DEP/DUA/1/47/43 (Normalised version)

Edward Crane

(1790)

---

No26. Edward Crane at 45.

Formerly pronounced case of this patient to be a distinctly marked instance of Dyspepsia.

And while no reason to alter opinion as to nature of affection have had as little with respect to prognosis

At least cannot say that hitherto have made any great progress in [cure].

And now still more than formerly have reason to conclude that affection will prove obstinate.

In this case, from symptoms inclined to conjecture, both that tone of muscle fibres of stomach diminished & that secretion also morbidly affected.

Is however chiefly from [due] muscle action that proper secretion formed.

Hence then chiefly by restoring tone to muscle fibres that cure to be expected.

At same time however employed such practices as might remove cause tending to diminish tone.

Was with these intentions that when patient came first under our care had recourse to Mixture with Aromatic Tincture

And to Foetid pills with Aloes.

In the first which contains some of most powerful vegetable bitters & aromatics [illegible] one of most common stomachic medicines.

And which often employed with great advantage.

In last again a medicine very powerful in removing both costiveness and flatulence.

And can be no doubt that both from one & other symptoms of Dyspepsia often aggravated

These medicines however not altogether attended with wished for effect.

For under use of mixture stomach complaint continued as distressing as before.

And pills from which wished only to obviate costiveness & expel flatulence had effect of producing several loose stools daily

[Uniformly] observed however that while dyspepsia aggravated by costiveness is also so by severe purging.

Or at least although may give apparent immediate relief yet in short time disease seemed worse.

From looseness here occurring therefore naturally lead at least to diminishing of dose.

And in place of ten grains daily [illegible] only grain V every second day.

While at the same time, to the aromatic mixture, substance Cortex Angostura.

An article lately imported from America with botanical character of which still unacquainted.

But which while represented as an effective cure of intermittents possesses such sensible qualities as would lead to [believe] of being excellent stomachicus.

Particularly a strong & pleasant bitter conjoined with very peculiar & grateful aroma.

Taken to extent of ʒi daily was here at least product of no bad effect.

For not only sat easily on stomach, but became also less affected with pain & vomiting & had some return of appetite.

While at the same time, pills in diminished dose now no more influence than that of keeping belly gently open.

This therefore encouragement to continuation of plan.

And although not without return at times of additional unease & vomiting yet upon whole easier.

By this led to increase dose to ʒ p ter de die.

And was even in hopes that by continuation should have been able to discharge patient if not cured at least with considerable alleviation.

But while in this situation, probably trusting that relief obtained would be permanent gave up attending for about three weeks.

And would not probably have returned had it not been for severe aggravation of affection.

Should naturally have thought of resuming use of Angostura.

But stock which had obtained nearly exhausted.

And not yet at least to be purchased in shops at this place.

Hence both to this & Foetid pills substituted Pill stomachicus.

Of these the basis Rhubarb combined With Aloes & Myrrh.

And often found very useful in stomach ailments.

Here however under employment complaint rather aggravated.

In place of this therefore have now directed Colombo root one of best stomachic medicines with which acquainted.

But whether with any more effect extremely doubtful.

And I own very apprehensive that here shall at utmost be able to do nothing more than give temporary alleviation.