DEP/DUA/1/27/08 (Normalised version)

Mary Downey

(1781-1782)

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Mary Downey

In history of this patients case numerous collection of symptoms.

And no room for doubt that affection of complicated nature.

Here particularly, complications which would naturally refer to alimentary canal, to head & to lungs.

Of these most obstinate & distressing of the former kind.

Appears not merely under form of affection of stomach but likewise of intestinal canal.

Chiefly however distressing in former.

And there appears under form both of pain, of sickness & of pyrosis.

Such symptoms commonly considered by practical writers under general title of stomach complaint.

Most of nosologists¹ however have formed them into different genera of disease

And if here were to follow these systems should consider patient as subjected to almost as many diseases as there are here symptoms of affections of alimentary canal.

Cannot help thinking therefore that Dr Cullen has acted with greater propriety in referring whole to one genus.

That viz of Dyspepsia.

For under this comprehend Dyspepsia Apepsia, Anorexia, Nausea, Vomitus Flatulence etc of other nosologists.

When however so many reduced to one genus, in some measure [exception] as running to other extreme.

And includes affections not only different in appearance, but also in mode of cure.

Besides this term Dyspepsia cannot with propriety be applied where there does not occur difficulty of digestion.

And perhaps would be better if were confined entirely to those cases where with this, there occurs also some degree of vomiting

Where neither of these occur [however] often patient very distressed from wind in stomach.

And that too even when function of stomach can hardly be said to be disturbed

For occurs principally when stomach empty & when flatulence makes way from intestines.

Have long therefore been inclined to think that flatulence should constitute a genus of disease

And if this a proper genera name of disease, must consider present case as affording example of it.

As constituting this affection here may consider pain & sickness at stomach borborygmi, pyrosis, & bound state of belly.

These however you will observe by no means only symptoms in present case.

Besides these patient also no inconsiderable degree of distress from headache vertigo, & tinnitus aurium.

And here naturally occurs as question, whether headache to be considered as an idiopathic, or symptomatic disease.

On this subject would not pretend to decide with certainty.

Yet of the two rather inclined to latter opinion.

Well known that sympathy between head & stomach very great.

And that stomach complaints one of most common causes of headache.

Here then from degree to which former subsists may readily suppose that is product of latter.

To this conjecture the rather led, from observation that attended with vertigo & tinnitus aurium.

For although these may undoubtedly also attend idiopathic headaches yet can be no doubt that even more frequently the product of impression on alimentary canal

And particularly of that impression arising from distension of stomach by wind

Here therefore inclined to consider affection of head as merely symptom of flatulence.

Perhaps also same in some degree case with respect to pectoral complaint.

At least distention of stomach by wind often product of dyspnoea.

But from this cause, very rarely happens that cough induced.

Present therefore in this instance against that supposition.

But besides this several other particulars also against it

Particularly difference of duration.

Stomach complaints have continued for several years.

While pectoral complaint only of three weeks standing.

And then ascribed to exposure to cold.

May then both from duration & cause consider it as recent catarrhal affection

And as being totally unconnected with affection of stomach.

This then idea of nature of affection here to be treated.

And from what have said may suppose that did not entertain same opinion as to termination of every part of it.

Of all symptoms affection of alimentary canal seemed to be most obstinate.

And had reason to dread that would be most difficult to overcome.

This the rather to be apprehended as patient not in situation of life to employ that mode of cure which have always found to be most effective.

For in this affection when appears under present form, much more to be done by regimen than by medicine.

Particularly by avoiding flatulent vegetable diet, & by free exercise in open air.

To these however highly probable that circumstances of our patient very ill accommodated.

And without these attempts in way of medicine could by no means have full advantage.

Did not therefore expect that even if direction had been exactly complied with patient under our care, could have complete recovery.

Yet hoped that by obviating some of most urgent symptoms, might at least have given immediate relief.

And that thus might in great measure, if not entirely have mitigated headache

With regard to pectoral complaint had also hopes of being of service.

Catarrh yet a recent affection & not very severe.

And imagined that with tolerable caution, might even of itself have tendency to favourable termination.

To this indeed season of year unfavourable.

And perhaps also habitat & clothes of patient.

Not wonderful therefore if should run on during whole winter.

And that the [rather] [has] had done so on former occasions.

A circumstance giving even reason to presume that might at last terminate in chronic state of that affection.

Upon whole however expectations were that in present instance, mitigation might be obtained.

And on this idea began practice [with] patient.

Here as have already observed consider flatulent as being most urgent complaint.

And this to be radically overcome by restoring proper vigour & due action to alimentary canal.

This however to be effected only as work of some time.

And although tonic medicine, such for example, as Peruvian Bark. Vegetable bitter & like, might be used with some [possibility] of advantage yet more to be expected as already observed from diet & exercise.

While these however, very great influence as removing morbid condition giving rise to flatulence still more immediate ease to be expected from expulsion of air [already] extricated.

And for this purpose nothing of greater consequence than promoting free discharge by belly.

Provided at the same time such articles employed, as have tendency to remove those spasmodic strictures of alimentary canal, by which air retained in it.

Was with view of accomplishing these intentions, that had recourse to principle medicine here employed.

Use viz of Pill Foetid cum Aloe.

These pills composed of equal parts of Aloes, Assafoetida & Soap.

Latter article intended merely to give form.

From aloes expected effect of gently moving belly.

And to extent here given, looked for that to such degree, as would give no inconvenience to patient.

For to be observed, that although in such complaints benefit from moving belly yet strong cathartic, always attended with bad consequences.

Assafoetida even to quantity in which enters these pills, in some degree operates as cathartic.

But still more useful from conjunction of stimulating & antispasmodic powers as tending to expulsion of wind.

Accordingly from this formula have in similar instances, often reaped best effects.

And here expected that patient would derive from it at least considerable temporary advantage.

But besides this had recourse also to another medicine viz Mistura Mucilage

Of this medicine the active basis is mucilage of Gum Arabic.

And intended merely as demulcent to take off irritation at fauces.

But till that be case if shall ever happen farther observations as to future treatment altogether unnecessary.

Under this hoped at least for some mitigation of cough.

And with these might probably soon have dismissed patient, although not radically cured, yet considerably relieved.

That this however has been the case, can by no means positively pretend to say.

Nor do we even know, whether patient has taken any of medicines ordered for her.

For since these were first delivered to her, has not attended weekly [reports].

Am however inclined to think it more probable, that desertion has proceeded, rather from her having obtained temporary relief, & considering farther attendance as unnecessary than that has arisen from any other cause.

If this conjecture well founded only chance of seeing her, is from recurrence of affection.

And in this way patients of themselves giving up attendance frequently return to Dispensary

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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.