DEP/DUA/1/46/22 (Normalised version)

Jean Thomson

(1789)

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N^o4 Jean Thomson at 48

Formerly represented case of this patient as being an example of Dyspepsia.

And from what have since seen of it, no reason to alter opinion.

For of symptoms entering definition of that disease, as given by best nosologists¹ greater part here evidently occurring.

And indeed are what generally known by title of stomach ailment.

These however as constituting not only dyspepsia, but likewise Dyspepsia & Apepsia of nosologists supposed to occur without any local disease, either of stomach or other parts.

Accordingly Dr Cullen in his definition after enumerating common symptoms has added Sine alio vel ventriculi ipsius, vel aliarum partium morbo.

For considered as a pure idiopathic disease.

Must however be allowed that perhaps no instances of Dyspepsia without what in one sense at least, may be called local disease of stomach.

And probable even that affections of different kinds may give rise to all symptoms.

May arise from morbid condition in state of action, of that viscus.

From morbid condition in state of sensibility.

From morbid condition in state of [illegible]

Or finally from morbid condition in state of fermentation.

And that too the consequence merely of a peculiar [assimilating] fermentation, acting upon all alimentary matters entering stomach.

But most frequently merely consequence of a general relaxed & atonic state of the stomach.

And this I own am inclined to conject is case with present patient.

One circumstance however which may be supposed to create doubt with respect to it.

That is injury to which was subjected at time when affection began

Then we are told received injury on breast in consequence of fall.

And not improbable that as much a lesion in region of stomach as of breast.

This though hardly to be supposed that would produce idiopathic dyspepsia, may yet give rise to different disease of stomach.

And among others not infrequent for such injuries to produce scirrhous.

But from scirrhous when affects any part of stomach, but particularly either cardia or pylorus [many] distressing symptoms.

And it must be allowed not a few of these occurring in present case.

But in such cases, other symptoms commonly observed not here taking place.

Thus for [example] swelling & hardness discovered, if not externally, at least by feel.

In most instances considerable degree of fixed pain.

Contrary to what here takes place unease & vomiting still more [readily] from solid than from light & fluid food.

And vomiting upon whole a more constant & more distressing symptom.

From all these circumstances then, [inclined] to consider it, rather as idiopathic dyspepsia than as depending on scirrhous or other affects of injury.

And on this ground prognosis of two by much most favourable.

For scirrhous a disease very [rarely] overcome.

And if happens at Cardia, still more at pylorus, not unfrequently fatal.

This event at least, if opinion of present disease well founded, but little reason to dread.

At same time must be admitted that in many instances a very obstinate complaint.

And such have here reason to expect both from long continuation which has already had, & also from increased severity.

May however still reasonably hope that patient may be benefited by proper remedy.

And with this intention may chiefly expect benefits from such as are capable of increasing tone & vigour of stomach.

From these however but little to be expected if care be not at same time taken to avoid whatever can diminish vigour.

And not unfrequently necessary to have recourse to such articles as obviate urgent symptoms.

Especially those, such for example as bound state of belly, which have particular tendency to increase & support the affection.

These different intentions, it will readily occur, much more to be answered by diet & regimen, than by medicines.

In this complaint greatest attention necessary, with respect to diet.

All flatulence & [illegible] food, particularly to be shunned.

Diet of solid & nutritious, rather than of weak & watery food.

And never to be introduced into stomach, in warm state.

Such diet not only proper for dinner but also even for breakfast & supper.

And has been alleged, that some with whom disease before very distressing complaint cured by breakfasting or rather living almost entirely on beef stake.

But from every attention in way of diet perhaps still less to be obtained than from air & exercise.

Nothing tends more to induce this affection than sedentary life.

And of all remedies, that can be had recourse to, exercise in open air, particularly riding on horseback, perhaps the best.

With these directions however, respecting diet & regimen, lower class seldom have it in their power to comply.

And hence an additional cause of obstinacy of disease.

How far, directions on these subject, given to our patient, will be carried into execution, cannot pretend to say.

But independent of benefit from this course as far as is employed, may expect some additional benefit from medicine.

With this view, had here in first place, recourse to Pill Stomachicus [Pharmacopoeia]² [Edinburgh].

Perhaps more properly named, Pill ex Kino & Aloe.

For on these two, activity may be considered as principally depending.

But besides this, [contains] also a preparation of Gum Myrrh.

And what perhaps to be considered as still more active, a proportion of essential oil of Mint.

In these two, particularly the last, have what furnishes useful carminative stimulant.

That is, a medicine tending to expulsion of flatus.

But two former, while have also this affect, operate still more as purgative.

Neither however to any great degree

And in quantity to which in general taken, particularly under form of these pills, serve merely gently to open belly.

While one of them, Rhubarb from astringent power, though laxative in first instance, tends rather to bind belly afterwards.

And this merely as consequence of [illegible] alimentary canal.

Thus then apparent that different grounds on which may expect good affects, as stomachicus from this article.

Hence can readily understand, not only name, by which distinguished, but also foundation of frequent use in stomach ailment.

In my own practice, have in such instances, very often had recourse to it.

And although some patients with whom Rhubarb in every form, very apt to give great unease yet have in many instances employed it with advantage.

Here however cannot say that product of wished for effect.

For after use, became subjected to considerable sickness at stomach & gripes.

These affects patient herself disposed to ascribe to pills.

And not improbable as have already hinted, that may here have been consequence of Rhubarb.

For, although in my opinion, a very excellent medicine, yet with some patients, occasionally very great distress.

Probably affect of some peculiar idiosyncrasy of habit.

And this observed to hold, not merely with individuals, but even in some instances with whole families

In so much, that with none of them can Rhubarb however strongly indicated, be used on any account.

But besides sickness & gripes here also another effect, attributed to pills.

In place of bound state of belly, there now occurred, considerable looseness.

And one state of discharge, no less to be avoided than other.

For while symptoms always aggravated by constipation, are likewise uniformly rendered worse by looseness.

And indeed that this should happen, not more surprising, in one case, than in other.

Nay evacuation under form of catharsis, will most readily operate, as augmenting the atonic state.

This affect, might perhaps indeed have obviated merely by diminishing dose.

But if, as conject Rhubarb cause of sickness & gripes, would have had little influence in diminishing these.

And as patient seemed to have taken prejudice against medicine reckoned it more advisable, not to persist in employment.

In place therefore, of Pill Stomachicus had recourse to mixture consisting of equal parts of bitter & aromatic Tincture, & Mint Water.

From these need, hardly observe that without purgative power, might expect nearly same affects as former.

One of them Tincture Amarum formerly denominated Elixir Stomachicus, as peculiarly adapted to stomach ailments.

And has for its basis Gentian one of [purest] of vegetable bitters, operating as very powerful tonic to stomach.

In other, a combination of some of most [grateful] & strong of vegetable aromatics

While mint water, from essential oil diffused in it, operates as useful [dilutant]

This combination, have employed in many cases of Dyspepsia.

And I think, very rarely, without at least some temporary benefit.

From the time, that began [use], gripes & looseness ceased.

Perhaps principally consequence of former medicine being given up.

And additional evidence of conjecture of patient, that to be ascribed, to it as cause.

But besides this, stomach ailment also somewhat alleviated.

This then sufficient inducement, to continue use.

And if progress to [amend] continues shall probably go on, with this medicine alone

If however has not desired affect may conjoin with it, or substitute to it use of Colombo root or Peruvian Bark.

Or may here make trial of the Cortex Angostura, combining bitter & aromatic to high degree.

But in these must be regulated by present situation of patient.

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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.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.