend little room for doubt.

By much most urgent part of complaint a pain in the abdomen.

In such a situation that possibility of its arising from different viscera.

Particularly might conject seat of it to be in different parts of alimentary canal.

May either originate from stomach or from large flex of colon.

But whether from [one] or other [these] not from any fixed affection sufficiently [apparent] from two circumstances.

In first place not a constant pain but returning at times.

And secondly, not confined to place at which originated but propagated from [there] downwards through other parts of abdomen.

To this may farther be added that no fixed affection to be felt.

And that pain on discharge of wind considerably relieved

From this last circumstance not only have proof that does not depend on any fixed cause, but led even to form probable conjecture, if not to arrive at certainty respecting cause which induces it

And can I apprehend be little doubt that wind immediately gives rise to pain.

May even I imagine go one step farther.

And may conclude that this wind acts in inducing the affection as pent up in stomach.

Of this I apprehend sufficient evidence from relief being afforded by eructation.

And from those eructations which are constantly observed to be consequence of eating.

Consider then most urgent symptom in this case to be immediate effect of wind in stomach.

Besides this however affected with some other symptoms.

Particularly headache & shivering.

These however well known to be often consequences of affection of stomach.

And that are so in this case is at least highly probable.

For observed only to occur when pain from wind is violent.

May therefore I apprehend consider wind in stomach as cause of all symptoms [with] which patient here affected.

For properly understanding nature of disease however [necessary] to consider from whence wind arises.

This can conceive only the affect of two causes.

Either latitude afforded for extrication in uncommon quantity from ordinary aliment

Or aliment introduced into stomach from which furnished in superabundant quantity.

Here I apprehend reason for supposing that both causes in some degree operate

And that in some measure the affect of aliment, may be inferred from particular severity during spring.

Well known that then flatulent vegetables employed in greatest abundance.

But presumption that this not sole cause.

Otherwise should not occur with present patient to much greater degree than with other people.

May conclude therefore that with him there took place that peculiar state of stomach favouring extrication of wind.

This however well known to be consequence of weakened tone

Probably operating principally as giving rise to greater [removal] of food in stomach than would otherwise take place.

On this footing then real nature of disease may be supposed to consist in chronic weakness of stomach.

And for my own part should have little hesitation in giving it appellation of Dyspepsia.

Although at same the characteristics of that affection as defined by best nosologists¹ not here present.

But if consider term as applied [more] to stomach ailments these here sufficiently marked in pain of stomach attended with flatulence & eructations.

Any observations on prognosis here now in great [measure] precluded

For patient already dismissed free from complaints.

May however observe that termination here more speedily favourable than expected.

Did not indeed consider affection as in any degree dangerous but was apprehensive that should find it tedious.

For although symptoms not numerous had proceeded to very considerable degree of violence.

Of this sufficient evidence in shivering headache & other affects of system produced.

But besides severity had already been of very considerable standing

Had been subjected to it for space of three years to nearly same degree as when came under our care.

And had been affected with some symptoms even for space of 11 years before.

Might therefore conclude that state of stomach here supposed to take place in some measure rooted in constitution.

And that would by no means be easily removed.

Must now add that though patient dismissed free from affection do not suppose [such] removal to have here taken place

For without cause being eradicated, consequences resulting from it on system may for the time be removed.

And by this means patient obtains at [least] [complete] temporary cure.

This must own utmost that imagine to have been effected in case before us.

Yet even this to be reckoned an [objective] of [great] consequence.

And without exciting cause may be means of producing radical cure.

For from such temporary relief tone of stomach better opportunity of being restored.

Next then object of inquiry how far this effected by means prosecuted while patient under our care.

Here on idea given of nature of [disease] great objective of cure restoration of proper [tone] to alimentary canal.

And this may conceive affected on one of two principles.

Either by use of such [measures] as immediately act in increasing tone.

Or by removal of such accidents as serve farther to weaken it.

Was on [latter] of these principles that here [accounted] cure.

And with this view employed a combination of Aloes & Assafoetida.

From these hoped that in consequence of antispasmodic power wind would not be put up in same manner.

And that by stimulus to alimentary canal action so far augmented as to prevent [removal] of food giving rise to generation of wind.

[These] different intentions seem to have been fully answered by this medicine.

For while had effect of operating as gentle cathartic, patient at same time freed from uneasiness from wind.

And while pain became less severe seemed also to have shifted situation

For in as far as remained seemed to be seated lower in bowels.

And had not continued use for any long period when entirely gone.

In this situation reckoned it unnecessary either to put patient on use of any other medicine or to direct longer attendance.

Was therefore dismissed with injunction to return on recurrence of affection.

But have since had occasion to see him [often] then cure continued in good health.

---

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.