DEP/DUA/1/35/38 (Normalised version)

Ann Brown

1784

---

Ann Brown July 20^t 1784

Disease of this patient consists almost entirely in two symptoms.

And these intimately, perhaps [may] even add in some degree inseparably connected with each other.

viz Sickness & Vomiting.

These indeed not always [proportional] to each other

And often very great degree of sickness where no vomiting.

But to be doubted if vomiting ever occurs without some degree of sickness.

And probably that is in every instance rather effect of peculiar sensation, than of direct stimulation.

But whether universally true or not yet little doubt that here these symptoms connected as cause & effect.

And to vomiting may I think justly attribute, weakness, heaviness, bound state of belly, & other particulars which though not too distressing, yet to some degree take place with present patient

To look therefore for name of disease in symptoms first mentioned.

And may observe that with several nosological¹ & practical writers, Vomitus even by itself supposed to constitute genera of disease.

Nay in some instances even terminating fatally.

Particularly when puts on that appearance which has been styled Emetartroph.

Vomiting however much more frequently connected with other symptoms of Dyspepsia.

And even when occurs merely by itself yet perhaps most properly considered as peculiar modification of that disease

Especially when takes place without febrile symptoms & without any evidence of local affection of stomach.

From these considerations then viewed disease of present patient as such an example of dyspepsia.

And although distressing yet had no reason to imagine, that would [prove] either obstinate or dangerous.

This the rather imagined, from suddenness of attack.

From originating without any obvious cause.

But above all from shortness of duration.

On these general grounds was led to infer, that in short time might entirely cease

And that too probably even without aid of medicine.

While still farther grounds to hope that by proper administration of these, recovery might be sooner obtained.

Here however as cause of affection obscure could form less certain conjecture with regard to morbid condition to be obviated.

But from being so immediately affect of taking food was led to conjecture that very much connected at least with peculiar morbid irritation of stomach.

And that might be successfully combated by proper tonic.

Was on this idea that had here recourse as an astringent & Stomachicus, to use of Rhubarb.

And to this the rather led from affect which has as cathartic.

For here bound state of belly naturally indicated use of some gentle laxative

But at same time from anything like cathartic had reason to expect an affect rather prejudicial than otherwise.

Hence Rhubarb employed only in small doses.

And in place of using it by itself here exhibited in conjunction with two other articles Magnesium & Ginger.

To the former had recourse on presumption that there might exist some acidity in stomach.

For though no mention made of it in case, yet in such instances but seldom that does not in some degree take place.

Latter again ginger intended as a warm stimulant to stomach.

And from influences of such well known that effects of morbid irritability often immediately counteracted

Accordingly in my own practice not unfrequently combined it with Rhubarb & Magnesium.

And from these whether with or without zinziber have often in cases apparently similar at least seen great benefit obtained.

And in present case reason to believe that followed by such consequences.

For soon after use begun [vomiting] considerably alleviated.

And had also affect of gently opening belly.

Am therefore hopeful that by continuation, disease may soon be removed.

Or at least that may aid & forward operation of system itself tending to produce that affect.

Have now stated opinion of all cases introduced into our Register².

Shall conclude present lecture with a few remarks on some of those patients dismissed from attendance since formerly spoke of cases.

From Sequel of case of [Mary] McFarlane appeared that by means of Fern powder obtained radical cure of Taenia & entire removal of that animal from intestinal canal

In case of David Shiels, labouring under symptoms of Lithias renalis had occasion to employ no other medicine than Cream of Tartar & Balsam Anodyne.

And under these affects was for time at least successfully terminated

---

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.

2) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.