DEP/DUA/1/26/11 (Normalised version)

Robert Wilson

(1780)

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At same time thought it more advisable that upon tolerable intermission, medicine should be given up than continued.

For nothing of more consequence to Hysteria patients than removal of every circumstance which can lead to supposition that considered by others as in bad health.

On this account therefore rather than as having obtained complete cure was dismissed from farther attendance at that time.

May at least say however that had obtained mitigation of stomach complaint.

And in hopes that from engaging in usual [mechanical] employment if return of affection not entirely prevented may at least be mitigated.

For after certain mitigation of symptoms this more to be expected from engagement both of mind & body, than from any other cause.

In this expectation however now appears that have been disappointed.

And perhaps even more truth in conjecture that patient will even for life continue subjected to returns of same affection.

That as formerly observed not cured although temporary removal of complaint; appears from situation in which has now returned to us.

Case as now introduced into our register¹ in following terms.

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And after view just given of sentiments of this case when began treatment need now add nothing of nature of disease

Still more than before disposed to consider it in light of a hypochondriac affection

And although may again obtain temporary yet do not expect radical cure

At least removal of morbid state on which depends more to be affected by [regimen] & course of life than by particular medicine.

In this way best chance both of restoring due mobility & counteracting occasional causes.

In as far as medicine employed is more with intention of obviating urgent symptoms than anything else

When regard however paid to most urgent symptoms when patient came at present under care, will perhaps be thought, that only medicine now employed not suited for that purpose.

Put patient on use of crude Antimony to extent of ℥p every morning & evening.

And without any other medicine has been continued regularly on use of it ever since came under care.

May at first be thought very ill suited for obviating urgent symptoms of which the most distressing stomach complaints particularly vomiting.

Well known that Antimony in general a tendency even to excite vomiting

But to this practice was here lead from former history of affection.

Will observe that while consider both stomach complaint & cutaneous affection as belonging to same disease, yet on occurrence of latter, very considerable mitigation of former took place.

This, which by the way, often [remarked] in such affections, was disposed to attribute to change in mode of circulation, & greater determination to surface.

And somewhat in favour of this [suspect] that after last dismissed, present return of stomach complaint took place, on cutaneous affection, being entirely removed.

Relief therefore again to be expected either from return of cutaneous eruption or from some measure having similar [effect]

And was as a means of [supporting] equable circulation, & due discharge by surface, that had here recourse to crude antimony.

In this form it must be allowed action very precarious.

For activity of the [metalline] part very considerably reduced by the Sulphur.

But besides this in order to action [presence] of proportion of acid in stomach is probably necessary.

And accordingly effects it must be allowed are precarious.

Sometimes both vomiting & loosening from small doses, in other large ones without any effect.

Notwithstanding these objections however must own that think very favourably of this medicine.

And this not from any preconceived opinion of powers which ought to have from principles it contains but from what have seen in practice.

Of all the antimonies have found no one to which more certainly operates as producing discharge by surface & as supporting free circulation there.

Accordingly here hoped that it might afford some relief to stomach complaints as cutaneous eruption, while would also prevent returns & save inconvenience resulting from that affection

In these views am inclined to think that have not been altogether disappointed.

At least as giving discharge by surface has had obvious operation even more than expected or wished.

For space of fortnight after began use had effect even of inducing pretty profuse sweating.

From this however patient felt no inconvenience.

While at same time without return of eruption his complaints were considerably relieved.

This therefore sufficient inducement for persisting in use

And after continuation for some time ceased to have former effect of inducing sweating

In this way continued for fortnight longer.

And during whole course complaint became gradually easier.

In this situation then for [reasons] formerly given have thought it better to omit all medicines.

And especially as patient at present in country at some distance from Edinburgh.

From which as changing scene may derive more real benefit than from any thing we could do for [him]

Hope therefore that will not now be necessary for us to do anything farther at present.

At same time far from considering patient as cured.

And if again returns measures to be employed must be entirely according to symptoms at the time.

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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.