DEP/DUA/1/42/45 (Normalised version)

Elizabeth Clark

(1787-1788)

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N^o10^th Elizabeth Clark at 59.

When formerly spoke of case of this patient represented it as complex & in some respects doubtful affection.

Most distressing affection headache, conjected to be of Rheumatic kind.

To this opinion led from seat which occupied course of coronary nature.

From striking down towards ears.

But above all from severity on first becoming warm in bed.

All these well known to be more common occurrences in Rheumatism than any other headache.

While at same time from Rheumatism a very considerable majority of headaches arise

But notwithstanding these presumptions am now inclined to think this supposition erroneous

Besides headache had also a variety of stomach ailments.

Or at least affection of alimentary canal from wind.

For to this cause was disposed to attribute pain both in stomach & side as well as sickness & vomiting.

Formerly remarked that from impression on alimentary canal, headache often arises.

And notwithstanding presumption of Rheumatism some grounds for supposing this in present case.

Particularly as headache most severe when stomach most distended.

Hence then conject that had at least considerable influence in aggravating affection

Would now appear that influence much greater than then imagined.

And from total removal of headache which has followed alleviation of stomach ailment would infer that sole cause.

Accordingly has not been necessary as formerly supposed might be case, to have recourse to any remedy, with view to headache alone.

For from beginning thought it most advisable to commence attempts to cure by endeavouring to combat stomach ailment

And particularly to obviate pains, by promoting discharge by belly both of wind & faeces.

With this intention had recourse to Pill Foetid cum Aloe.

Consists of p. a Assafoetida Aloes & Soap.

In former of these have a vegetable gummi-resin exudence, possessing very great antispasmodic [powers].

At same time combined with stimulating quality.

And particularly useful as promoting expulsion of wind from alimentary canal.

In Assafoetida itself there resides [somewhat] of purgative power.

But to inconsiderable degree only.

And if of good quality, for inducing catharsis, more required than stomach can in general bear without vomiting.

Hence where with flatulence belly bound something possessing more powerful cathartic stimulation in general requisite.

And what here wanting fully supported by Aloes.

For of these very few grains sufficient to give at least one or two easy stools.

And this ultimate in any such cases to be wished for.

For from [considering] cathartic affection always aggravated.

Hence even where constipation very obstinate is always proper to try first to move belly by gentle means.

In effect expected from these pills were not disappointed.

For while gently opened belly occasioned considerable discharge of wind.

And with this, all her symptoms but particularly headache much relieved.

A circumstance giving additional strength to supposition, that headache entirely symptom of affection of alimentary canal.

In this situation nothing farther seemed necessary than continuation of pills.

And reason even to hope that by persisting in these alone [affection] might be removed.

But although use persisted in, did not continue to have all former effects.

For although a stool every day yet rather bound

And with this both much uneasiness from wind & aggravation of headache.

A circumstance affording additional evidence of constipation.

In this situation seemed less necessary to do anything farther to open belly than to correct flatulence.

While therefore with former intention reckoned it sufficient to continue pills, with latter had recourse to mixture of bitter & aromatic tincture.

Of this combination as useful in stomach complaints have already had occasion to treat.

Consists of most pleasant & active vegetable bitters & aromatics.

This united with proportion of Peppermint water.

Than which as expelling wind have few medicines more immediate in [effect] or more active.

While at same time serves to dilute ardent spirit in Tincture.

Cannot however say that here attended with all benefits expected.

For still continued to be much affected both with wind in bowels, & severe headache.

This however was disposed to attribute, to pills now ceasing to have former affect.

For notwithstanding employment belly continued very bound.

This might be merely return of former condition.

For not unfrequently happens, that purgative stimulant, by habit loses influence.

Or might be consequence, of some accidental cause of constipation

Such for example as article in diet, want of exercise or like.

But whatever cause seemed particularly necessary that should be obviated.

Still however by a medicine not purging violently.

And particularly by one which could be continued with some regularity.

Accordingly to Pill Foetid cum Aloe, substituted Pill extract Colocynth cum Aloe, Pill Cociae, as formerly called.

A formula operating still more powerfully than aloes alone.

For purgative power increased by Scammony & Colocynth.

This pill to quantity even of grain V in general operates as obviating costiveness, if belly not very bound.

Here however to secure effect ordered to extent of grain X.

But these to be repeated only every second night.

Purgative pills had rather more effect than could have wished.

For from every dose, two or three loose stools produced.

But with this, considerable alleviation of some of symptoms.

Still indeed continued to be at times affected with pain in stomach & bowels.

But headache became considerably easier.

This therefore sufficient encouragement to continue.

And particularly as from what had happened with regard to former pills, imagined that would soon have less effect.

While trusted that tone of stomach & intestines, would be gradually restored, by use of mixture.

And thus regeneration of flatulence prevented.

In these expectations not altogether disappointed.

For at succeeding report, though still at times complained of pain yet flatulence much less considerable than before

And although pills not now purging to same degree as before, yet headache continued much easier.

In these circumstances then could have no inducement to alter course.

And accordingly directed continuation

Under use, became still more easy.

And in this situation seemed [unnecessary] to persist farther in any medicine.

Have accordingly dismissed patient from attending at least free from headache.

And for present at least with very little of stomach ailment.

Am very far however from representing patient as entirely rid of disease.

For need hardly remark that few complaints more apt to return, than stomach ailments.

Nor can this seem strange when consider how much exposed to action of [causes] inducing them

For stomach acted upon by everything taken in way of aliment.

And that not merely both from quantity & quality but also from [temperature]

For by this last circumstance, am convinced that are often both induced & aggravated.

And particularly apt to be renewed with those once subjected to them.

For to be observed that what will have little influence on a vigorous stomach will have great effect on one that has once been weak.

Is only therefore by great degree of attention on part of patient that can ever expect to remain tolerably easy.

But from what have seen in this case [apparent] by what means temporary relief [might] at least may be effected.

And affords also example of headache entirely dependent on affection of stomach although apparently attended with symptoms which might have led to suspicion of being of Rheumatic kind.

While at same time shows [properly] in cases where headache & stomach complaint are [complex] of at least endeavour in first instance to obtain relief of former by mitigation of latter.