DEP/DUA/1/29/04 (Normalised version)

Margaret Grieve

(1782)

---

Margaret Grieve.

Case of this patient consists of but few symptoms.

In these however have sufficient characteristics of a disease very common in this country.

And that too with people of all ranks.

Probably from mode of life, particularly from hot tea as article of diet.

At least from this conjoined with other causes would account for affection being more frequent now than formerly.

Disease to which here allude is Dyspepsia.

This term as expressing a genus of disease adopted by several nosologists¹.

But by none so particularly considered or distinctly defined as by Dr Cullen

Here indeed must admit that in our case many of symptoms mentioned in his definition wanting.

But to be observed that affection there defined as occurs when most distinctly marked.

And that every day instances of the disease subsist for long time before assumes that form.

The general terms of Dyspepsia Apepsia & Diapepsia in strict [acceptance] [signify] slow or difficult digestion.

But under these general terms may with propriety include all stomach complaints occurring as idiopathic diseases & not depending on any local cause as scirrhous or like in the stomach.

That such the affection of present patient cannot admit of doubt.

Not only indicated by want of usual appetite for food, but by uneasiness which food creates.

For in place of ready digestion, pain weight & oppression

And although natural condition of stomach, not such that vomiting easily excited, yet when does take place, affords temporary relief.

To these also another symptom superadded, viz bound state of belly.

This likewise if not constant, at least very general attendant, of Dyspepsia.

And not improbable that here some truth in conjecture of patient, that all other ailments, to be ascribed to this cause.

For at least certain, that by bound state of belly, Dyspepsia always aggravated.

From these different circumstances however, may infer that disease of present patient but slight

And even in most distressing state seldom dangerous.

Upon whole then in present situation of patient no grounds for being alarmed.

At same time though slight, may prove obstinate

And indeed, after has once taken place to considerable degree, few diseases more difficult to be entirely removed.

At least liable to be renewed again from slightest accidents

Particularly from irregularity in diet want of due exercise in open air, sedentary employment, or like.

These circumstances however, may readily presume unfavourable to complete recovery with present patient.

Hence then expect rather to alleviate than entirely remove complaint.

This however hope may soon be able to accomplish even by single circumstance of keeping belly gently open.

But may be still more readily & completely effected if at same time such articles employed as tend to strengthen tone of stomach & increase action

As answering this purpose however, whole tribe of vegetable balsams so commonly employed that have even got general appellation of stomachicus medicine.

Was with intention now mentioned then, that practices here employed were directed.

Began with prescribing for this patient, pills consisting of equal parts of Aloes Assafoetida & Soap.

These pills to which give name of Pill Foetid cum Aloe I very frequently employ where with gentle purgative mean also to obtain effect of expelling wind from bowels.

And among all articles which have tried with these intentions find few answer the purpose better.

As here much bound these pills at first employed to extent of grain V both morning & evening.

But while in this disease is of consequence to keep belly regular, much caution in avoiding brisk catharsis.

For much evacuation in this way, also aggravates affection.

And indeed the discovering proper purgation, often greatest part of cure.

With our patient purgative already directed has hitherto answered very well.

But from apprehension of doing too much have at last report, confined patient to evening dose only

And as a strengthener of stomach have directed in former part of day use of infusion Amarum with Tincture Aromatic

This combination, in many such cases, I have found attended with best effects

And hope that in present instance, no other medicine may be necessary.

And that in no long time patient may be dismissed from attendance, with affection if not entirely removed, yet considerably alleviated.

But if after proper trial present remedy shall not be found to succeed will still persist in similar course.

That is use of gentle laxative & stomachic bitters.

And as conjoining both these [properties] have next thoughts of trying Rhubarb.

But in this must be determined by circumstances in which shall find patient after trial already begun

---

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.