DEP/DUA/1/40/48 (Normalised version)

James Brown

1786

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James Brown. December 16^th 1786.

In case some complication of symptoms

But chiefly affection of alimentary canal.

Accordingly formerly mentioned as case of Dyspepsia.

This general term however taken in very extensive sense.

Includes all different modifications of stomach ailments

At least where no local cause.

And here notwithstanding severe pain no reason to suspect such.

For no local hardness to be discovered.

Had been but of short standing

And probably consequence of abraded state from severe looseness preceding.

And in this also cause of diminished tone.

These conjectures at least to irritated state am inclined to think most frequent morbid condition in dyspepsia affection.

At same time far from being only ones.

In particular inclined to think that often from state of secretion.

No doubt that powerful [menstruum] [separate] in stomach.

That in natural condition chief agent in digestion

That subjected to diseased state both in quality & quantity.

And that from these many different modifications of stomach ailments, whether under form of Dyspepsia Diapepsia or Apepsia may [arise]

But of such a cause no indication in instance before us.

Nor as already said of any fixed local disease.

Hence formerly inclined to give favourable prognosis.

And still I own disposed to same opinion.

Cannot however say that progress to recovery considerable.

But upon whole stomach complaint alleviated.

And hopeful that in no long time entirely removed.

These however not only complaints.

Affected also with cough.

Attended with expectoration of viscid matter.

And especially severe in morning.

In these common characteristics of chronic catarrh.

A disease very common at this [season].

And particularly with patient advanced in life.

Indeed at age of 66 might get name of Senilis Catarrh.

An appellation by which often distinguished.

But improperly as by no means confined to advanced age.

No doubt that patient also subjected to this affection.

And although of same date yet inclined to view them as unconnected.

For this a rare occurrence

And as so frequently exist separately no reason to think that one can operate as a [cause] of other.

In present instance uncertainty respecting cause of either.

Consider it however as probable that dyspepsia affection consequence of looseness.

And not improbable also that by diarrhoea system rendered more susceptible of influence of cold.

For to this according to [concurrent] testing of all observations little doubt in attributing catarrh

Hence frequent in winter.

And hence advantage which those habitually liable to it obtain from passing winter in warmer climates or keeping house in cold weather.

But though this affection existed yet never with present patient considered.

Had not with him been before habitual disease.

And even before applied for our assistance had somewhat subsided.

Hoped therefore that even notwithstanding unfavourable season would soon yield.

And accordingly hardly object of attention in practice.

These almost entirely [directed] to Dyspepsia.

On idea given chiefly expect recovery from strengthening tone.

And for this purpose recourse to an article often before employed with advantage.

A mixture of vegetable bitters & aromatic.

Prescribed under title of Mist Tincture Aromatic.

Consisting of equal parts of Tincture Aromatic Tincture Amarum & Water.

First of these strong & most [quality] of vegetable aromatic.

Cinnamon Cardamom & Pepper

While seemed some of strongest & purest of vegetable Bitters

Gentian Cortex Aurantii etc

For extract of both however Spirit menstruum.

And both from this & articles themselves before use some diluent.

Hence addition of water.

And in this form as already said have often used with advantage.

From commencement of use felt at least no inconvenience.

And upon whole somewhat [easier].

Still however complained a good deal of fixed pain.

From this led to trial of opiate

Than which as allaying pain of every kind no remedy more effective.

Hence with continuation of mixture directed Opium under form of Pill Thebaic.

To extent of grain X – viz 1 of Opium

In this form united with [Pepper] [illegible ] one of best corrigents

And given at bed time [from] sleeping ill in night.

At first seemed product of benefit in every way.

Considerable relief of Cough & Pain.

And without any inconvenience from Costiveness.

But succeeding report not so favourable.

For stomach complaint much as before.

And had now induced bound belly.

Besides slept worse in night.

An effect not unfrequently arising from Opiates

Especially [where] dose not augmented.

From these considerations then led to intermit

And directed continuation of mixture alone.

At succeeding report found slept better

Some proof that [wakefulness] effect of Pills.

Or at least that no effect as inducing sleep.

And that with this intention not necessary.

Now however strength considerably increased.

A proof that stomach complaint [decreasing]

But belly still bound, though Pill [increased]

Thought it necessary therefore to do something with view of moving.

For this purpose thought aloetic purge best.

But as imagine pains in part from flatulence conjoined with assafoetida.

Pill Foetid cum Aloe. p.a.

These hope will have desired effect.

And that by continuation affection removed.

If in this disappointed however have thoughts of conjoining of Cicuta & Bark.

Or of Caustic alkaline Lixivium a remedy of which no experience.

But of late informed of success.