DEP/DUA/1/20/05 (Normalised version)

Robert Dunneval

(1779)

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Robert Dunneval

Case of this patient exhibits a set of symptoms by no means unfrequently to be met with.

And much more difficult to cure than to distinguish from other affections.

From perusal of case might be concluded that here subjected to two distinct sets of symptoms.

Affections of stomach & those of head.

Here however can have no doubt that latter consequence of former.

And that disease to be solely considered as being a stomach complaint.

Symptoms of which principal complaint when came under our care was pain at stomach.

This well known may arise from different causes of which judgement only to be formed, by attending to concomitant circumstances

Here may be observed that pains [much] aggravated from taking food.

And that use of almost all kinds of food succeeded by frequent windy eructations

In these circumstances have I think evidence of weakened tone in stomach

And from this well known that pain as well as many other circumstances may be induced.

With this pain to be remarked that another set of symptoms sometimes alternating.

At irregular intervals on remission of pain, is seized with vertigo, [privation] of sight & of hearing

These affections of sense thus occurring, would naturally argue affection of state of brain.

Well known however that by [intern] of brain induced in consequence of stimuli applied even to most remote parts.

And from none more frequently than from peculiar irritation in alimentary canal

Whether as effect of peculiar stimulus or of peculiar state of sensibility.

Could have little hesitation then in considering it as in present case from this [origin]

And apparent suspension of pain not from removal of cause but from state of [Sentient] principle induced by which [mean] being affected in usual manner by painful impression.

Viewing then complaint in this light would refer whole to morbid state of alimentary canal principally of stomach.

And with this idea of nature [although] has not all symptoms of Dyspepsia as introduced into some nosological¹ systems yet would be disposed to give it that name

As to prognosis this affection in general well known to be very obstinate.

And particularly with those whose occupation like that of present patient of a sedentary nature.

Yet on other hand unless arises to a very great height although a distressing is seldom a dangerous affection.

In many instances symptoms much more severe than those which occur in present case

And disease of our patient cannot yet be said to be of long standing

At least present degree of severity has continued only for space of about 4 weeks.

Must here however observe that for similar complaints same patient once before under my care.

Hence then may infer disposition to this affection of much earlier date

But even from this circumstance judgement in some measure favourably to be drawn.

For as then soon in great measure yielded may expect same on present [occasion]

Now however more than formerly [cannot] look for radical cure.

And on slightest exciting cause reason to apprehend that complaint will be again in some measure renewed.

Such however from situation of patient hardly to be supposed will be capable of avoiding.

Is however our business to alleviate or remove present disease & as far as we [can] to prevent return

[Of] measures for this purpose then come next to speak

Considering disease as affect of weakened tone of stomach had to look only for cure from restoration of proper vigour.

For this purpose great variety of different tonics in common use.

Principally however recourse had to vegetable bitters & astringents.

And that from these [conjoined] at least with tonic regimen often greatest benefits cannot be refused.

Have often however been inclined to think that no less advantage here to be expected from mineral than from vegetable tonics.

And wished to make trial in present instance

To this the rather induced, from peculiar affection of head, particularly vertigo to which stomach complaint here gave rise.

From this inferred that debility [corresponds] with peculiar morbid state of sensibility.

And as counteracting such have ever found that best effects obtained from mineral tonics.

Here had recourse to Zinc in state of calx.

A medicine with regard to medical power of which practice a good deal divided.

Must indeed be allowed that has not answered high expectations which on late introduction entertained with regard to it

And many from frequent disappointment now look upon it as really a medicine of no efficacy

That given to much greater extent than commonly done will not cure every or even many instances of Epilepsy must be allowed.

But that from thence should infer it of no activity is by no means a fair [conclusion]

Nor can such a conclusion be drawn from want of obvious operation.

From similar arguments might deny efficacy of best medicines, Peruvian Bark etc.

That is an astringent & tonic in saline state as in form of white vitriol no one will deny

And that when given in state of Calx should as well as other metal, [illegible] be rendered active in stomach is at least highly probable.

But while these grounds for inferring active powers efficacy farther confirmed by numerous observations.

Many cases in different [periodical] works by practitioners of great eminence & accuracy in which attended with best affects.

And besides these observations am from my own experience inclined to think favourably of it in all cases depending on atonia with morbid sensibility.

Present however first instance of a dyspeptic affection in which have ever employed it.

Here conjoined with valerian, an article chief affects of which depend on purulent impression to nerves.

And thus operates sometimes as antispasmodic

But here chiefly employed with intention of giving form.

From time that use of this medicine began has had no returns of vertigo.

And indeed all complaints very greatly relieved.

After however had continued use of it for eight days belly very bound.

This imagined might possibly proceed from the medicine.

But besides this in disease itself [natural] disposition to it.

And whatever cause has unquestionable [tendency] to aggravate the affection.

Considered therefore as necessary to take measures for removal.

For this purpose conjoined with Zinc the use of aloetic pills

By these means belly kept regular in point of discharge & complaint in every respect very much alleviated.

And am in hopes that by continuation may be entirely removed.

Shall not therefore wish to have recourse to any other plan of cure

And on that account do not reckon it necessary to propose other measures if present in end found ineffective.

Especially as these greatly regulated by state of complaint at time.

Am however in hopes that in place of other remedies may soon be able to [dismiss] patient from future attendance.

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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.