DEP/DUA/1/40/56 (Normalised version)

Helen Adam

(1786-1787)

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Helen Adam. January 13^th.

In history of case many symptoms.

And indicating in some degree complaint.

Some as vomiting would argue bile.

Particularly from colour & taste of matter [discharged]

Others, as sense of ball & constriction Hysteria.

And of same kind also cold & hot [fits]

But formerly gave it as opinion that chiefly effect of flatulence.

And that from this other symptoms probably originate.

For well known that wind in alimentary canal cause of many symptoms.

And indeed Flatulentia, though not entering most nosological¹ systems in my opinion properly to be considered as genus of disease

Formerly then disposed to view case of this patient as principally an instance of that

And this view course of disease has I think confirmed.

For soon yielded to treatment proposed.

Must however own, did not then expect that termination would have been so quick.

Had indeed little apprehension of danger.

For of different complaints of which [here] [appearance] none fatal.

And viewing flatulence as foundation of others, less alarming than if idiopathic.

Besides this but of short duration.

Hence less difficulty in combating it.

But at same time even slight case will run on to great length.

And suspicion notwithstanding mitigation of symptoms that yet frequent recurrence of attacks.

In treatment from view given of case what seemed chief objective removal of flatulence.

And this consider as very much effect of Costiveness.

Hence then chief objective to keep belly open by means of a medicine tending also to expulsion of wind.

For this purpose directed Pill Foetid cum Aloe

Equal parts Aloes Assafoetida & Soap.

Latter chiefly to give form

Two others considered active.

In aloes a very certain purgative even in small doses.

Particularly when meant merely to open belly

This effect have even in doses of few grains

And not much more from larger.

A peculiarity of this purgative that effect by no means increases in proportion to quantity taken.

Hence well fitted for habitual costiveness.

Especially as no tendency to bind belly after operation.

And perhaps more used for obviating costiveness that any other.

From assafoetida also some effect in opening belly.

But by itself not much of purgative.

Unless in instances where retention of faeces effect of spasm.

For in obviating spasm in alimentary canal a very powerful effect.

And thus operates as one of most effective means of expelling wind.

Hence then combination of aloes & assafoetida seemed particularly proper in present instance.

And here in every respect attended with desired effect.

Had influence both in keeping belly open & in promoting discharge of flatus

And to this may I think with probability attribute her being no longer affected with sensation of ball.

As well as being free from [return] of vomiting.

Soon after began pills, another [symptom]

Eruption viz on skin.

This however could in no degree suppose effect of medicine.

And doubtful if any connection with disease.

For neither attended with aggravation nor alleviation of symptoms.

And any rate of short duration.

And before any opportunity of [seeing] it had entirely disappeared.

Hence afforded no grounds for alteration of plan.

And merely therefore directed continuation.

These during course of following week more effective in moving belly.

Or at least in generating three loose stools in course of day.

This however might in part be effect of sourness at stomach.

For well known that [previous] [accident] often that affect.

Hence while diminished quantity of pills directed Magnesium for counteracting acid.

Under this got entirely rid of that symptom.

And at same time entirely free from any return of other effect.

Hence reckoned any father attendance unnecessary.

And dismissed sooner I own than at first expected.

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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.