DEP/DUA/1/39/12 (Normalised version)

Edward Ross

1786

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Edward Ross. February 25 1786.

Of disease of [this] patient opinion I confess somewhat changed since last spoke of case.

At least with respect to termination.

For now inclined to consider it in more serious light than formerly.

When came under care chief affection pain of stomach.

And this not constant but chiefly after taking food.

While at same time attended with sickness nausea acid eructation & great distension.

In these have common marks of dyspepsia.

And here no reason to believe any fixed affection.

For at that time no local [hardness] to be discovered at any particular part from examination of stomach.

No constant pain.

And no vomiting which very common attended of scirrhous or local affection of stomach whether at Cardia or Pylor

Hence then disposed to view it as being affection merely of atonic state of that viscus.

And what probably a very common consequence of that condition a morbid affection of fluid secreted by stomach on which digestion very much depends.

This opinion as to nature of affection corroborated also by account which gave of cause.

Ascribes disease to [drinking] spirit liquors of bad quality.

Well known however that by abundancy of spirits whether good [or] bad stomach affection [induced]

And such abuse was I confess disposed to think had been case in present instance.

Much more frequently however induced weakened tone than any local affection.

Which again very generally consequence of [strokes], preceding inflammation or some similar accident.

Hence then inclined to view disease as being merely instance of Dyspepsia.

An affection which though often obstinate & troublesome yet in general not dangerous.

And often where to greater heights & of longer continuation than present, yet favourable termination.

In present case consider short duration as somewhat in favour of patient.

Had only been of four months standing.

Which though long period for some diseases yet cannot be considered as such for dyspepsia.

Besides then that symptoms far from very urgent consider us as having here opportunity of treating affection in incipient state.

To this also to be added as another favourable circumstance that had once before been subjected to similar complaint.

And on that occasion had even spontaneously terminated in recovery.

On these grounds then, hoped that by aid of proper regimen & medicine in no long time affection if not entirely removed might at least be alleviated.

And for some time change which took place in complaint seemed to favour this idea.

But since patient came under our care, a circumstance mentioned of which [were] not before informed, giving much more serious aspect to complaint.

Report of 4^th February last in our register¹ in following terms.

Is entirely free from the cardialgia & acid eructations but complains of a sense of stoppage at his stomach so that can swallow nothing excepting in fluid state & small quantity at a time.

Such temporary difficulty of swallowing often at times merely consequence of spasm.

And not unfrequently such spasms induced by flatulence.

But here [represented] as having been so constant with patient & with so little pain, that could hardly attribute to that cause.

And was I own inclined to suspect some local stricture at cardia

Such however often consequence of scirrhous

And where this occurs disease very generally in end fatal.

On this ground then now disposed to view disease in much more [serious] light than before.

With regard however to termination of affection now unnecessary for us to offer any conjecture.

For since last report urgency of complaint has led him to apply for admission into infirmary² where at present under care of another physician.

And for same reason also hold it necessary to say but little with respect to practice.

At commencement of treatment, though considered principal morbid affection as [consisting] in diminished tone of stomach yet before employed remedy to restore it seemed necessary to do something for obviating urgent symptoms.

And here, consider sickness nausea & [ ven] pain as a good deal affect of acid as indicated by eructation seemed to be object of consequence to destroy it.

With this intention had recourse to Pulveris Cretacea, the basis of which need hardly observe one of most powerful of absorbent [earths].

But which in that formula united with two of most active & grateful of vegetable aromatics Nutmeg & Cinnamon.

From these hoped that same affect as removing flatulence & thus alleviating distension

In this however cannot say that expectations were answered.

For after employed for space of week acid eructation as severe as before.

While no alleviation of other complaint.

From this then thought of conjoining use with some medicine for strengthening stomach

And thus removing in some degree at least cause of acid

As such had here recourse to the Tincture Absinthe the basis of which one of strongest of vegetable bitters.

And which indeed, long employed against stomach ailments.

With view to flatulence was given in combination with Peppermint water.

Which as means of expelling wind from stomach has very immediate & powerful affect.

From use of this Tincture very considerable relief.

Was not only less affected with nausea & pain but entirely free from acid

In this situation reckoned farther continuation of Pulveris Cretacea unnecessary.

And directed that should go on with Mixture of Tincture Absinthe alone

At succeeding report affection in some respects still continued to be easier

And in particular no return of acid.

Now however were informed of a particular which had never before been mentioned.

Obstruction viz to passage of food into stomach.

In consequence of this could swallow nothing but in fluid state, & small quantity at a time.

Of this have already in some degree expressed doubts.

But consider it as most probable supposition that the affect of stricture from scirrhous directed for him use of Cicuta.

If entirely mistaken as to affection was at least a remedy from which no reason to fear bad consequences.

And if scirrhous Cicuta one of very few articles from which could look for any benefit.

Here indeed am very far from representing it as what under even best management will be product of cure.

Great majority of cases I have seen where scirrhous either at Pylor or Cardia have terminated fatally.

But one case communicated to [me] by Dr Odier of [Geneva] where strong evidence that successfully removed scirrhous at cardia

Wished therefore here to give it trial.

Was only however from continuing for considerable length of time that could form any judgement.

And from such trial entirely precluded from patient being now under care of another practitioner.

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Explanatory notes:

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

2) The Royal Infirmary of Edinburgh, established in 1729.