DEP/DUA/1/44/18 (Normalised version)

James Gordon

(1788)

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+ Respecting case of this patient first question that occurs whether in reality subjected to any disease, or whether exists only in his own imagination.

Taking it however for granted, that has given us fair [representation] of complaint which now some reason to doubt

N^o18^th James Gordon at 30.

Disease to which this patient subjected not very distinctly marked.

And perhaps in some degree of [complex] nature.

Yet little doubt that most urgent symptoms such as characterise asthma.

And that too of spasmodic kind.

For principle part of affection as history introduced into our register¹ consists in fits of difficult breathing.

And these too not permanent but recurring at particular times even very much at stated time.

In such paroxysms however whether regularly periodic or not, attack of Asthma consists.

And where such regularity of attacks & remission an additional argument in favour of that disease

+ Has more of constant pain of breast than commonly occurs in that disease.

But here some other circumstances tend to create doubts.

For neither ordinary attack nor ordinary termination of each paroxysm.

And some of most obvious symptoms also wanting.

In general asthma begins with peculiar [sense] of stricture on breast.

And attended, probably from this stricture with peculiar noise in respiration.

While again very generally terminated by profuse sputum.

Although sometimes by considerable urinary discharge.

With our patient however attack begins with very considerable swelling in abdomen particularly in region of stomach.

And terminates either by discharge of flatus or by loose stool.

+ May however observe that from several different circumstances entertain doubts with respect to this patients description of affection. Am inclined to think that somewhat of a hypochondriac, if not creating imaginary complaint at least aggravating description of feelings

While during course, as far as we have been able to learn no peculiar noise in respiration.

And patient particularly affected with sense of motion, which according to his description seated in alimentary canal.

Hence would appear that inordinate action more in this part of system, than in any connected with respiration.

Or at least that there principally begun.

And easy to see that affection of organs of respiration may in second way be induced from affection of alimentary canal.

Hence then rather than refer it to either of three species of Dr Cullen Spontaneous Exanthematicum or Plethora more properly stomachicae or flatulus.

And both these species of Sauvages.

0 And in hypochondriac affection of alimentary canal often accompanied with affection of Asthmatic kind

But in place of continuing attendance here find that this patient since our last visit admitted into Royal Infirmary².

Will not therefore be subject either of farther practice or observation at this place

0 With respect to termination cannot I apprehend look for speedy cure.

For Asthma well known to be a disease often continuing for many years.

If however as conjected chiefly excited by affection of alimentary canal more readily combated than in other cases.

In effecting this first objective to produce resolution of spasmodic or inordinate actions, while [continuing]

And in interval to remove tendency to these.

Is with first intention that remedy [almost] directed Foetid Pills & Aether employed.

And with last had thoughts have recourse to some tonics, Example Bitters Bark or Zinc.

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.

2) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.