DEP/DUA/1/12/19 (Transcript version)

Peggy Byers

(1776-1777)

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Peggy Byres.

Case of this patient not altogeth with diffic

At same time symptoms of her affect such as may be consid charact of a partic disease

Have in history allmost every sympt of that disease which in system of Dr C. def. under title of Dyspep.

And cannot help thinking that what gener. calld stomach compl. more properly referrd to one genus, than as has been done by Mr [S.] & others of divids into numer. genera of [name] vomitus, cardialgia, gastrodynia &e.

All these sympt conjoind with bound belly a common sympt attend of the disease, are here pres.

And except rumin, by no means a cont attendant, every sympt. mentiond in defin here pres.

Yet some circum giving room for doubt how far all sympt to be consid as [mere] affects of idiop affect of stomach.

This cheifly from seat of pain & still more from cause supposd to induce it.

In pain in this case have not every appear of gastrod attending stom compl.

Seems to be rathr lower situated

And is besides this more const. & more [severe]

Patient herself disp to assign no partic cause for her compl.

But in history a [cause] fully suffc mentiond.

And what at same time might give rise to diff. suspicion from that of pain dep. on affect of stomach.

Immed before attack of sympt. had affect a very consid uter. haemorrhage.

Which if not viol while existed at least of long cont.

For are told that was more or less affected with it for space of ten months.

Are farther told that this haemorr. began at time when suspected herself to be preg

From our history howevr does not [apper] that this conject well founded.

For patient was not sensib of any abort

And that she has not cont. with child abund. appear from time that has [since] elapsed

Conj. at same time with regul. of menst. discharge.

May howev remark that patient not less liable to decept. in second than in first partic

Pregnan. may not have been so far adv as she suspected.

And foetus may have been disch. unob. with [cloted] blood.

But whether [haemorhagy] to be viewd as succeeding pregnan as obst. of menst flux perhaps immat

At any rate affords ground for two conj respecting pres pain.

May either suppose it to have operated as giving rise to dyspepsia

And thus prod pain from spasm affect of debil bowels

Or may have given rise to some local affect. of uterus.

Of which also well known that prof [haem] often a cause.

And which when occurrs is freq. the origine of pains as in pres. case shooting from side to back.

Seat of pain & fixd origin somewhat in fav of this suppos.

But on othr hand, regul of menst disch both as to time & quantit. & evid affect. of alim canal in other respects against it.

And as would necess. be cause of more ted & obst disease would fain hope that is not [this]

Willing therefore to concl. that from cause already mentiond tone of intest as well as stomach greatly weakend.

And that from spas. affections in these are to acct both for seat of pain & direction in which propag.

Since this case however came under care still another circum claiming some attent.

And from which some would be disp to form very diff. idea of the disease from that here mentiond.

That is worm which patient disch.

Well known that from exist of worms in alim canal most anom sympt will sometimes arise.

And wherever appear many disp to [ascr] to them every future affect.

Am however convinced that have often been supposed to operate as cause of [dise] when in reality appeard merely in consq. of it

And this I own disp to conject in pres case.

Notwith want of diagn sympt. worms may in reality be cause of pres. affection

Or more may yet exist in bowels without being cause of disease.

Since wrote these notes find that a fresh inst of obstip has occurred.

And that pills last prescribed have not had affect of moving belly

But reckon it of the three the more probab suppos. that worm already disch the only one.

And upon whole disposed to view the case to be an affect of alim canal.

On this idea should not I own be disposed to unfav. prognos.

Dyspep. an affect very univ more ted than dangerous.

And when does prove fatal is rather by inducing other affect. than by itself.

Of this however notwith debilit of [patien] no appear in pres. case.

Besides disease cannot be consid as of long standing

And since came under care although [much] has not been done, has rather gaind ground as otherwise.

One circum howevr to be mentiond from which unquest in case of neglect some threating of danger.

That is state of patients belly.

In one inst already by viol constip. severe pain & much distress induced.

And from second occurrence of same natur even enteritis or ileus may be induced.

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Unless from such occurr howevr if conject right shall probab. be able to dismiss patient if not cured at least relievd.

But if any truth in what threw out respecting local affect of uterus shall find it equally obst & more danger [affectn]

In treatment of this case according to idea given of it consid cure to be aimd at on two prin.

1 By removal of causes tending to [waken] tone of stomach

And 2d. By use of such means as serve to encrease it.

But at same time during course of affect have found it farthr necess to employ mean for obv. partic occurr.

Here two cheif causes weaken tone were acid & constip.

Imagind that for both intent no remedy better suited than use of Magnes.

While at same time thought that by combin it with small propor of Rhub. would both encrease purgat power & [serve] to strengthen tone of stomach.

Was not from one or even a few doses of this that could expect much affect.

Began it therfore with intent of persist in use for some time

And although imagind that dose very moder when gave only ℥p of Mag. Rhub gr twice a day, yet more than suff.

To be observed of this affect that while nothing more benef. than to keep belly gently open purging [ever] followd by bad [affec]

Thought it necess. therefore at first to [mod] dose

And afterwards to encrease it as might seem requis.

While on this course howevr vomting eructat & other stom compl. somewhat somewhat abated, pain of back became more [illegible]

And as from fixd seat, suspectd that might in some deg. be combined with musc affect. ordered frict with camph. oil

Which seemd to be so far attended with good affect.

But soon after had recurrence of sever vomiting

Which I appreh. to be ascribed to bound state of belly occuring notwith cont of Mag.

In this condit could not trust to any purgat taken by mouth.

As few of these from which tendency to vomiting is not even encreasd.

Gave merely therfore conjoind Spt of Lavender as a gentle cordial.

And for affect moving belly orderd an inject with Glaub Salt.

Both these med seem to have been attended with [diur] [aff]

This however not it seems attended with desired affect.

For while inject prod sever stools sickness consid abated from Spt Lavend.

Was prob. also in conseq. of inject that disch worm before mentiond.

And what would indeed seem to corrob. suppos of its having some concern in inducing the affect sympt [after] this much easier.

While even appear of acid almost entirely gone

In this situat in place of having again recourse to Magn. thought of trying the infus. amar.

And at same time of at same time of obv. constip by use of aloet pills.

How far this practice will have consid affect cannot yet say from exper.

But am in hopes that if does no more may be able to put her on use of some other which may at least be means of keeping compl. in pres. easy state tolerab. easy

And if that the case shall not think it necess. for her to attend us here for much greater length of time