DEP/DUA/1/39/16 (Normalised version)

Sarah Allan

1786

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Sarah Allan March 4^th 1786

Symptoms enumerated in history of this patients case as formerly observed all of that kind which every day occur in instances of dyspepsia.

Here no reason, from examination by touch, from sensation of patient from constant fixed pain or any other particular inference that originates from any local affection.

And although have by no means in history of case every symptom mentioned in definition of dyspepsia yet little hesitation in viewing this as principal affection.

But from circumstances which have learnt since came under care, cannot consider it as only complaint to which subjected.

Besides this also subjected to another affection in all probability in no degree connected with former.

An eruption viz of herpetic kind

Not indeed generally [over] surface.

But to considerable degree appears on both arms.

Cutaneous affections of different appearances not infrequently observed connected with stomach ailments.

This particularly demonstrated from the tendency they have to alternate with each other.

Thus while eruption considerable, stomach complaint entirely disappears, & [contrary].

A natural consequence of that connection, which well known to subsist between stomach & surface

But in these cases eruption seldom [circumstantial], & partial.

Seldom that remains as it were static for any considerable length of time

And very generally two affections of same duration.

In all these particulars however, case very different with present patient.

And hence here disposed to consider two affections, as altogether unconnected.

A circumstance also by no means rare.

For not to be expected, that any one being present, should afford defence against other.

While thus however consider patient as subjected to complication of diseases, Dyspepsia symptoms, particularly when came under care both most urgent, & most important.

And in these also, there took place some peculiarities.

This particularly the case, with respect to appetite for food.

In most instances of Dyspepsia there occurs an aversion to food.

This indeed so much the case that anorexia generally considered as one of symptoms characterising the disease

And accordingly, introduced into definition of best nosologists¹.

But in case before us, appetite even uncommonly keen.

Without entering into theory of hunger, a consideration foreign to [business] in this place, may only observe, that this would argue quick solution of aliment in stomach

For evidently not hurried through intestines, without proper solution, as abundantly apparent, from state of stools.

As in that case there would occur both looseness & discharge also, in an undigested state.

Hence then, reason to presume that only causes to give distension of stomach, by being dissolved.

For as long as distension takes place perhaps no instance of what can be called hunger occurring.

From this then some grounds for presuming that in induction of stomach ailment here a morbid condition of succus gastricus had some influence.

Have long been inclined to imagine that with morbid condition of this fluid, stomach complaints much more connected than commonly thought.

Now universally allowed that in performing function of digestion succus gastricus, has in all animals, very great influence

And particularly that in those who like human species, have [illegible] stomach, does much more than both muscular action & fermentation put together.

Hence then but reason to infer that while as well as other secretions, liable to diseased states, there should from time arise affection of digestion.

And thus as well as muscular action on which again longer or shorter retention in stomach [depends] should be very much concerned in inducement of Dyspepsia.

In most instances of Dyspepsia however reason to believe, that either activity or quantity of secretion diminished.

For in place of ready solution food, remains like load at stomach.

And in place of keen appetite there occurs aversion to victuals.

From contrary circumstance however in present instance some reason to presume that either increase of activity, or quantity.

And this state also may readily conceive often united with sickness vomiting, acid eructation pains & other dyspeptic symptoms.

But presumption of morbid affect now mentioned drawn from state of appetite corroborated by another circumstance

The nature & condition viz of that pain in region of stomach with which so often affected.

In most instances Dyspepsia not without pain.

Particularly takes place when stomach distended either with food or with flatulence.

And in this way no time at which may not occur.

But particularly remarked to occur after food taken.

And in general indeed, some degree of uneasiness, till either digested or discharged by vomiting.

In case before us however more especially observed when stomach empty.

And then occurs with uncommon degree of severity.

In so much even, that said to give tendency to deliquium animi.

From these circumstances then naturally led to conject some other cause.

And is I think no improbable supposition, that might be effect of menstruum furnished by stomach.

This fluid, even in natural condition, unquestionably possesses very strong solo power

When morbid increase of activity, may be capable of giving painful impression to stomach, even when [def]. by [liv]. [prom]

Especially if stomach empty, so that no other matter on which activity exerted

Hence then, from this circumstance, some additional presumption at least, of morbid condition in succus gastricus.

And upon whole disposed to conjecture that here, with diminishment of vigour in muscular fibres of stomach, there occurs increase of activity in menstruum furnished for solution of ailment.

On this idea of affection when formerly spoke of case, was disposed to hope that might soon have favourable termination.

As far as effect of morbid increase of [energy] in succus gastricus reason to hope that soon even of itself terminates.

And as far, as diminished tone of stomach had concerned, was at least an affection of no long standing.

Although therefore in its nature often obstinate, had at least some reason to hope that by proper remedy might soon be counteracted.

Was indeed somewhat against patient, that originally of unhealthy constitution.

And particularly that formerly liable to bowel complaints.

But notwithstanding this hoped that affection in present form at least not of long continuation.

Now however reason to think that expectations more sanguine than ought to have been.

For after has now been for two months under our care, can hardly say that much progress to recovery.

At same time in several respects complaint certainly easier.

And even not improbable that might have been still better, but for irregularity in her own part.

Particularly lately when affection much alleviated.

Began practice you will observe by prescribing for this patient an emetic with view of evacuating stomach & thus paving way for other medicines.

Particularly those which from [acting] as stimulant to muscular fibres of stomach might both strengthen tone & change state of secretion.

And with this view had recourse to a mixture consisting of equal proportions of aromatic & bitter tincture & Peppermint Water.

To this formula in Dyspeptic affections have often had recourse & I think with very great advantage.

Consider it as one of most convenient & powerful formulas for exhibition of bitters & aromatics.

And these need hardly observe so much used in such affections, that even known by general title of stomach medicines.

In obvious operation of emetic was not disappointed.

And stomachic mixture seemed at least to have so far a good affect.

For after some continuation of use stomach ailment, particularly sickness vomiting & acid eructation very considerably diminished.

Still however not free from pain when stomach empty.

And still rather uncommon keenness of appetite.

These however hoped might also be overcome from continuation of medicine.

And accordingly at succeeding report all complaints considerably relieved.

Progress however in this way did not continue uniformly.

For without any manifest cause afterwards rather aggravated.

To this however paid but little regard.

For during course of Dyspeptic affections is very common even from most trifling accidents.

Such for example as slight irregularity of diet being more sedentary than usual or the like.

Still therefore hoped for cure from persisting in course begun.

And accordingly soon became so little affected with stomach complaint that reckoned farther continuation unnecessary.

To omission of use the rather led as complained that occasioned some degree of vertigo.

An affection which might possibly [arise] from spirit menstruum by which Tincture formed.

At this period when stomach complaint so easy were informed of other affection eruption viz on arms.

This had never before thought it necessary to mention.

And indeed was rather deformation to her than product of any unease.

Imagined that might easily yield to external application of Vitriol Acid

Accordingly directed Unguent Vitriol

While at same time omitting mixture directed Pill Aloetic with view of keeping belly open, that return of affection might not be induced by costiveness.

After this prescription however saw nothing of her from some time.

A consequence of now thinking that little farther occasion for assistance.

But being accidentally subjected to costiveness after pills done became subjected to vomiting which again led her to apply for assistance.

Found however that in other respects stomach complaint easier.

And that affection on arm very considerably diminished

Imagined therefore that might yield to farther continuation.

And with view to vomiting had recourse to Tincture Amarum [combined] with [illegible] & Rhei

By this hope soon again in former [illegible]

If not measures to be adapted to accommodate.

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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.