DEP/DUA/1/13/05 (Transcript version)

James Ritchie

(1777)

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James Ritchie.

As to nature of this patients disease little room for doubt.

May however be some question what name to be properly affixed to it.

Can have no hesit in consid alim [cana] to be here great source of affect.

And in viewing morbid state of this as source of all sympt.

May however be matter of doubt whether can with strict prop. be stiled a stom comp.

Or as is now very generally termd an inst of Dyspepsia

Here indeed very manif. greater part of sympt of that affection disease.

Of idiopath affect of stomach have evid in various sympt here pres.

Partic in want of appetite, vomiting of acid matter, pain at stomach, [eructate]

Evid howevr that affection here by no means conf. to stomach.

Although at same time uneasiness of patient immed after taking food, would even argue that this princip seat of the affect.

Yet even some of first & most urgent sympt of this affect. indic that disease of greater extent.

And appears that pain often origin from flatus in bowels

From thence told that propag. upwards to region of stomach where afterwards source of greatest uneasiness.

From this together with bound belly have I think suff. evid of a debilit state, or what may be calld chronic weak of alim canal in general.

And perhaps more prop. that practice should proceed on this idea without [pret] to give it any partic name than on affix to it partic appellat not strictly applic.

With regard to termin here can see no circum from which any reason for being alarmd.

Stomach compl. in general far from being of dangr. tend.

Especially when no partic local [effec] as schirrus, ulcerat, or like.

And even then is usually a very ted. [affec]

This however often also the case where even of slightest nature.

In such compl. therefore a prudent practit will never perhaps promise very speedy cure

And the longr the affect has alredy contin. less chance of this.

For admits of cure princip if not only by artifi. means.

And this cheifly to be expected when but of short standing.

This circum would in some measure lead to favour. judgement in case bef. us.

For when patient came under our care was only of five or six weeks standing.

Which with an affect of this nature at least comparat. speaking may be consid as but recent date.

If howevr this circum in fav of patient leads us to mention anoth perhaps as much against him.

That is rapidity with which sympt of patient had augmented.

Will rarely find inst of Dyspep. or aton state of bowels where in so short space sympt. have gone to so great height

For not only very consid vomiting want of appetite &e but also high degree of pain returning at intervals.

And affording evid mark that with atonic state there takes place consid dispos. to spasmod affection.

To all this may add that treatment hitherto followed does not seem to have had great influ.

Although patient in some respects relievd, partic with regard to vomitin, yet in other circum compl. very much in same state.

From all circum taken togethr then cannot give very favour opin as to termin of case.

And besides measure already tried shall probab. be obliged to have recourse to sev. others, before can be obt. for patient tolerab. easy condit.

And after all presumpt is that will be dismissed with compl. rather allev. than removed.

With regard to treatment may here remark that princip part of remed hitherto [used] directed with intent of allev. sympts

Partic as counteracting influence of flatul constip & acidity.

On idea given of disease indeed radic cure of affection, must be supposed to dep. on restor. due tone of alim canal.

But this not more to be effected by med augmenting tone than by avoiding such causes as serve to weaken it.

When these fully counteracted restorat often more readily affectd by natural powers of syst than by any medic aid.

These general princip will suff. explain intent which have had in view by med already used.

Had here recourse to pil Gum. for remov. of spasm. strict, retain wind in bowel

And for giving such stimul. as would serve for farther expuls.

Used Magnes. cheifly with view to destruct of acid.

And that might not have tenden. to farther generat of wind ordered it in calcined state.

After cont. it for some time alone united it with a proport of Rhubarb.

From which hoped by astring quality to strengthen tone of intest & by purgat prop to obviate costiveness.

As notwith Pil. Gum flatul. contind very distressing, had recourse to Tinct. Fulig.

And as this also proved abortive had recourse with same intent to Tinct. Aromat.

Which although possessing nothing of antispas. quality of other yet to be consid as stronger & more immed stimul.

With intermiss of Magnes. which given up when acid left him became more costive.

By this led to employment of the Pilulae Aloeticae

Under these diff. measures compl. have in sever. respects been somewhat mitigated.

And while cont. in pres situat shall not think of immed altering course.

Persisting in use of Tinct aromat in morning & aloet. pills at bed time.

At same time however regulating quant by effect observd to be produced.

And with these enjoining as much exercise out of doors as patients situat will allow him to take.

Do not howevr pretend to assert that these measures will be found effect.

And if this the case shall conclude that something farther requis. than merly obviating sympt & counteracting causes dimin tone.

Shall then think of having recourse to such meas as have tenden. to encr. tone

With this view besides employing means acting on system in general may have recourse to bitters astring & tonics strictly so calld acting immed on [stomach].

And if shall be found necess. have thought of having recourse success to may employ in success. Peruv. Bark. Columb. Root to Tinct Japon & to Tinct e Kino.

At same time obviating effect of any farther constipat which may have tendency to produce.

But before employing any of these is intent to make this patient subject of trial with anothr med as a tonic to stom

That is cold water.

Of tonic powers of this as applied to system in general need say nothing.

Can be no question that will excit simil influence on an organ so sensib as the stomach.

Is a med howevr rather too simple to be taken with any regul merly by itself.

Is with this intent that shall employ it as it were in medic state.

Using it as it were as vehicle for Elix. Vitriol. dulce or Tinct. Martis.

At same time exhib these in such small quantit. that whatever effect obt. may justly be attrib to the water or rather to action of cold upon stomach than to any other circum.