DEP/DUA/1/17/06 (Normalised version)

Alexander Oman

(1778)

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Alexander Oman.

With regard to disease of this patient must acknowledge myself much at loss.

Equally in dark both with respect to name & nature of affection.

And must own that have never before met with any case to which could by any means be considered as similar.

Affection according to description given consists in violent attacks of pain uniformly arising from particular part in abdomen.

This pain so severe that becomes unable to stand and therefore must either throw himself down, or grasp some support.

In these few symptoms disease to which subjected may be considered as solely consisting.

For other particulars enumerated in history rather consequence of fit than any thing else.

Such for example as profuse & general sweating sense of weakness in abdomen, & lowness of Spirits. inactivity etc

That pain in abdomen by no means an infrequent occurrence is indeed true.

And as seated in alimentary canal may [arise] from same general causes producing it elsewhere

Particularly inflammation & spasmodic affections

To both intestinal canal perhaps as much subjected as any other part of system.

Yet in instance before us very great doubts as to its originating either from one or other.

That cannot be of inflammatory nature is in great measure demonstrated from various particulars.

But especially from suddenness of attack

From frequent recurrence.

From short duration while is severe

And from great length of time for which has now subsisted.

A period viz of upwards of twenty years

Besides therefore that symptoms of inflammation wanting, here several circumstances in the disease irreconcilable to that supposition.

Must here be allowed that many of those particulars pointed out as objections to inflammation in some degree arguments in support of opinion, that pain here occurring of spasmodic kind.

Particularly observed that with such often very sudden attacks, very great severity & very short duration.

Is however in but rare cases that have not farther indication of it than merely in [pain]

When occurs to intestines is in general not [static] but propagated through tract of alimentary canal.

Where patient liable to repeated attacks very rare at least that has [commencement] from same spot.

And lastly from supposition of spasms can hardly explain constancy of pain for so great length of time.

For here to be observed that although not always subjected to severe attacks yet never entirely free from pain.

Even supposing then that spasmodic affection here occurs must yet imagine that acts in conjunction with some other circumstances.

And what that is must own am totally at a loss to conject.

Can only conceive it however to depend on one of two causes.

Either peculiar morbid sensibility at part, or peculiar local stimuli.

But to which should rather attribute [must] own am totally at loss to conject.

May perhaps be considered as in some measure objection to local stimulation that no diseased condition at part discovered by examination.

On other hand some argument in [support] of it from constant uneasy feeling.

And from what happened to patient at very early period of disease.

Account [viz] which gives of having at very early period of life discharged ball long reddish coloured worms.

This description will apply to none of usual kinds of worms commonly observed in intestinal canal.

And what variety of other kinds may be [harboured] there.

How far may be able to secure for themselves permanent lodgement.

Or what symptoms they may induce impossible to say.

If therefore could suppose any peculiar kind of worm still present in intestines might explain all symptoms

Yet must be allowed that this [supposition] liable to many difficulties

And were it from nothing but uncommon nature alone sufficient to create great doubts.

Must then conclude that respecting [particular] cause of pain in this case am totally in dark.

And was chiefly with view of observing whether any circumstances should afterwards [occur] by which might be illustrated that selected this case as subject of treatment here.

From this however of late precluded by want of due attendance on part of patient.

And since gave up visits here as has shifted residence in town have not been able to find him.

Had he however continued to attend us expectation of [necessity] could have been by no means great.

After duration of disease for by much greater part of life, & for period at which most remarkable changes occur in system from infancy viz to Manhood, cannot now look for natural cure.

Or at least if does occur will in all probability be effect merely of some very accidental circumstance

If however thus little ground for expecting natural, not more foundation to look for artificial cure.

Before patient came under our care had been under direction of most [eminent] [practitioners] & by their advice had tried very great variety of medicines.

Had therefore very little grounds for expecting that from accidental or random trial, should have been fortunate enough to accomplish cure.

Even this however not altogether to be despaired of.

And in cases where totally at loss [respecting] nature, hold that even such trials where no [reason] to dread bad tendency never to be neglected.

Should not therefore be astonished to find that after present affection has resisted skill of so many regular practitioners, should yet removed by some empiric.

