DEP/DUA/1/24/14 (Normalised version)

Robert Watt

(1780-1781)

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Robert Watt.

Principal complaint evidently affection of Stomach

And perhaps better entitled to name of Dyspepsia than any other.

From this then may be considered as a common affection.

Yet with respect to appearance is a modification of the disease very different from what commonly occurs.

And for own part have not before met with any instance exactly similar.

This will appear from comparing history of case with common symptoms of Dyspepsia.

Those principally are, acid, flatulent eructation. want of appetite. nausea. vomiting, pain in stomach & intestines & bound belly.

Of these symptoms it is true several here occurring in usual form

Particularly flatulence & constipation.

But pain in stomach & intestines but very inconsiderable.

Is an occurrence only which has but lately taken place

And is much more of dull & [illegible] kind than what commonly attends

Were this however only peculiarity should consider it as but inconsiderable

Much greater singularity in another symptom

And that too one of most common [occurrences]

What expressed viz by vomiting

Here according to account given us rejection of victuals from stomach not consequence of violent action.

But brought up in such gradual [manner] that rather to be considered as Ruminative than vomitus.

This, to some degree indeed by no means a rare occurrence in Dyspepsia.

But very seldom occurs to that height which takes place in present case

And in former practice have never met with it to such degree.

In so much that consider present case as with greater propriety entitled to appellation of Ruminative if such genus can with propriety be [established] than any before [occurring].

This symptom also with some Nosologists¹ has given [name] to genus.

But at same time multiplication of genera attended with many difficulties without good effects.

And although different modifications of symptoms yet agrees essentially in nature with Dyspepsia or stomach complaint.

Many symptoms indeed of Dyspepsia wanting. Yet unease after meals, [illegible] of victuals, flatulence, & constipation, sufficient to constitute this affection.

Here however to be observed another symptom not commonly marked in Dyspepsia.

That is frequent & severe attacks of Headache

May be question how far this symptom of stomach complaint or a separate disease.

Would not positively assert that latter is not case here.

But at same time when consider how frequently headache consequence of disordered stomach more probable that connected.

And that Cephalgia merely symptom of Dyspepsia

This then idea of present affection.

But whether diseases in reality depend on each other or not can with regard to neither give favourable prognosis.

Nothing indeed in either so far alarming as to threaten danger.

But obstinacy with which already [subsists] precludes hopes of speedy cure.

This particularly the case with regard to stomach complaint.

For notwithstanding different remedies has now we are told subsisted for space of 8 years.

And during that period means of cure very little effect even in diminishing.

For although temporary relief yet upon whole increase in violence.

And if Headache depends on stomach complaint till removal of latter, cannot even look for alleviation of former.

But besides obstinate nature of complaint, another circumstance in case also leading to unfavourable opinion.

Well known that such affections after mitigation very liable to relapse.

Particularly in consequence of irregularity in diet or in consequence of improper food.

Can hardly however expect that with patients situation & employment in life, these particulars attended to as ought.

Hence then even if alleviation produced yet constant danger of relapse.

And upon whole expectations with this patient by no means sanguine.

Utmost that expect is to be able to dismiss him with some alleviation.

And shall not be surprised if leaves us in no better situation, than when came under care or even with increase.

Yet still may at least afford us opportunity for trial of different measures.

And [several] which without any [hazard] from use may be employed with some probability of success.

If any of these shall succeed in effecting cure, obstinacy of case stronger evidence of efficacy.

Here, if cure can be effected, is principally to be expected from means giving [strength] & vigour to stomach.

For although disease principally [characterised] by inordinate action, yet consider this as depending on debilitated & irritated state.

While however for radical cure means to be employed for restoring strength, necessary also to attend to means of obviating urgent symptoms.

And particularly the obviating those symptoms which can have any tendency to increase affect.

Such however never fails to be consequence of acidity, bound belly etc.

