DEP/DUA/1/47/29 (Normalised version)

Mathew Steele

(1789)

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N^o19 Mathew Steele.

This case I formerly remarked though attended with some peculiarities was disposed to consider as an example of Dyspepsia.

And have since had no reason to alter opinion either with regard to nature or termination of disease.

Now indeed more manifestly than before appears that pain not from any fixed cause as scirrhous or like.

For has frequently had considerable intervals entirely free from it.

And no doubt that when has occurred, has been consequence of violent action & distension, induced by flatulence.

Principally if not entirely consequence of weakened tone in stomach.

With regard to prognosis formerly expressed hope that in no long time might be able to combat the affection.

And although in this have not altogether succeeded yet little doubt that upon whole at present much easier.

And perhaps may even add [that] would have obtained still greater benefit if attendance had been more regular.

For as from nature of our practice is a very frequent occurrence did not attend us when thought himself restored to health.

And by this means medicine for some time interrupted.

On idea that disease chiefly depended, on relaxed & atonic state of stomach, began by directing for patient mixture with aromatic tincture.

This consists of equal parts of Tincture Aromatic Tincture Amarum & simple water.

And is as I have already oftener than once observed, an excellent stomachicus.

For besides tendency to restore tone & promote action has also effect of expelling flatulence.

And thus tendency both to radical cure of disease & relief of symptoms.

Here therefore had reason to hope that might have influence as relieving pain

But as this symptom more severe than in most instances of Dyspepsia thought something farther necessary with view of alleviation.

And as most effective article with which are yet acquainted for this purpose had recourse to Opium.

Opium from whatever cause pain may arise has tendency to allay it, from rendering sentient principle less susceptible of painful impression.

And indeed when carried to great height proved such state of Torpor that no impression whatever has any influence.

When proves fatal [well] known to operate in way of inducing apoplectic insensibility.

But even in doses inferior to these produces sleep renders influence of painful impression less powerful.

Besides however generally affects in this manner, in particular instance tends also to alleviate pain on other grounds.

Thus when [acts] on extremities of nerves from which pain arises renders them less sensible at least for the time.

Here then as introduced into stomach might expect at least some benefit in this way.

But in present instance expected still more in another way.

For pain here as already observed viewed principally as being effect of [inordinate] action.

And well known that nothing more powerful in allaying action than opium.

On all these grounds then here expect to obtain benefit from use.

But while thus hoped for advantage had in another respect some reason to apprehend inconvenience from use.

For need hardly remark that has a very great tendency to bind belly.

A consequence necessarily resulting indeed from influence as allaying action.

This however a circumstance well known to be extremely unfavourable to [illegible ].

And particularly where are subjected to much pain from flatulence.

Nothing indeed more pernicious to them than strong evacuation.

And although from emetics & purgatives sometimes immediate relief, yet in end never fails to increase the affection.

But at same time a state of [illegible ] equally to be avoided.

And here to be observed previous to opium tended rather to bound state than other

To counteract this therefore, rarely failing in operation.

Pill ex colocynth cum Aloe to extent of ten grains.

But though this very powerful in moving belly seldom operates as inducing any considerable catharsis.

And here directed it not to be regularly continued, but to be had recourse to only when occasionally required.

By this article effect wanted was fully accomplished.

For while produced free discharge by the belly was at same time without Catharsis.

While this the case however had also very considerable relief from pain.

An effect probably principally to be ascribed to the Thebaic pill.

In this situation thought himself so easy that for some time neglected medicine altogether.

But consequentially soon was an aggravation of his affection.

A circumstance affording at least additional presumption that these the cause of former relief.

Could therefore have little hesitation in directing repetition.

And again experienced former relief from pain.

Found however, that unless from frequent use of purgative pills, belly still disposed to be bound.

Wished therefore to try how far would he continue easy without opiate

As thus hoped that at least less frequent repetition of purgative pill would be necessary.

And accordingly under Mixture & occasional use of purgative pills continued tolerably easy for space of fortnight.

But then on another intermission of all medicines had fresh aggravation of his complaint.

On resumption again relieved.

But even this not sufficient to secure future regulation.

For as well observed by report of 6^th of February after being almost entirely free from complaint for some time had another return on discontinuing medicine.

Since that has continued medicine without any intermission.

And symptoms upon whole very much relieved.

Can therefore be little doubt that has been considerably benefited by practice here employed.

And would probably have been more so, had he been more attentive in following directions given.

Here however must be allowed that intermission of medicine not only cause giving aggravation of affection.

For observed also that subjected to some returns if feet [allowed] to be very cold.

A circumstance by no means wonderful when consider influence which coldness of extremities has on whole system.

And by no means rare with dyspeptic patients.

To this cause of aggravation therefore is to be hoped that patient will afterwards also pay attention.

And trust that benefit already obtained may soon be rendered both more considerable & more permanent.

At the same time dyspeptics apt to be aggravated by so many different accidents, that can by no means be surprised at some returns of uneasiness.