DEP/DUA/1/13/10 (Transcript version)

John Lithgow

(1777)

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John Lithgow.

In affection of this patient a pretty numer. assemb. of sympt.

By no means such however as indic complic of diseases.

Consider affection to which this patient is subjected to be both simple & distinctly [marked].

And have little hesitat in pronoun. it an inst of pure hyperchond.

May however observe respecting this disease in general that is one of those unstable affect in diff cases putting on various appear.

Hence in many inst will find that several sympt with which pres. patien is affected are wanting.

Among this list may enum Nausea yawing & partial sweats.

And indeed method of attack in format fits to which this patient is subjected.

Inst indeed by no means rare where access. in hypochond still more distressing to patient than what here mentioned.

Partic in those instances where occurrs under form of palpitation.

These with hypochond patients often occurr even to great extent.

And while they cont. give degree of distress to patient which can hardly be conceivd.

To this even would appear that some tendency in pres. case.

For appreh. that may consider of as of this nature, that fluttering on slightest accid. with which patient affected.

Though here indeed format spont fits consisted more in sickness partial [sweat] & even tenden to fainting.

But whatever may be more accid symp of the affect when pres. always charact. by two great marks.

A diseased condit in functions of alim canal

And a diseased state of mental facul.

This last perhaps to be consid as most essent. part of the disease.

In so much that reckond by Mr Sauv among [illegible] or those affect the most disting mark of which is an [illegible]

And that such occurrd with pres. patient could I appreh. admit of no doubt.

And if from no other circum sufficiently evid from method in which patient related the history of his case.

That was by no means free from corpor. sympt. would readily allow.

But from [simp.] attent in relating them evid that mind dwelt upon affect.

And in descript showd partic dispos. to employ terms of art.

Though sphere of life no higher than that of journeyman shoemaker had taken opin not only of diff. practit respecting his disease but consulted also var practic authors

To these partic may farther add, great appreh. respecting his disease.

Which of all other imagin of hypochond patient is that most generally pres.

With this state of mind here also evid conjunct of affect. of alim canal.

Partic appearing under forms of acid, [eruct] & constipation.

Symptoms which which the commn attend of Dyspep whether occurring as an idiopath disease or as a constit of part of Hypochond.

And which in latter case probab. arise from a very diff cause from what do in former.

From all these partic taken together then little room left for hesit respecting this case.

And may farther add that as far as extern marks go have here also evid of existence of the melanchol. tempr.

Patient evid of that dark complex. black hair & spare habit and hard rough skin which consid as external evid of this state.

Some have consid hypochond to be a disease entirely confined to this temper.

This opin howevr must own can by no means adopt.

Yet not to be refused that with such habits hypochond. most freq

And with those even consid as an essen part of the affec. such a requis not here wanting.

Hence farther character. of this affection in accid by which is aggravatd.

For partic remarkd that access. with which patient affected especially induced by close applic of mind.

May then upon whole consider pres. to be a case in which hypochond. pointed out on every ground.

On this suppos. then next to speak of prognos. & plan of cure.

In pres affection notwith appreh. which patient has at diff. times entert. nothing which can in any degr. be consid as alarming.

In most other affections indeed partial sweats, with tenden. to fainting might be consid as threatning immin danger.

But in nerv. affect in general by no means to be consid objects of very great terror.

Must therefore own that entertain no appreh. as to life of patient.

And indeed remarked that those affected with hypochond. often rather long lifed as otherwise.

But while pronounce case free from danger am far from consid it as of little importance.

On contrary disposed to fear that patient shall find it both an obstin & troublesome comp.

Entertain little expectat that shall be able to erad affection.

At least consider disease to be so much interwoven with constit. that doubt much of being able to prev. renewal on action of exciting cause

Partic such as lead to thought & anxiety.

Although however can hardly expect to remove may yet be able to allev. patients compl.

And to mitig some of most urgent sympt

Hope therfore to dismiss patient if not cured at least consid releivd.

And contin of that relief must in [great] meas. depend upon himself, especially as observing prop. regim.

Partic with regard to what respects general heads of diet, exercise & temperat

May even farther remark that on these suppose greatest part of cure to depend.

As to general princip of cure in this affect must own am much in the dark.

Which indeed must be case with regard to every affect in which mental facul have much concern.

Or where there occurs even diseasd state of what consider as connect med between sentient & corpor. parts of syst. viz Nerv. [fluid]

And no doubt that what freq. consid as diseased states of mind are conseq of morbid affection of this part of system.

As far as know any thing respecting this affect. consider it to depend on [state] of torpor of Nerv. syst.

At least with evid [marks] of such a state is manif connected.

And removal of this consider to be great obj. at which are to aim in attemp. to obt. radic. cure.

Cheifly howevr to be brought about by med which here have it not in our power to employ.

Such for ex. as change to steady & warm climate

Benefite also might be perhaps reapt from long cont. use of tepid bath.

A practice which want conven. for [ext] in proper manner.

From affects of Camphor on constit have often been disp to believe that from this good conseq. might be reapt in pres. affect.

And if pres. patient found subj. to freq. returns of his affect have though of trying it.

Wishd first howevr to see how far good affect to be obtained from mere mitig of sympt

Trusting merely restorat of due state of [nerv] inf to natural powers of system aided by propr exercise

Is then with view of mitig sympt that med hitherto used have cheifly been intended.

From relief obtained by patient on disch of wind concluded that this to be consid as source of greatest compl.

And was even disp. to ascribe to it those fits of Nausea, sickness & fainting with which compl. of being often affected.

Was with intent of expelling wind by action as antispas. & stimul. that had recourse to Pil. Gummos. & Tinct. Fulig.

As howevr compl. much of being affectd with acid at stomach, & as pills had not affect of moving belly had recourse to Mag.

From these med has derived at least temporary relief.

And if cont. in same easy [condit] shall not probab. think of any farther meas at pres.

If however should be subjectd to recurr of urgent sympt may be led to meas. of which cannot at pres be aware.

And if subjectd to freq. returns in pres. form shall as already [hinted] try what may be obtained from use of Camphor.