DEP/DUA/1/21/28 (Normalised version)

James Chalmers

(1779-1780)

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James Chalmers.

Affection probably somewhat complicated

But upon whole singular.

And in my own practice have not met with an analogous case

Of symptoms with which affected by much great part as Cough, Dyspnoea Borborygmi gripes pain of stomach etc very common occurrences

But with these a peculiar symptom conjoined which have never before observed.

viz Convulsive sonorous affection resembling Hiccups

Of this, every Gentleman who saw patient at time of visits, able to form distinct idea.

But does not admit of being described by words.

Have [indeed] in [report] given name of singultus

And to this greater resemblance than to any noise have before observed

Yet at same time could be no doubt, even from peculiar noise alone, that different.

And somewhat intermittent between noise of Hiccup & eructation.

And if noise most similar to latter progression rather resembles former.

For by no means of instant nature of Hiccup.

Hiccups & eructations however well known morbid affections of different organs.

And while one from inordinate action of alimentary canal, other from Diaphragm.

Here matter of doubt which particularly concerned.

And perhaps may be offered as conjecture that both some share.

Patient during [attacks] sensible of something rising up from stomach.

And not impossible that after certain [height], might induce inordinate action of diaphragm.

If however, from either by itself should be inclined to look upon it as from inordinate action of alimentary canal.

At least this rendered most probable from other symptoms.

Particularly borborygmi & gripes.

But whatever organ immediately affected no doubt as to nature.

That an inordinate action of Convulsive kind.

And formed part of patients disease if not most painful at least most distressing.

Here however many other symptoms also occur.

Particularly those indicating affection of alimentary canal borborygmi gripes, & [sense] of pain in belly.

Highly probable that these also origin of Dyspnoea.

For this well known always in some degree, effect of distension of intestines or stomach, with wind.

And not impossible also from same cause to account for cough.

For to be observed that not catarrh, but merely of dry tickling kind & without expectoration.

Besides these at times also affected with headache

This at least a less uncommon occurrence than another particular.

Constant sense of coldness in extreme part feet.

To these farther to be added that patient very much affected with dejection of [Spirits]

In all these symptoms taken together can by no means consider us as having infallible diagnostic of any disease.

Yet any one acquainted with history of hypochondria must be sensible that all these & many other symptoms frequently occur.

And that although appearances very greatly diversified yet chiefly characterised by affection of alimentary canal, & state of mind.

To genus of hypochondria then might perhaps with greater propriety be referred than to any other.

And patient of that habit of body in which Hypochondria most frequently occurs.

For in dark complexions, rough coarse skin, & black hair, have at least common external marks of melancholy temperament.

But here though disease really in nature hypochondria yet affection most obviously marked by another circumstance.

That is peculiar [singularity] or eructation with which patient affected.

And although not perhaps most important yet most striking feature in present disease.

From this then would rather [choose] to name it.

And from what already said of nature consider it as more affection of alimentary canal than of diaphragm.

Hence then not to be referred to genus of singultus.

All cases of inordinate action of intestinal canal with flatulence whether merely borborygmi or flatus actually discharged upwards or downwards. Mr Sauvages has referred to one Genus Flatulentia.

And among other species very full description of Flatulentia Hypochondria.

To this as he describes it case of present patient more near resemblance [than] to any other genus

Consider this title [then] as more applicable to case when came under care than any other.

At same time look upon it as essentially hypochondria.

Yet must again repeat as [definition] that is a modification of that disease which have not before met with.

How far this peculiarity in any degree to be attributed to an accident to which patient subjected not long before came under our care may at least be stated as question.

From accidental cut in hand, to which from profession as a wright exposed had very considerable loss of blood.

To such extent even are told as to induce fainting.

This however with some habits much more readily induced than with others.

And would appear that with this patient great disposition to it.

For according to [computation] occurred from discharge not more than ℥XVI.

Still however whether to judge from effects, or quantity must view it as considerable.

And when consider general influence on such habits can have little doubt that remarkable increase of affection to be attributed to it.

Probably even had great influence in giving hypochondria, form here assumed.

Yet that not to be considered as sole cause may conclude from having existed even for years before this accident happened.

And probably like other instances of hypochondria more from originating constitution than from any particular exciting cause.

After this opinion as to nature of affection cannot here be supposed to give favourable prognosis of every part of disease

Probable even that from all his symptoms will not be entirely free [at] any future period of life.

Yet from beginning had hopes that this would not be case with regard to most urgent part of affection Sing. or [illegible]

Expectation that in no long time should be able to free our patient from this most distressing complaint.

And if does not again return, which probably will not happen [unless] from some particular cause inducing it, may consider it as already terminated.

