DEP/DUA/1/42/10 (Normalised version)

Elizabeth Clark

(1787-1788)

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N^o10. Elizabeth Clark at 59.

Disease somewhat of complicated nature

One of most distressing symptoms Cephalgia.

From situation from course & particularly from severity when first becomes warm in bed, reason to conclude that is of the Rheumatic kind.

And no doubt that a number of instances of headache depend on Rheumatism

But besides this is affected also with complaint of alimentary canal.

Particularly distension with wind followed by pain, sickness & vomiting.

Pain also of side, probably also effect of similar distension there.

This the rather probable as notwithstanding distension no free discharge either by eructation or vomiting.

And not improbable that affection of alimentary canal may have even considerable share in inducing headache.

For well known that from affection of stomach headaches often arise.

Hence perhaps to be considered as chief objective both with view to prognosis & practice.

With regard to former may observe that nothing in case alarming or dangerous

And may I think with some confidence entertain hopes if not of complete removal at least of considerable alleviation.

This first & principally to be expected by free discharge of wind particularly downwards.

And by [obviating] costiveness probably operating as one great cause of retention.

From this as already observed reason even to hope for relief of headache

For observed that always most severe when stomach distended.

Is with these intentions then that have directed for this patient the Pill Foetid cum Aloe.

P. [Ae.] of Aloes. Assafoetida & Soap.

If from this obtains relief may have recourse to some other medicine to [secure] advantage.

Such for example as vegetable bitters tonics & aromatics.

Particularly the Peruvian Bark.

But not improbable that although from these, all the success that could be desired as obviating stomach ailments, yet some other measures may be necessary for headache

In this however, must be regulated by circumstances in which shall afterwards find patient.