DEP/DUA/1/40/60 (Normalised version)

Daniel Miller

(1786-1787)

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Daniel Miller. January 19

In history of case many symptoms.

And greatest part referred to alimentary canal.

No doubt that many of these as sense of ball, excessive eructation etc immediate effects of air in bowels.

But show also inordinate state of action.

And to this are to attribute, eructation sense of constriction, vomiting, etc.

These well known to be [train] of symptoms occurring both in Dyspepsia & Hypochondria.

And formerly gave it as opinion that rather example of latter affection.

Cannot indeed say that mental affection, great characteristic of hypochondria to any great degree

Cannot be said that complaint of patient particularly engages attention.

But in this case many symptoms common in hypochondria seldom occurring in [pure] dyspepsia.

Among others may mention vertigo & deliquium animi.

Disturbed sleep during night.

And affection of urinary discharge.

All these often to high degree in hypochondria.

And often concomitant or forerunner of state of mind by which peculiarly characterised.

While in dyspepsia even to greatest height seldom discovered.

Here therefore give presumption that mental affection in hypochondria, will either soon follow or have even already taken place

For may be observed that see so little of patient as to be hardly able to judge of this

And for anything we know to [contrary] present state of mind may be very much that of hypochondriac.

With this view of affection cannot form any sanguine hopes of speedy recovery.

For though not dangerous yet in general very obstinate.

Especially when of long standing.

And with our patient had already in some degree subsisted for 10 years.

Can hardly therefore entertain hopes that able completely to remove them.

But to be observed that only of late subjected to considerable aggravation.

And may entertain some hopes that by [proposed] remedy may be able somewhat to mitigate affection.

that in no long time may be brought again to former condition.

In this inclined to think that from treatment employed some progress already made.

For at two succeeding reports considerably mitigated

Cannot indeed expect that will not from slight accident be subjected to aggravation.

But still if enjoys in general relief that has done for some weeks past, may be considered as much better.

In treatment remedy employed directed with two intentions.

Seemed first & perhaps not least important objective to obviate urgent symptoms.

But besides this propose also, as far at least as could be accomplished to counteract morbid condition of alimentary canal on which these depend.

And particularly by restoring due disposition to natural & regular action.

Was with first intention mentioned that began treatment of case by Pill Foetid cum Aloe.

Where great unease from flatulence with costiveness know no medicine answering purpose better.

Does not indeed in every case sit easily on stomach.

And particularly where natural disposition to vomiting.

This symptom then might here have been thought objection to employment.

And in my opinion was so.

But at same time, trusted that might be product of greater benefit than inconvenience from even increase of vomit.

While by no means certain that would be case

And accordingly could not be said, as appears from subsequent report that had any influence in that way.

For though vomiting still continues was not more severe than before.

Cannot however on other hand say that relieved unease from flatulence.

For still much distressed with unease from wind.

But had at least some influence in moving belly.

And after began use less distressed with costiveness.

Probably also to attribute to pills relief in discharge of urine.

For this not unfrequently consequence of employment.

And where urine released from flatus in intestines easy to see how may have effect.

A case very common

In so much that among vulgar will every day hear of affections of this kind distinguished by appellation of windy gravel.

In this manner then may have given rise to more free discharge.

But not so easy to see how should have diminished sense of heat.

And indeed difficult to say from what this symptom here arises.

But not to be denied that very common in Hypochondria.

And while in some instances & at some times scanty & high coloured, in others profuse & limpid.

But whether all these changes to be ascribed to pills or not yet no circumstance had occurred as objection to use

Hence therefore resolved to [illegible ] in employment.

But with this wished also to employ some [remedy] with view to radical cure

With this intention & with view of restoring disposition to natural action in alimentary canal, had recourse to a chalybeate conjoined with Peruvian Bark.

A scruple¹ of latter united to grain x of Rubig Ferr & taken twice a day.

From this combination, in cases where much distress from flatulence with tendency to inordinate action, have I think in former instances seen benefit.

And here inclined to think that not altogether disappointed in desired effect.

Still indeed continues to be subjected to returns of vomiting.

But this not at least immediate consequence of powders.

For these from beginning sat easily on stomach.

And after use for fortnight though still [distressed] with eructation yet vomiting less considerable.

While at same time, pills affect of giving regular discharge by belly & other symptoms rather easier

At succeeding report indeed some aggravation.

Probably effect of some accident escaping observation.

Perhaps even of some irregularity with respect to diet.

But whatever cause again mitigated.

And for two weeks past considerably easier.

In this situation no thought of changing plan.

And if continues thus [easy] shall not be displeased at good opportunity of dismissing.

For after continuation for ten years cannot as already said entertain any [strong] hopes of complete recovery

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Explanatory notes:

1) A unit of weight equal to 20 grains, used by apothecaries and physicians.