DEP/DUA/1/32/09 (Normalised version)

Ann Wright

(1783)

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Ann Wright. June 6^th

In case of this patient a collection of many different symptoms.

Still however some reason for thinking that whole connected.

Complaints with which has been longest affected & which still most distressing are stomach ailments.

These particularly manifested by distension & pain, flatulent acid, nausea & sometimes vomiting.

This however though formerly frequent now we are told but rare occurrences.

And rejection of food at present rather under form of rumination.

Rising from stomach in mouthfuls as it were from inverted peristaltic motion.

In all these common characteristics of dyspepsia.

And although not an essential have also at least very common concomitant of that disease in bound belly.

But besides dyspeptic symptoms others also in case before us.

At least are such as do not commonly occur in that affection.

As of this kind may mention eruption to which subjected.

Red pimples we are told often appear over whole body.

Seldom however of any long continuation.

And indeed according to account rarely remain out for more than few minutes.

That such cutaneous eruptions may be altogether unconnected with any affection of stomach is indeed true.

At same time as little doubt that frequently originate from that cause.

And this connection often particularly marked by two affections being observed to alternate with each other.

Here then from frequent connection as well as transitory nature, reason to presume that this complaint dependent upon the other.

But besides these still third set of symptoms.

Affections viz of breast.

Of this kind are frequent short coughs, distressing dyspnoea & sense of tightness about breast.

These symptoms in common to several affections.

And particularly are the attendants not only of catarrh but also of Phthisis.

With this patient cannot I think be altogether without apprehension of Phthisis.

For tall & slender make, narrow chest, long neck, & fair though florid complexion, indicate that habit with which Phthisis most common.

Besides this well known that Phthisis a very insidious disease.

And that in many instances has made very considerable [approach] before giving any alarm.

Hence then if in end found subjected to this affection would not be wonderful.

Yet to me seems most probable opinion that has not at present at least taken place.

For in that case should not expect to find pulse at natural standing.

And during space of three years the period for which has been liable to cough, should have expected that would have arisen to much greater height or even already proved fatal.

Upon whole then several circumstances much against supposition of Phthisis here.

And more probable that pectoral complaint of a different kind.

In my opinion some grounds for conjecture that these as well as eruptions also depend on affection of stomach.

For from this cause by no means uncommon to find both cough & dyspnoea.

Have every day examples of this inordinate action, proceeding from irritation of other parts, as well as lungs.

And while not unfrequently from irritation at liver, still often at stomach.

From stomach affection also dyspepsia no uncommon symptom.

Particularly where flatulence considerable.

For from distension of stomach free descent of diaphragm & consequentially free expansion of lungs prevented.

Not improbable [thence] to be referred in present instance.

And in short that all symptoms to be attributed to Dyspepsia.

With this view of case judgement of event more favourable than if considered patient as labouring under complication of affections.

For in that case would probably require different modes of cure.

And one not successfully combated till another fully overcome.

But supposing that dyspepsia the origin & cause of whole still [cannot] look upon affection as slight or what will be easily removed.

For dyspepsia in most instances rather an obstinate disease.

And particularly so when before [attempts] to cure allowed to be of long standing

Or where has continued notwithstanding that [there] had recourse to

With our patient however is [as] it [were] a [constitutional] complaint.

For although arrived to 25^th year has been subjected to it almost from infancy.

And during that period many different modes of cure tried in vain.

Thus circumstances then cannot I think look for speedy recovery.

And perhaps not even for radical cure.

Yet reason I think to hope that by proper means complaint may be somewhat alleviated.

And that by alleviation of affection of stomach other symptoms will be mitigated.

For accomplishing this is in first place necessary to correct [most] urgent symptoms & to [prevent] arising to [great] [height].

Of these what chiefly claim attention are the costiveness & flatulence.

For not only of themselves distressing to patient but augment morbid condition on which affection depends.

But not sufficient merely to counteract causes augmenting weakened & irritated state of stomach.

Is necessary also what will increase vigour.

And by this means can with greatest confidence expect that return of costiveness & flatulence will be [prevented].

These general intentions will sufficiently explain practices to which with this patient have had recourse.

When first came under care prescribed for her the pill Foetid cum Aloe.

These consist of equal parts of Aloes, Assafoetida & Soap.

And usefully answer intention of at same time obviating costiveness & expelling flatulence.

Where however patient ill to [move] a single five grain pill will seldom answer the purpose.

For you will observe contains little more than single grain of Aloes.

Aloes however taken as purgative do not operate in proportion to quantity.

And where grain or two sufficient to move belly taken to extent of scruple¹ or even upwards will seldom do more.

While again where action of intestinal canal readily increased by Aloes even very inconsiderable quantity will do more than wished.

This accordingly appears to have been case in present instance.

For even from one pill at bed time not merely effect of opening belly but some degree of purging.

And that too although patient before very costive.

Was therefore obliged to employ them in still smaller quantity.

But with this intention in place of diminishing dose directed that should be taken less frequently.

To quantity viz only of single pill every second night.

While by this means hoped that costiveness & flatulence would be obviated had recourse also to a medicine with view of strengthening tone of stomach.

For this purpose employed you will observe a combination of bitters & aromatics.

Substances possessing one or other of these powers, but particularly such as have then naturally conjoined generally known by name of stomachic medicines.

And have long been successfully employed against such complaints.

Of all vegetable bitters employed as stomachics in few a more pure or more powerful bitter than Gentian

And is accordingly primary active article in Infusion Amarum.

Combined however with small proportion of Orange pill & Coriander seeds to give aromatic flavour.

But this aroma in many cases usefully increased.

For from action of aromatic on stomach, digestion promoted, & removal of food prevented.

Thus then less chance at least for occurrence either of [acidity] or flatulence.

[illegible] useful aromatic however few formulae better suited than Tincture Aromatic of Pharmacopoeia².

A combination of Cinnamon Cardamom & Angellica.

Accordingly in such stomach complaints as present, am almost daily in habit of employing a combination of Infusion Amarum & Tincture aromatic.

Sometimes conjoining them in equal proportions.

But more frequently as with present patient using former to double quantity of latter.

From this combination in many [former] cases have I think seen best effects.

Cannot however say that in present instance such have yet taken place.

After continuation indeed for space of eight days was less affected with acidity.

But still much distressed with other symptoms particularly flatulence & headache.

And even at last report these affections continue still much as before.

By this however have not been discouraged from farther use of the medicine.

And still hope that by persisting in use ends in view may be accomplished.

Still find however, that even from diminished dose of pills, belly more moved than could wish

For though taken only to extent of single pill every 2^d night had daily several stools

With such patients however while nothing of more consequence than obviating costiveness nothing more prejudicial than purging.

Hence then of importance to obtain a remedy which will merely produce regular discharge by belly.

As this however seems not to be affect of Pill Foetid cum Aloe have intermitted use.

And if costiveness does not return shall attempt cure by mixture with Infusion Amarum alone.

With this view you will observe since omitting pills have increased quantity.

And in this course mean to [persist] till have had full opportunity of judging how far can be effective.

If however costiveness returns must employ some article with view of obviating it.

And if patient still [much] distressed with flatulence may for this purpose try assafoetida alone.

Or at least use it under form of simple pill foetid consisting of mixture of equal parts of Assafoetida & Soap.

Or in place of Infusion Amarum may employ Tincture Amarum with small addition of Elixir extract Aloe & Rheo.

If these medicines unsuccessful future practices must be accommodated to [appearance] which shall then take place.

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Explanatory notes:

1) A unit of weight equal to 20 grains, used by apothecaries and physicians.

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.