DEP/DUA/1/38/51 (Normalised version)

Barbara Orrock

(1785-1786)

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Barbara Orrock.

Respecting disease of this patient am I own not without doubts.

Can however have no hesitation in considering her as subjected to a complication of affections.

And perhaps not an easy matter to determine which to be considered as most dangerous or most important.

Complaints however at least most urgent when came under our care were different stomach ailments.

Particularly was affected to very considerable degree with pain both in stomach & bowels.

And this pain accompanied with frequent eructation & flatus.

From which as well as from [transitory] nature, might infer that affect merely of wind in alimentary canal not of any fixed cause.

Besides this affected also with [want] of appetite disagreeable taste in mouth & headache.

In all these cannot indeed be pretended that have characteristics of Dyspepsia as defined by nosological¹ writers.

But often where for months together fewer symptoms take place, [in] no long time there occurs nausea vomiting rumination, cardialgia & all other symptoms which attendant of that affection.

And will not at least be denied that in symptoms here enumerated have unquestionable evidence of morbid state of digestion.

Hence in strict language entitled to appellation of dyspepsia.

One particular indeed which may seem objection to that supposition.

That is loose state of belly.

Must be allowed that with Dyspepsia if not universally at least very generally constipation occurs.

But this neither a constant nor necessary symptom of the disease.

Accordingly Dr Cullen in his definition, has only said, alvus [pleurunque] astricta.

But although might consider obstipation, as almost universal attendant of the disease in ordinary cases, yet no reason to doubt, that in particular instances, may be [complexed] with diarrhoea.

And this I own from what have seen of progress of disease consider as being case in present instance.

For when patient last attended us Diarrhoea one of most urgent symptoms.

And can at least conceive, that with that morbid affection of stomach giving symptoms of dyspepsia there may at same time occur in inferior part of intestines conditions giving diarrhoea

That is augmented deposit of watery [secretion] & increase of peristaltic motion.

But besides these here also symptoms of another disease & that too of more alarming nature

In cough pain of breast & dyspnoea have common attendants of Phthisis Pulmonalis.

And these the rather alarming as were ushered in by considerable Haemoptysis.

From this circumstance am I own not without apprehensions.

At same time several particulars which now at least against supposition of Phthisis.

Neither has at present nor as far as we can learn, has she had during course of affection, any marks of hectic fever.

And neither that progression which might have expected during course of disease, nor any appearance of haemoptysis for many months past.

While pulse, in point of number, even below natural standing.

Am therefore disposed to conclude, that affection of lungs, which accompanied rupture, has entirely ceased.

And this the rather to be imagined as haemoptysis occurred at a time, when menstrual discharge wanting.

Well known however that haemorrhage vicarious to menstrual discharge, seldom attended with any danger.

Accordingly both Haemoptysis & [ Haematem] to great degree happening in Amenorrhea at period when menses should flow, seldom considered as grounds of alarm.

As therefore haemorrhage in present case, occurred during obstruction – As has now for long time entirely ceased. – And as menstrual evacuation now regular, have I think, grounds for presuming, that all danger from this source over.

And am I own inclined to hope, that pectoral complaint, merely catarrh.

But whether Phthisis or catarrhal, at least add to complaint here occurring.

And besides what already pointed out, have some suspicion that may also add to disease of this patient, another affection.

Have not indeed, in any of complaints enumerated in case, what can be considered as in any degree approximate in appearance to the hysteria paroxysm.

But several of her complaints, are what more frequently occur, as hysteria symptoms, than from any other cause.

Particularly flying pains in different parts of body, fits of sickness, faintness, & the like.

And indeed with hysterical females, both stomach complaints, & cough very frequently occurs.

Hence not impossible that may have very considerable share, as inducing affection.

Whether however has in this way any influence or not, after what already said respecting different affections here occurring, need hardly add, that can say very little, with any degree of confidence respecting prognosis.

