DEP/DUA/1/46/40 (Normalised version)

John Keith

(1789)

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N^o13. John Keith at 38.

Had no hesitation in formerly giving it as my opinion that disease to which this patient subjected an example of Dyspepsia.

And although often an obstinate complaint yet expressed hopes of favourable termination.

In this particular prognosis now [illegible]

For patient some weeks ago dismissed from attendance free from affection.

And this I own am disposed not a little to attribute to practice here employed.

Although symptoms [consisting] dyspepsia may arise from different morbid affections yet was here inclined to attribute them to diminished tone of muscular fibres of stomach.

From this were to explain distension from flatulence & pains evidently resulting from that cause.

And probably also the vomiting with which was often affected.

For well known that with [diminished] tone a peculiar irritability often connected.

Here then first & principle objective was to restore due state of vigour to stomach.

Seemed however also to be of importance to produce immediate action for expulsion of flatulence.

For from discharge in any way had at least temporary alleviation of complaint.

While from removal of distension, removed a circumstance tending to diminish tone

And thus both to support & aggravate the disease.

Was then on these grounds that had here recourse to mixture of bitter & aromatic tincture.

First of these has for basis some of strongest & purest of vegetable bitters particularly Gentian.

Is especially suited to act as restoring tone to the stomach.

And indeed so much employed against affections of this viscus, that for long time known under title of stomach elixir.

Term indeed now changed.

But not from idea, that virtues formerly attributed to it were groundless.

Is I believe by practitioners in general held in same esteem in stomach action as before.

But article in general much better [denominated] either from constituent parts or sensible qualities.

And this accordingly done in present instance.

Same also case, with other article here employed, the Aromatic Tincture.

This again has for basis two of most powerful & grateful of vegetable aromatics Cinnamon & Cardamom.

This quality depends on an essential oil they readily yield to a [spirit] [menstruum].

In consequence of this act as powerful stimulus to stomach & intestinal canal, in way of carminative.

That is both increased action for expulsion of flatus, & removing spasmodic stricture by which retained.

Here therefore while expected that would somewhat aid tonic power of bitter tincture, imagined also that might relieve several other urgent symptoms to which was subjected.

Particularly violent pains in course of alimentary canal.

For little doubt that these, as well as swelling, were affects of flatulence.

But besides these, was occasionally also subjected to two other symptoms.

Vomiting viz & looseness.

These consider as being chiefly affects of peculiar irritation.

And perhaps ultimately to be removed by restoration of tone.

But affect in this way only work of some time.

And here thought it necessary to employ some means of more immediately allaying irritation at least for time.

As otherwise reason to fear that disappointment of affects of medicine from immediate rejection.

On this account added to the mixture a proportion of Tincture Thebaic.

From ʒi in ℥VI mixture would take five or six drops in each dose.

By this hoped that medicine both more readily retained on stomach, & tendency to vomiting & looseness somewhat diminished.

Whether had these affects or not would not positively pretend to say.

But may at least venture to say that had no bad affect.

For from time that medicine begun symptoms very evidently diminished.

Was not indeed immediately freed from all returns of pains.

But was soon sensible of being less distressed with swelling from flatulence.

Continued also free from any return of vomiting.

While at same time discharge by belly nearly in natural state.

Circumstance at least increasing presumption that addition of opiate here serviceable.

In this situation were naturally encouraged to continuation of medicine.

And under use had almost uniform progress to recovery.

A circumstance perhaps rather surprising when consider how easily stomach ailments are aggravated by any accidental occurrence.

For not only, particularly liable to be affected by every irregularity with respect to diet, but by many other almost unavoidable occurrences.

From these can hardly imagine that our patient was altogether exempt.

But would appear that stomach had soon so far recovered tone, as to be able to resist them.

A circumstance from which may with some degree of probability infer, that recovery not a little owing, to operation of system itself.

At same time from almost immediate relief which medicine afforded as well as from obvious change induced, can I apprehend be little doubt, that affords example of benefit to be derived from bitters & aromatic, or what commonly called stomach medicine in such ailments