This however must acknowledge has not been effect of our medicine.

For this patient among other symptoms of this disease seems not to have wanted one pointed out among peculiar characteristics of it by Mr Sauvages.

When treating of obstinacy of disease observes that frequently proceeds from patient

For seldom that can [submit] to continuing under [care] of one person.

Saepius, says he et medicos & method medendi mutant.

Probably from such disposition that our patient after few weeks attendance put himself under care of a benevolent lady, the widow of a Clergyman, who is I may say a celebrated practitioner at this place.

This by no means first patient who has been transferred from my care to hers.

And in my turn too have sometimes had occasion to treat patients after had applied to her without success.

Nor surprising that should be so, when consider that one of principle diseases for cure of which is celebrated is epilepsy.

What her medicine is I do not know.

And indeed have never examined or even seen it.

Am ignorant also of any well [vouched] cases in which attended with desired effects.

But have met with several in which has had fair trial without success.

From this however would by no means infer that inactive or useless.

For convinced that while some cases of Epilepsy curable others not so

And that of these admitting of cure, recovery sometimes to be brought about by one medicine sometimes by another.

From all that have seen therefore am by no means warranted to draw any conclusion against remedies employed by this Lady.

Whether that which exhibited to this patient was her specific for epilepsy or not, I cannot tell.

But whatever was, little reason to doubt that with our patient had good effects.

From time that began it affection of convulsive kind became much more slight.

And after no long continuation has we may say entirely left him.

In this state then look upon prognosis as to this part of complaint as superseded.

And consider patient as cured of this ailment by medicine which this lady has exhibited.

How far medicine thus removing one part of affection may really have [affect] in combating others, cannot pretend to say.

Do not however imagine that [numerous] train of symptoms to which otherwise subjected & which have now continued for long period, will thus be removed.

And this I apprehend not to be expected from any medicine whatever.

After relief therefore which patient has now had, unless from some nervous occurrence shall reckon farther attendance here unnecessary.

And at present recommend it to him to continue attendance only that may be more certain as to relief really [received].

Although as have already [observed], am not disposed to attribute this, even in any degree, to medicines which we directed for him, yet may not be impossible to make few remarks with regard to them.

And at least to explain footing on which different practices directed.

When patient first came under care directed for him mixture consisting of equal parts of Tincture Fuliginis & Tincture Aromatic.

Both these I consider as active articles.

With respect to first however do not think that virtue to be attributed to article from which derives name.

Look upon it rather as being active & not [inelegant] preparation of Assafoetida in Liquid form.

And this consider as being one of most powerful antispasmodics of stimulant kind.

With respect to aromatic Tincture can be no doubt that efficacy from essential oil of vegetables particularly of Cinnamon [illegible] it, as extracted by Spirit menstruum.

And even by itself in cases where flatus affords stimulation to inordinate action of intestines, often best effects

On this ground chiefly induced to advise it in present case.

And hoped that from [conjecture] should have derived salutary & even immediate effects.

In this however entirely disappointed.

Only manifest effect a sense of heat in stomach.

Probably consequence of aromatic & of even of Spirit menstruum which taken to considerable extent for dose.

But with this sense of heat sonorous spasmodic affection neither less frequent nor less severe.

While former circumstances therefore some objection to increase of dose, from latter want viz of success was led to think of trial of some other measure.

And had next recourse to two articles which in general at least very powerful agents on Nervous energy.

Camphor & Vitriol Aether.

Both these hold also to be very active antispasmodics & of stimulatory kind.

And here exhibited in such doses that from either if well adapted to case might have expected good consequences.

But in place of relief under [these] affection seemed rather to be aggravated.

This indeed not manifestly a consequence resulting from Aether.

For on being taken only obvious effect the induction of frequent eructation.

And that not in peculiar manner but of natural kind.

In as far therefore as consisted in expulsion of flatus from stomach might be reckoned salutary.

But from pills, while sense of heat excited in stomach, peculiar distressing symptoms became manifestly more severe.

This can only say, is contrary to what have observed in many cases of obstinate singultus.

For in such have found from Camphor in different forms most beneficial effects.

Here however aggravation of complaint led to intermit use, & to trust to Aether alone.

With view of giving every chance augmented very considerably dose to be taken internally & directed also external application.

From use in latter way alone have often seen most distressing fits both of singultus & Vomiting almost instantly [checked]

On this however continued for several days without any manifest benefit.

And was in this situation that employed prescription of Lady which have already spoken.

Under this affection soon so far diminished that other trials superseded.

And if at next report continues free from affection shall consider any farther attendance here as unnecessary.