But besides [chance] in this manner was at least also a possible circumstance that during course of patients attendance some particular might occur serving to illustrate nature of the disease.

And that then on principles different from what had hitherto been followed might yet be able to bring about recovery even on rational & dogmatic plan.

Of both one & other chance however will now probably be deprived by desertion of patient.

Perhaps therefore now almost unnecessary to say any thing either with regard to remedies employed or measures which might afterwards have been tried.

May only in general observe that according to account given us chief remedies employed before patient came under our care were evacuant & sedative.

And on conjecture which have ventured to propose would naturally occur as very [rational] practice

On any supposition first indicated with a view to removal of cause giving pain, last with intention of allaying it after excited.

When reflect however that such measures pushed to great extent without success, imagine that ought rather to make trial of other.

And as could not learn that patient had used tonics was prompted to employment of these.

Even on supposition of local cause pain might yet be supported by peculiar irritable state which tonics capable of removing.

Is I apprehend as removing such irritation that sometimes at least successful in cases of Epilepsy even where affection depends on fixed & local cause, as exostosis of skull or like.

Here notwithstanding conjecture possible that might even be no local cause

And that, as in some instances of Epilepsy might solely depend on peculiar mobility from which action induced even by ordinary stimulation in intestinal canal.

These then considerations which led me to think that trial might at least be made of Pill Caeruleae.

And if found product of no good effects was at least apprehensive of no bad consequences.

For in many other instances have before used it not only with safety but with manifest advantage.

Need not observe that in Pill Caeruleae the active ingredient is Cuprum Ammoniala.

Nor need add that all preparations of Cuprum of very considerable virulence.

Possess indeed very remarkable tonic power

Yet all so highly stimulating that excepting [present], in which metal brought to saline state by Ammoniac salt none ventured upon [illegible].

Even this, in small doses will with most people excites nausea

And with some no inconsiderable degree of [vomiting].

Yet ascribe it rather to peculiarity in patients stomach than any thing else that in extent to which here given excited severe vomiting & looseness.

Such a consequence however alone sufficient to induce to intermission of use.

But besides this farther reason for it from another accidental occurrence.

For patient became then also subjected to a catarrhal affection.

Was solely with view to this last, particularly cough & hoarseness, that had recourse to Mistura Oleosa.

And after catarrhal symptoms somewhat abated again intermitted use.

After this put patient on the Pill Gum. which considered chiefly as formula for introduction of Assafoetida.

And in such state too that will act more on intestinal canal than on stomach.

From this I own entertained no very high expectations.

And indeed from what already observed will perceive that could entertain high expectations from no remedy.

Yet led to [treatment] of present on two grounds

In first place might I imagine be of service as counteracting peculiar morbid [sensibility]

Might alleviate pain from operating as antispasmodic.

And that from this source to considerable extent at least [immediately] arises may be inferred from [ease] often given by small quantity of Spirits taken when pain most severe.

May farther observe that in another case in some respects at least similar to present found pil Gum of greatest [service]

And these good grounds for present that operated on principles now mentioned.

But besides this farther known that Assafoetida to no inconsiderable degree possesses power of killing many species of worms.

And among others those commonly present in intestinal canal.

Had then some expectation that might here operate as anthelmintic.

Since first directed however have seen nothing farther of patient

Of effects therefore can say nothing

And as probable that may not see him again perhaps unnecessary to suggest what future measures might here be taken.

If however shall again return to us will I must own be my wish to push use of Assafoetida somewhat farther.

To try exhibition of it not only by mouth in other forms but in other ways also

And particular in way of injection.

In this [latter] mode trial might also be made of introduction of smoke of Tobacco into intestinal canal.

And if these [abortive] would not be improper at least to see effects of a Mercurial course.

From these measures if any truth in idea given of disease some chance at least of reaping benefits.

And the rather throw them out since as far as can learn have not hitherto been used.

Is on this ground more, than on any opinion whatever, that would suggest trial of another mode of cure.

That is electricity.

While a mode of cure perfectly innocent [will] [continue] succeeding in cases where little expected.

And the rather encouraged to such suggestions in present instance from being persuaded that not less affective in removing morbidity [than] in restoring lost sensibility.