If however as we are disposed to believe be really free from Phthisis, though symptoms numerous, yet affection cannot be considered as immediately dangerous.

And am inclined to hope that if attendance regularly continued may in no long time, be able, if not to remove, at least to alleviate, most of complaint.

This however it must be allowed, the more difficult as in combination Dyspnoea Diarrhoea, & Pectoral complaints, different modes of treatment may be required.

And in such cases, cannot pretend to lay down any general plan of cure.

Or at least, though may form [such] yet practice must be very much regulated by urgency of symptoms which occur.

And this I own, has hitherto been grounds for different practices directed to present patient.

Before selected her as subject of case lecture prescribed for her, a mixture of Peruvian Bark & Valerian.

From first of these had in view the strengthening tone of stomach, & thus alleviating symptoms of dyspnoea.

From last, the counteracting peculiar irritability of habit, which consider as cause of pains.

Particularly of those flying pains when viewed as being of hysteria kind.

And from Valerian as a nervous medicine have in many instances since remarkable benefits.

This medicine however from state of patients stomach attended with very different operation from what wished.

For not only, always excited [sickness], but in general also vomiting.

While this the case, in place of any benefit had reason to think that would be attended with bad consequences.

From even from sickness, while always highly distressing to patient, reason to believe, that tone of stomach weakened.

And this certainly case, from frequent action of vomiting.

Such therefore being obvious operation of medicine, could have no hesitation in laying aside use.

But upon this, had recourse you will observe, to another with same intention

A mixture viz of the Aromatic & bitter Tincture.

Is at least general opinion that is as containing & combining those principles vizr bitterness & aroma, that Peruvian bark operates.

And whether any other foundation for action or not, certain at least, that does possess these to considerable degree.

And also certain, that for Peruvian Bark article possessing these powers, useful substance.

But particularly in stomach complaints where when bark not retained, these not only sit easily on stomach, but product even of cordial affects.

Basis of first article here used, the aromatic Tincture, are Cinnamon, & Cardamom, two of most active, & most [aggressive] of Aromatics.

While chief basis of latter, the Gentian one of purest & strongest of Vegetable bitters.

And in state of combination here employed that viz of Tincture Amarum, has been so much used in stomach ailments, that formerly when medicine named from supposed virtues had title of Elixir Stomachicus

From these therefore, expected that might derive same benefit as from Peruvian Bark, without inconvenience found to result from it.

But as in both Tinctures, a spirit menstruum employed considered farther dilution as necessary.

And with this view added a proportion of Peppermint water which without any thing of intoxicating quality, has affect of operating as a carminative.

And in this way highly useful in many dyspeptic cases.

But besides this directed also you will observe another addition.

A proportion viz of Thebaic Tincture.

To this not so much led, from hopes of diminishing tendency to vomiting, as with view to other particulars in case.

The cough viz & looseness to which was subjected.

While from both of themselves very considerable distress, could be no doubt also that augmented present affection.

Both cough vomiting often excited a circumstance on many accounts to be avoided.

And well known that while bound state of belly very distressing to dyspeptic patients, if to obviate this, purgative employed operating briskly complaint never fails to be afterwards aggravated.

And this consequence we may readily expect, will result from spontaneous looseness as well as from that artificially induced.

Indeed may be considered as consequence of every preternatural evacuation.

Hence then independent of distress, when these symptoms of themselves occasion the obviating cough, & at least gently restoring looseness, were very desirable objectives.

And in answering both intentions no medicine from which could expect more [than] opium.

Whatever different opinion practitioners may entertain as to mode of action, no one can deny, that influence as allaying inordinate action in general, both very immediate & also very considerable.

And in this way, benefit in particular daily felt from it both as allaying cough, & as restoring looseness.

Hence then here expected some [benefit] from present directed, both as tending to remove dyspnoea to mitigate cough & to restrain looseness.

