DEP/DUA/1/43/04 (Normalised version)

Mary Dickson

(1787-1788)

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Mary Dickson

Formerly pronounced case of this patient an example of Flatulentia.

And in that view considered it as an affection no less common than troublesome & obstinate.

Still inclined to think that this opinion not ill founded.

And no room to doubt that at least greater part of complaint are effects of flatulence.

But do not now look upon case as so simple as then imagined.

For reason to presume that pain in part at least proceeded from other causes.

This at least probable with respect to pain of back.

For from situation as well as sense of heat with which attended, little probability of its arising from flatulence.

While at same time from [transitory] nature can as little suppose it effect of inflammation or any other local affection.

More probable that to be ascribed to inordinate action taking place in muscular fibres at part.

And if this case similar action even without flatulence may give rise to pain in side

Or may arise not from affection of muscular fibres of intestinal canal, but of other & more superficial parts.

But still can be no doubt, that from flatulence, many of most urgent & what shall probably find most obstinate symptoms have arisen.

To these therefore practice first was & still is principally directed.

Begun by directing for her, the Pill Foetid cum Aloe to extent of grain V every night at bed time, & mixture with bitter & aromatic Tincture during course of day.

From first of these objectives was to facilitate discharge & promote expulsion of wind already accumulated in intestine.

And from second to prevent farther generation.

In Foetid pills have aloes operating as laxative & Assafoetida as Antispasmodic.

Hence while force for expulsion of flatus augmented passage at same time facilitated.

Accordingly with those not difficultly moved even to extent of grain V very generally found to give one stool a day

And at same time to promote free discharge of flatus.

Probably by relaxation of these spasmodic strictures tending to retain it.

From these pills in circumstances where distress from wind very great have often seen very considerable relief.

And here cannot be said that disappointed of effect.

For from commencement of use considerable discharge of wind.

And with this some alleviation of affection.

Still however at times considerable pain in abdomen.

Probably the consequence of fresh air extricated.

For where tone of intestines weak this very apt to happen

Is particularly indeed consequence of aliment abounding with air in very [detached] state.

Or what called flatulent food

From this will [arise] even where tone of stomach in natural state.

As then power of extrication greater than resistance can oppose.

But when tone of intestines weakened & this resistance diminished will arise from any aliment.

For no alimentary matters which do not contain air in fixed state.

Is therefore by increasing tone that regeneration of air to be prevented.

This however only to be expected as work of time.

Perhaps principally by means augmenting vigour of system in general.

Such for example as air [extrication] & the like.

But in part also by an immediate action on alimentary canal itself.

And in this way few articles more generally useful than bitters.

Particularly when at same time combine, a gentle stimulant to stomach, from aromatic.

For by this in general obtain immediate expulsion of flatulence at least from stomach.

Was on these grounds then, that in conjunction with foetid pills here [directed] for patient mixture of Bitter & Aromatic Tincture

An article from which in weakness of alimentary canal, particularly of stomach have often seen best effects.

These however as have already said not to be expected at once.

But hoped that by continuation might at least have some effect.

Hence notwithstanding returns of pains directed merely that should persist in use.

Accordingly on continuation thought appearance somewhat mended.

An evidence that stomach exerted [function] with more facility than before.

Now however became affected with a complaint in some measure new.

viz sense of heat in back.

This seemed to me [unconnected] with other parts of affection.

And hoped that might soon of itself cease.

And as not very urgent to give at least chance of this directed [merely] continuation of former course.

At succeeding report however found that still more distressing to her.

And that besides heat affected also with considerable pain

Without however any marks of inflammation or other local affection

Hoped therefore that might be alleviated by a sedative application

And as such had recourse to friction with Anodyne Balsam.

Upon use of this became much easier.

While at same time almost free from other symptoms particularly pains striking through whole belly & [unease] from flatulence.

Still however complained much of costiveness.

In this situation continuation of Foetid pills & aromatic Tincture seemed [unnecessary]

And did not wish that should be long habitual to use

For from this alimentary canal [becomes] incapable of exerting function without such stimuli.

Was however necessary to [pres] regular discharge by belly.

For constipation a powerful cause both of weakening tone & [incontinence] from flatulence.

Was therefore with this intention that directed Pill ex Colocynth cum Aloe.

A more powerful laxative than aloetic pill alone.

By this hoped that regular discharge would be obtained

But to prevent doing too much ordered only to quantity of grain V & every second night.

From this dose on day [second] use of pills had in general two stools

And with this state of discharge all affections of alimentary canal continued easier.

Complained however of pain of side

But as without [marks] of flatulence suspected that might be of same kind with that of back.

Hence directed continuation of [former] friction

And hope that may be attended with good effects.

If this the case & patient in other respects as well as at last report shall reckon farther attendance unnecessary.

For prevention of future flatulence & complete restoration of tone only to be expected from regimen.

Particularly from air, exercise & diet.