DEP/DUA/1/35/32 (Normalised version)

Cath Muir

1784

---

Cath. Muir. July 19. 1784

In history of this patients case many symptoms are enumerated.

And some of them, such for example as peculiar kind of pain with which affected, & which [referred] to region of stomach, rather uncommon.

At same time have not, as far at least as I am able to discover the exact characteristics of any affection described by nosological¹ writers.

In Dr Cullens system can have however no hesitation in asserting that appearance most nearly to definition of Dyspepsia.

But at same time as far as can learn at least has been entirely free both from vomiting & even nausea, two of leading symptoms of that affection.

But even from definition itself appears that Dr Cullen does not consider whole symptoms there mentioned as by any means essential.

For observed that pauciora vel plura saltem concurrentia, constitute this disease.

And indeed disease must be defined in this vague manner, if under general title of Dyspepsia are to include all those affections which in common language known by title of stomach complaints.

And when consider how apt these are, to run as it were into each other, perhaps only with propriety to be viewed as one genus.

At same time must be admitted that on particular occasions appears under very different modifications.

And these too in some cases at least remaining in regular & permanent manner without any [appearance] characterising others.

Hence then some apologies at least for other nosologists who have considered stomach complaints as constituting several different genera.

For in their systems will find that Anorexia Cardialgia gastrodynia Nausea Vomiting Flatulenta each considered as separate & distinct genus.

And although often occurring in combination & successively yet as have already observed sometimes permanently separate & distinct.

When this the case then affords at least grounds for distinction of genus into different species.

And to disease of present patient may I think with propriety give name of Dyspepsia Flatulenta.

For although ultimately from irritated & atonic state of stomach yet no doubt that flatulence immediate cause of most urgent symptoms.

To this, are, I think, not only to refer flatus & eructations but also all pains to which she is subjected.

That this the cause even of peculiar pain of stomach resembling pricking of lancets can I think admit of no doubt.

This demonstrated by ascent of this pain from stomach to throat.

And still more by relief from it on eructation.

From this no doubt that pain the effect of distension from flatulence

While again this flatus evidently retained by spasmodic stricture to which oesophagus subjected.

And from this I apprehend to explain eructation being followed by discharge of water from stomach.

A consequence very frequently resulting from resolution of spasm.

To flatulence would also refer pain of breast as well as of stomach.

And would even attribute to same cause the Dyspnoea to which she is subjected.

For nothing more common than that distension of stomach should affect diaphragm.

This however may naturally suppose will be particularly the case when laid in horizontal position.

And when consider that spasmodic [contraction] as well as [distention] from flatulence propagated all the way from stomach to throat, not surprising that should often be referred to [breast]

Upon whole then appears that notwithstanding numerous symptoms yet all these to be considered as affections of an irritable & debilitated state of stomach giving rise to [illegible] flatulence.

And this again in its turn produced pain, dyspnoea & all other symptoms

Hence with sufficient propriety may be considered as an example of Dyspepsia Flatulenta.

On this idea then both of name & nature of affection both Prognosis & practice to be founded.

With regard to latter however may be observed that as patient already dismissed from attendance observations in some degree superseded.

May only remark that from time she came under care saw nothing in case which could be considered as alarming or dangerous.

Dyspepsia in general much more a distressing & tedious affection than one which has frequently fatal conclusion.

When this does happen is chiefly consequence of exhaustion from excessive vomiting.

And although with our patients loss of flesh & strength yet still at least entirely free from vomiting.

While with respect to pain to which subjected from frequent [change] of situation had demonstrable evidence, that did not proceed from any fixed [cause]

When this the case however although one of most distressing, is yet one of least dangerous symptoms.

And when arises from flatulence often without much difficulty at least to certain degree counteracted.

Hence then hoped that might soon be able to obviate most distressing part of affection.

And that in no long time might be able to dismiss patient at least with considerable alleviation of affection.

An event, which accordingly has now taken place.

But although this has taken place, yet very far from considering affection as cured.

For many accidents, to which patients frequently, sometimes unavoidably exposed, by which such complaints again liable to be renewed & aggravated.

Such for example as irregularity in [diet] flatulent food, abuse of warm liquors etc.

Hence then should be by no means surprised to find her again applying for assistance subjected to all former symptoms

But for present at least, so far free from affection, that should consider continuation of medicine as not only unnecessary, but even improper.

For very few medicines, from habitual use of which, inconvenience at least is not [entailed] upon system.

Hence then in state of relief which patient had obtained consider it as advisable that these should be entirely omitted.

While at same time still looked upon them as the means by which that relief had been brought about

In treatment of this case, consider principle morbid affection as depending on irritability & relaxed state of stomach became objective of most importance to restore due tone & vigour to stomach.

But as more urgent symptom, the effect of flatus pent up in alimentary canal became also an objective of importance to expel flatus & relax spasms by which retained.

These general intentions led to particular practices to which recourse was here had.

Began treatment you will observe by prescribing for this patient the Pill Foetid cum Aloe.

A formula which as have already oftener than once had occasion to remark, consists of equal parts of Aloes Assafoetida & Soap

To this article in cases of flatulence particularly if combined with bound state of belly have frequent recourse.

And indeed am acquainted with few, or rather none, from which in such cases, equal benefit obtained.

A power of relaxing spasms in alimentary canal is in particular manner the property of all foetid gums.

And of these, Assafoetida unquestionably the most powerful.

While at same time, with antispasmodic, unites considerable degree of stimulating power tending to expulsion of flatus.

These affects produced, when given under form of Pill Foetid simple made merely by conjoining Assafoetida with Soap, & where whole virtue attributed, to assafoetida.

In this form also from influence on intestinal canal has some effect as moving the belly.

But purgative power inconsiderable only when taken to extent of but few grains.

And to this dose in most constitutions limited from influence on stomach.

Hence then in flatulence accompanied with dyspeptic symptoms, often benefits from conjunction with Aloes.

For in that affection, bound state of belly a very common occurrence.

And when occurring never fails to aggravate other symptoms.

While however dyspeptic symptoms increased by flatulence, are also uniformly aggravated by every article inducing brisk catharsis

Hence small proportion of aloes which have in general affect of giving merely single motion, often attended with best consequences.

Was therefore with view of obviating [unrest] from wind, & supporting regular discharge by belly, that had here recourse to this medicine.

But while directed the Pill Foetid cum Aloe advised also the Infusion Amarum.

This need hardly observe is a simple watery infusion of Gentian at least with addition only of small proportion of Orange skins & Coriander Seeds to give slight aroma.

And such a quantity of Spirit as will preserve infusion, for some length of time.

As water however, fully extracts powers of Gentian look upon it as one of best of Vegetable bitters.

And these in general well known to be product of most beneficial consequences in restoring tone & vigour of stomach.

Thus remove morbid irritability promote digestion, counteract acid, & indeed obviate almost all symptoms of Dyspepsia.

From use of these medicines, patient soon derived very considerable relief.

For while pills had no more affect than that of keeping belly gently open, to employment of these am I own disposed very much to attribute relief from flatulence which soon received.

While to bitter infusion would ascribe restoration of appetite & alleviation of all other affections.

After therefore [had] continued in [this] state for some time reckon farther attendance unnecessary & farther continuation of medicine for present at least, inadvisable.

For if again subjected to return, by intermittence for some time better chance of obtaining similar relief.

And upon whole present case affords example of benefit of Assafoetida & Gentian in Dyspepsia [Flatulenta].

---

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.