DEP/DUA/1/41/10 (Normalised version)

Alexander Burn

1787

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Alexander Burn. February 25. 1787.

Of this patient have seen very little since last spoke.

For soon gave up attending.

Hence while not subject of those trials in practice which produce no farther opportunity of observing disease.

Still therefore liable to same doubts respecting it as formerly.

Then observed however that disposed to consider it as example of Dyspepsia.

A name as expressing a genus of disease but new.

And accordingly term hardly employed by any practical authors.

But though name new disease by no means.

In all ages & in all countries one of most common affections

And neither more nor less than what here commonly known by general title of stomach ailment.

This indeed it must be allowed includes even very opposite & different affections.

But so does Dyspepsia.

For by no means to consider it as corresponding to exact definition of nosologists¹.

For even in same patient appearance of that set of symptoms by no means permanent.

But although sometimes entirely one set of symptoms, sometimes another yet general [tenor] of symptoms [profoundly] uniform.

And commonly such as indicate slow & [depressed] digestion.

In this respect from general history of case such coincidence as to leave little doubt of affection.

Must however be allowed that here not altogether without peculiarity.

At least as related in history given us by patient.

Indeed this so much the [case] that formerly observed would be improper to risk conjecture on some particular till truth ascertained.

But of this now no prospect of any farther opportunity.

Taking case however as represented to us some peculiarity.

Perhaps to consider as such even very first symptom mentioned in history.

Sense of Ball viz moving up & down in Abdomen.

And from thence [ascending] to stomach.

A circumstance principally observed we are told after meals.

Uneasiness immediately after meals one of most common appearances in Dyspepsia.

But in general does not appear under this form.

For most part, consists principally in sense of weight at stomach.

And not unfrequently with pain.

Often also distress from flatulence.

But chiefly under form of eructation.

Flatulence probably chief cause of present [symptoms]

But here appears more under form of globus hystericus as called.

Of this symptom had very lately occasion to state opinion.

Consider it as by no means pathognomonic.

Although frequent in hysteria yet as sometimes absent there sometimes occurs in other diseases.

And indeed as being merely effect of inordinate & irregular motion of alimentary canal with wind pent up

And in consequence of its thus propagating sense of ball.

Here then, though no other symptoms giving disease title to name of Hysteria yet may presume that disposition to such action.

And that this excited even in inferior parts of alimentary canal by impression of food on stomach.

When however this inordinate action reaches stomach would appear that [there] different modification.

For in place of globus propagating to throat vomiting ensues.

An [inordinate] action in which diaphragm more concerned than stomach.

But at same time an [inordinate] action well known to arise either from peculiar impression made on stomach or from peculiar condition of that organ.

Accordingly a very common symptom in almost every instance of Dyspepsia.

In vomiting which here ensues a peculiar progression with respect to taste of matter discharged.

At first acid, afterwards tasteless, then bitter

This if not commonly remarked, at least not an unnatural progression.

In dyspepsia in general tendency to acid in stomach very strong.

Hence till acid discharged this taste may naturally be expected.

After this discharge however nothing to be evacuated but more watery fluid immediately effused into stomach.

Hence necessarily tasteless.

But from violent straining bile emulged from gall bladder & [illegible] into stomach

Hence bitterness.

When straining violent sometimes told tinged with blood.

These more consequence of rupture of small superficial vessels.

And indeed constant attendant of alimentary canal severe vomiting.

But if in state of vomiting [appearance] not always observed one still more [rare] in hunger with which affected.

Want of appetite one of most common symptoms in Dyspepsia.

In general even aversion to food.

Probably from [recollection] that often remains like load on stomach.

Hunger however the natural consequence of an empty stomach.

And here to be observed immediate consequence of severe vomiting.

Hence would argue that from this vomiting stomach fully emptied.

To this then might here perhaps without farther inquiry refer it.

But to be observed that something peculiar in manner in which allayed.

Best done we are told by a little warm milk or cold water

If however ordinary [appetite] should have rather induced disposition for solids.

Hence then view it rather as peculiar craving than natural [hunger]

This peculiarity of stomach [appears] also from another circumstance.

Kind of food viz agreeing best with him

These we are told flummery & watery fluids.

This however by no means in general case with dyspeptics

For while often product of great uneasiness frequently also observed that [degenerates] less readily than others.

Very commonly least uneasiness from solid food, as beef stake if taken in moderate quantity.

And often where even this gives uneasiness ready digestion if meat highly seasoned, salted, or smoked.

Hence circumstance of diet justly ranked among peculiarities.

And probable effect of peculiar state of stomach.

Of other symptoms as exhibited no singularity unnecessary to say anything.

Loss of strength, want of sleep flying pains & bound belly, common symptoms of this affection.

And some of them even necessary consequences.

With regard to prognosis as little need be said.

Or at least nothing to be added to what before observed.

After five years continuation could not expect speedy favourable termination.

At same time from account given us affection even of itself on decline.

Greater hopes therefore that from proper remedies some alleviation might be procured.

And this farther reason to expect from relief [experienced] after began remedy here directed.

But after short continuation gave up farther attendance here.

Whether this proceeded from farther alleviation of symptoms or from some other circumstance cannot pretend to conject.

And probably no information on subject as little chance of [seeing] anything more of patient.

When first began attending here directed use of [Pill] Stomachicus

Consisting chiefly of Rhubarb Aloes & Myrrh

These however united with considerable proportion of Volatile Aromatic Oil

viz distilled oil of Mint.

May therefore expect that will excite on stomach, both stimulating & tonic power

Not only immediately producing action but tendency also to increase power.

While at same time effect of gently moving belly.

Accordingly where symptoms of flatulence with costiveness often of great use.

And in this instance may at least venture to say that no bad effect.

For obvious operation that of gently moving belly.

And this, whether cause or not at least attended, with considerable alleviation of symptoms.

Still however continued to be affected with frequent vomiting.

And this as already said consider as more effect of peculiar irritability than of anything else.

Was with this intention that while continued stomachicus pills directed also another medicine for patient.

A mixture viz consisting of weak vitriolic acid & Thebaic Tincture diffused in water.

From both one & other of these reason to expect good effects.

Of effects of opium as [allaying] inordinate action unnecessary to say anything.

This experienced not only in stomach but over whole system.

And that too in consequence of action on stomach.

Influence of acid not perhaps so general.

But with respect at least to inordinate action of stomach very [great]

This apparent in cheek which [given] to influence even of emetic.

When acid taken, Ipecacuanha has power of exciting vomiting if not destroyed, at least very much diminished.

Appears no less in effect as [checking] hiccough.

This sooner checked by acids particularly Vinegar or Vitriolic acid than perhaps any other remedy yet known.

But though both articles thus promise advantage mixture objected to.

Has been alleged that on destructive effect of other.

And particularly that by acid power of opium destroyed.

This however at least in [such] mixtures as here employed by no means case.

And indeed as thus employed does diminish narcotic or intoxicating power of opium

And accordingly thus useful corrigent.

For confusion of head perhaps never wanted.

But from repeated experiments have found, it still to exert sedative power

Particularly effect of allaying action & inducing sleep.

In so much that have of late frequently employed it with both intentions.

And for allaying vomiting acquainted with no medicine which in general answers purpose better.

But what effect in this case have not been able to learn as have seen nothing of patient since [first]

And as shall not probably see more of him farther observations unnecessary.

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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.