DEP/DUA/1/26/10 (Normalised version)

Robert Wilson

(1780)

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Robert Wilson.

When formerly under our care disease introduced into register¹ in following terms.

Robert Wilson at 23.

Is affected with vomiting about an hour commonly after meals, though sometimes it will happen in few minutes. What he discharges is commonly a clear acid liquor at other times part of his food little changed. He complains of great pain at the Scrobiculus cordis, violent palpitations, Borborygmi, headache & a very great discharge of flatus by the mouth. The pain in the Scrobiculus cordis & region of the stomach is much increased when his stomach is full; & when empty he says he feels an inexpressible want, somewhere about his heart. He is attacked also with a sense of cold which is at first confined to a spot about the size of his hand, between his shoulders, but soon extends over his body at which time he is threatened with deliquium animi

Pulse & heat natural – Respiration somewhat impeded. Belly bound urine regular, but it often varies in colour

His complaints began about the month of April & he imputes the pain to a hurt he got in carrying too heavy a load at which time he says, he thought something was broke or torn within his breast

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After reading this history for [illegible] opinion which at present entertain with regard to this patients affection may not be improper briefly to [state] idea which then had of this complaint.

This opinion as already remarked formerly delivered in lecture

Then observed that

In case great diversity of symptoms.

And besides what mentioned in history several others also had taken place from time that came under care before subjected

Particularly a cutaneous affection with which at times very much distressed.

How far, all symptoms to be considered as belonging to one disease, a matter of some doubt.

Not impossible that unconnected.

Yet looked upon it as more probable supposition that all symptoms of same affection.

And that notwithstanding rank of patient, & period of life was subjected to Hypochondria.

Hypochondria it is true principally an affection with those who have passed prime of life

And more frequent with those who by situation enabled to brood over complaint than with others.

Yet that no situation absolutely sufficient to counteract it, [apparent] from many instances.

And with age of present patient [although] more rare than at after periods, yet not unfrequently occurs.

Must therefore, determine present by symptoms.

In case now read by much most numerous [train] of symptoms of the dyspeptic kind or in other words stomach complaints

Not only affected with uneasiness after meals, & pain at stomach, marks of want of ready digestion; but also with borborygmi flatus, vomiting etc.

And besides rejection of food often discharge of a clear coloured fluid.

These at same time attended with bound state of belly.

In that train of symptoms have common constitution of dyspepsia strictly so called.

And if no other appearance in case should without hesitation consider it as example of that affection.

Will particularly observe that corresponds very exactly to definition of Dyspepsia by Dr Cullen.

But while these symptoms constitute dyspepsia to be observed that occur also in hypochondria.

In so much that this affection defined by Dr Cullen, Dyspepsia cum languor, torpor, [illegible] & [illegible]

And although variety of other symptoms in hypochondria yet will still be allowed that stomach complaint, & mental affection most distressing.

Here however although admit that stomach complaint same appearance in dyspepsia as in hypochondria, yet would not be [understood] to infer, that morbid state on which depends precisely of same nature.

For well known that as affecting state of digestion in particular, same [appearance] from very different, nay opposite causes.

But whether this observation well founded or not little doubt that such appearances in way of stomach complaints as here mentioned equally in common to both.

To inquire therefore how far in other symptoms characteristic of hypochondria.

And from definition already given should naturally first look for state of mental affection occurring in this disease.

Here however situation does not enable us to form proper judgement.

For condition of mind to be known only by those who have frequent opportunity of observing patient.

And from all such, we are here entirely excluded.

Cannot therefore with confidence say that such exist.

Yet some grounds for suspecting such state of mind, in cause to which patient refers affection.

Affection attributed by patient to carrying heavy load.

At that time imagined that something broke or torn within him.

That internal rupture may be consequence of very violent straining no one can deny.

Yet had it happened in present instance, must have been immediate product, of very different consequences, from what have here taken place.

Hence little doubt that entirely imagination of patient.

Indication therefore of that state of mind particularly with respect to complaint with which Hypochondria attended.

But while stomach complaints & mental affections great constituents of hypochondria; many other symptoms though less frequent, yet often occurring in this [disease]

And of these not a few in instance before us.

Have very common & what on many occasions very distressing symptom of this affection in palpitations to which patient subjected.

Same also may be observed with respect to headache.

But a symptom still more characteristic than either in that peculiar sense of cold, which at times began in [back] from thence propagated over whole body.

And attended even with such uneasy feelings as to threaten deliquium animi.

Such affections may indeed occur in different diseases.

But is none more frequently than in hypochondria.

Seldom that disease takes place without local & partial coldness

Or rather perhaps what may more properly be styled unequal generation of heat.

And while occurs in various forms in none more frequently than that here described.

In more instances than one of most distinctly marked hypochondria, have seen affections of this kind proceed even to such length that actual deliquium animi induced.

Consider this particular then as affording if not certain proof at least strong presumption of hypochondria affection.

Besides what already mentioned [might] also point out if not as characteristic at least as common symptom of this disease, affection of respiration occurring in present case, state of discharge by [urine], belly etc.

And upon whole symptoms at attack of affection such as to afford strong [presumptive] evidence of this complaint.

In appearance from time patient came under care nothing to lead us to alter this opinion.

And may even observe that supervening symptoms rather favour sentiment as otherwise.

This particularly the case, with regard to itchy eruption which had supervened.

For among other affections from which proceeds, is not unfrequently concomitant of hypochondria.

Reckoned it therefore more probable that in case before us, proceeded from this, than other cause.

And notwithstanding diversity of symptoms in affection considered whole as what justly entitled to name of hypochondria.

With this opinion of name of disease will readily suppose that could not entertain sanguine expectations of speedy termination.

For hypochondria affections well known to be in nature most obstinate.

Might indeed have been considered as some objection to supposition that patient [already] dismissed free from complaint.

But notwithstanding situation at that time, then observed that was far from considering patient as cured.

Had little doubt that on future occasions perhaps even through future life will be subjected to returns of complaint.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.