From use of this medicine however expectations hardly more answered than by former.

Seemed indeed to have some effect in mitigation of cough.

Or at least during use that symptoms became easier.

But while stomach complaint continued much in same state as before looseness upon whole aggravated.

And often particularly distressing, during the night.

In this situation, to continuation of mixture, thought it proper to superadd a larger proportion of opium.

And this directed to be taken at bed time under form of Thebaic Pills.

From this however though looseness prevented during night, no other material advantage was derived.

For still continued to have frequent loose stools through the day.

And while other complaints nothing mitigated was more than ever affected with sickness at stomach

While as might naturally be expected from continuation of disease strength continued to be diminished.

In this situation thought that little to be expected from persisting any longer in use of medicine.

And indeed now consider mitigation or rather removal of looseness, as a necessary condition, before could expect to do anything with advantage as counteracting dyspeptic complaint.

With view then especially to Diarrhoea have you will observe at last report, put patient on use of Infusion Japonica.

This article often prescribed under title of Julap sistens, a name [improper] as being derived from supposed virtues.

For no doubt that much greater advantage & less chance of error, when medicine derives name principal constituents.

And accordingly Edinburgh College² in last edition of Pharmacopoeia³ have almost universally followed this rule.

But whether presently under title of Julap Sistens or Infusion Japonica, has for its basis, the succus or as very improperly styled in our Pharmacopoeia the Terra Japonica.

For what formerly supposed to be an earth now well known to be a vegetable extract or [illegible] juice.

Obtained from a species of the Mimosoideae growing abundantly in many parts of India particularly in Bengal.

From kilns dug in ground in which is prepared by evaporation of water [plant] acquires earthy appearance often discovered on external surface.

And which indeed has led to belief of its being an earth.

But earth thus adhering to it merely to be considered as an extraneous impurity.

Accordingly is a desired objective to free it from this.

And in some Pharmacopoeia a succus japonica depurative. with great propriety introduced.

Formed by first dissolving in warm water & again evaporating to dryness the clear liquor

By this means vegetable part of it obtained in pure state

For earthy matters, not soluble in water almost immediately falls to bottom.

Nearly same end obtained by employing it under form here directed that viz of Infusion Japonica.

For thus also, although no future evaporation, by throwing away sediment, get rid of all earthy impurities.

And in this respect consider Infusion Japonica as preferable to mixture made by diffusing in water the Electuary Japonica.

For in that case, as several articles insoluble in water, mixture directed to be shaken before use.

And by this means earthy impurities swallowed as much as when taken in substance.

To infusion Japonica here added you will observe a proportion both of Cinnamon Water & Mucilage of Gum Arabic.

First chiefly with a view to action on stomach & to forward expulsion of flatulence.

Last again, with a view to demulcent affects, as lubricating fauces, & for mitigation of cough.

And both as a means of allaying cough, & of restraining looseness here also added a proportion of Thebaic Tincture.

This where astringent I have mentioned is employed a very common adjuvant.

And often with best affects.

Nay observe that much more obtained from two together than from either separately.

And not improbable that as opium gives temporary suspension of inordinate action, astringent has thus full opportunity of action.

Whereas otherwise would be [hurried] through intestinal canal before could produce affects.

While again by astringent, temporary advantage obtained from opiate are continued.

But whether this reasoning well founded or not, cannot be question that from medicine here employed very great benefit often obtained.

And am hopeful that in present case may find such an affect resulting from use.

But at same time after trials already made without success, cannot speak with great confidence.

If however as at present directed has not affect of removing looseness, shall probably employ it to greater extent & with larger proportion of Laudanum.

And if this also fails may have recourse to more powerful astringent or to astringent & sedative topically applied to rectum.

But as already observed need hardly offer any suggestions as to future practice.

For from complicated nature must be very much regulated by circumstances.

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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.

2) The Royal College of Physicians of Edinburgh, established in 1681.

3) 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.