On these general intentions medicines [illegible] employed in this case, have been [directed]

Here will observe that since this patient came under care, uniformly continues on course with which began

Directed for him mixture [consisting] of Tincture Absinthe diluted with Peppermint Water

From latter expected some effect as counteracting flatulence & promoting expulsion of wind from stomach.

But here chiefly employed as corrigent.

As [illegible] from aromatic oil which contains to cover taste without diminishing effect of the Worm wood.

Same also will readily conject was sole intention of addition of sugar.

And this even with many, in [some] measure necessary to correct the Peppermint Water.

Here what principally relied upon as active basis of medicine was Tincture Absinthe

This tincture formed from one of [strongest] vegetable bitters which this country [produces].

Formerly two species of Absinthe a place in Pharmacopoeia².

Now however one only as equally serving purpose of both retained.

And College have with propriety preferred what indigenous in this country, while at same time strong & purulent bitter.

Here may remark that Tincture Absinthe a new formula.

For although formerly two species of the plant in Pharmacopoeia was only employed in combination with other articles or occasionally added to stomachic bitters.

Considerable advantage however from such [forms] as present.

For thus can be occasionally & to any extent, introduced in extemporaneous prescriptions.

To be observed that in preparation a particular mode employed.

That viz of double infusion Spirit Menstruum used first added to quantity of pound ii to ℥iv

Afterwards second infusion of same spirit with half quantity of Wormwood

Supposed that in this manner greater strength & purer bitter, than if same quantity of spirit applied to whole wormwood at once

And that this the case at least highly probable.

At same time have never for my own part, seen any decisive evidence of it from proper trials.

But whether stronger or not, can be no doubt that by rectified spirit [strength] of Wormwood very fully extracted.

As means therefore of exhibiting [actions], of this vegetable bitter, was here employed.

And although in present form but little experience of efficacy, yet from some trials both in this & other ways expected influence as counteracting complaint.

With this however from [beginning] conjoined also another medicine.

I mean Pill Foetid cum Aloe

Of these pills, which consist of equal parts of Aloes. Assafoetida & Soap have already had occasion to speak.

Look upon them as very useful both in counteracting flatulence & in obviating costiveness.

And with these intentions here employed.

After what already said of them when used in other cases for similar purposes now unnecessary to add anything.

May only observe that at first given only to extent of grains V

In this quantity although had some effect yet not so considerable as could have wished.

Since that increased to double the quantity

And now have effect of keeping belly gently open.

On this course patient has now continued for space of several weeks.

Cannot say that progress to cure [great]

Yet upon whole rather alleviated as otherwise.

Change so far favourable as to lead me to think of still continuing same measures

At least at present no thoughts of any other alteration than augmenting quantity of Tincture Absinthe in mixture.

And if shall be means of complete cure or even considerable alleviation will lead me to think very favourably of this medicine.

Will not however be surprised to find that after proper trial cannot obtain from it the wished for effect.

And that with view of attempting cure obliged to have recourse to other expediencies.

If this the case shall first wish to try effects of some purgative operating more [briskly] than what already [employed].

For this purpose in place of present pills have thoughts of trying Aloes in liquid form.

And particularly of employing it under form of Elixir Aloes or Prop as commonly called.

This while warm purgative at same time generally considered as stomachicus.

And by producing purgative action may have affect of counteracting inordinate motion which most distressing.

If this fails have some thoughts of trial of Columbo.

Which upon whole one of [best] stomachicus among tribe of Vegetable bitters with which am yet acquainted.

Have some thought also of having here recourse to use of [Ag.] [Pip.] Jamic.

In which one of most pleasant & best of vegetable aromatics.

And which of late in some cases of stomach complaints have used with considerable success.

Among other trials also, as [means] of restraining inordinate action, & morbid [sensibility] may here suggest Laudanum.

At same time however taking care to obviate costiveness by proper measures.

But in all these measures must be regulated by future circumstances.

And if continues to be benefited by present course shall not soon substitute another

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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.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.