DEP/DUA/1/13/14 (Transcript version)

Peter McDairmid

(1777)

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Peter McDairmid

Of this patient since applied for aid have seen very little.

And must own that am able to form no very certain judgement respecting nature of his disease.

Sympt. of affection to which subj but few in number.

These however of such nature that might be explaind on diff. grounds.

Evid that in case before us the stom to be consid as cheif seat of disease.

And affection princip charact. by pain attacking that viscus.

Partic after taking food.

This pain at same time attended with gripes & flatulence.

And as is very generally the case in Dyspep. with a bound state of belly.

From these circum then led to suspect affect to be of this nature.

Although must at same time be allowd that several of more common sympt. here wanting.

Partic want of appetite, sourness of stomach, cardialgia, nausea &e.

And these also sympt usually [appa.] in earliest stages of the disease.

Must however own that do not consid any one of these to be const or essent sym of this affection.

Yet occurr at least so freq. that when absent room for suspicion.

And this suspicion still farther [corrob] by description which patient gave of his pain

Repres. it as entirely attacking in form of fits.

And these fits at same time of greatr severity

Would naturally led us therefore to referr pain to some accid & viol. [affec].

And to such well known that [stoma] not unfreq. subject.

This viscus as well as other [muscul] organs of body, liable to be attackd with fixd tonic spasm or cramp.

A disease while subsists even of greater severity

And even from short cont. prod most remarkab. affect of system.

In so much that even from single attack greatest prostrat of strength will be induced.

This therfore affords at least some obj. to suppos. of being of this nature.

For notwith acct which patient gave of severity of his pain was not followed by those conseq. commonly resulting from cramp of stomach.

To this may be added as farther [objec] the freq. of the return.

For at least not common that patien should be liable to such affect sever. times in the day.

Notwith these circum howevr consider this opin as of the two the most prob.

And although would not perhaps assert that patient subjected to that very severe affect known by title of Cramp of stomac yet disp. to consider prin. part of his dises as consisting in spasm. affect of that [viscus]

This suppose to depend on pecul [sens] of that viscus.

And thus would acct. both for [connect.] with bound state of belly & for its occurrence more especially after taking food.

For both one & other to be consid as causes affording irritat.

This then opin which was disp to [adop] respecting nature of affection.

And on this founded judgemt both [respectin] termin & plan of cure.

When this patient first admitted on [list] must own that not entirely without [appreh]

Princip from being doubtful as to nature of affect to which he was subject.

And in some meas. also from idea that at least partook of nature of Cramp.

An affect by no means without danger.

And that too both from immed affects & from conseq.

While therefore could not say what [turns] the disease might take, evid that some grounds at least for appreh.

At same time had hitherto at least shewn no bad affect on system.

And from recent date ground at least for hoping that in no respect rooted in constit.

Besides consid it as an affect. which by medic aid might entertain hopes of being able to allev.

Especially as could at least in great [meas] remove some of exciting causes.

And where could not be entirely removed, might at least be able to dimin that pecul tendency to action contract in stomach on which action depended.

Thus though remaining would yet cease to have former affects.

On these grounds then although not free from doubts was yet disp. to hope for fav. & speedy termin.

How far event of disease has verified this predict cannot pos. say.

For from patients having discont. attend have not of late had opport. of exam. him

And have never seen him but on street

There however at least appar. in good health.

Which at least some ground for presump. that if disease has not already had termin which could have wishd for, is at least on mending [hand].

And not even of such severity that thinks it necess. to apply for farther aid.

Must howevr acknowledge that even suppos. this to be case cannot ascrib very much to practices employd while under our care.

In treatment of this case, consid cure as in great measure hinging on two partic.

Consid as have already said what might be reckond proxim cause of the [disease] to be spasm. affect of stomach.

This howevr after short contin. had evid tendency to resolut.

Became much less therefore an object of practit [care] to remove it when pres. than to prev. return.

On removal of causes therfore inducing return, cure must entirely depend.

Of this causes first to be mentiond & perhaps princip. a pecul. state of stomach giving disposit to spasm. affection on slightest irrit.

This condit. may suppose to be perhaps in some measure connectd with state of simple solid.

More immed depend howevr on condit of nerves.

And without pretending to enter into any inquir respecting nature of these to be consid as remov. by those agents found from exper. to possess power of dimin disp to spasm.

Of this kind however are various artic known by title of antispas.

These therefore naturally suggested as princip part of indicata in case before us.

But even where greatest disposit to action will yet not be induced without some exciting cause.

On removal of such therefore or at least on guarding against action much in cure must depend.

And if be not means of radical cure will at least be most effect method of prev future returns.

Under this general princip of avoiding exciting cause sever. partic compreh.

But must especially have in view all irritat either immed acting on stomach or affects of which commun. to that viscus.

Of artic immed acting on stomach are all ingesta whether in way of food or drink.

On proper regul. of diet therfore must considr prevent of freq. return of fits as in great measure depending.

But aliment. even in nature the [least] stimulant, in conseq. of [remora] in bowels acquires stim qualit.

Especially when united with excrem parts of fluids intended to be thrown off by faecul. disch. as bile &e.

Irritat. to any part of intest. canal howevr readily commun to stomach.

Hence obviating bound state of belly to be consid as one of most powerful mean of removing & avoiding exciting causes.

These then general principles on which appreh. that cure of pres case to be conducted.

And on these princip. treatmnt as long as patient remained under our care proceeded.

Was with view to operat as an antisp. that resolvd to try this patient with use of the pil. Gummos.

From which hoped that might obt. removal of that state of stomach giving dispos. to action.

At same time had some expect. that might serve also to move belly.

For this not unfreq. the affect of stimulus from foetid Gums which [entr] compos.

In this expectat however were disappointd

And while remained for several days [without] stool not strange that notwith use of this med pains both more freq & more viol.

While therfore afforded no reason for discont. course begun was strong argt for having recourse to most immed means of moving belly.

Was with intent of obt. disch most suddenly that here directed use of an inject.

And to secure regul. disch. afterwards [directed] use of Pil. ex Colocynthid.

From these then with contin of the antisp. hoped both for removal of praedisp & [exciting] [cause]

How far however intent answered have not been able to learn.

For patient has not of late visited us.

But from circum already mentiond am disp. to conject that has rather had fav. termin as otherwise.