DEP/DUA/1/14/20 (Transcript version)

William Malcolm

(1777)

---

Wm Malcolm

Disease of this patient may at first sight appear somewhat pecul.

Hold it however to be a simple & uncomplic inst of an affect by no mean rarely occurring.

Look upon it to be an inst of Hypochond. an affect of which already occas. to speak under case of John Lithgow.

The two cases indeed in many respec diff. from each other.

But this merely conseq. of unstable nature of affect.

Well known to be a disease putting on very various appear.

In this case princip part of affect a very pecul. palpit. felt immed below cartil ensif.

That this not merely a sensat of patient but the conseq. of real motion evid from being both seen & even felt by bystander those around him

That this may proceed from various causes partic especially from diff. local affect is well ascertaind by exper of every day.

And partic conseq. of disease of [heart] or large artery.

But that no such fixd cause any concern in pres. case, proved by manner of [atta]

For here not a const affect but attack in fits.

And these sometimes more sometimes less freq. never at time of any long contin.

From this therfore might conclude [that] motion or palpit. here taking place in reality a nerv affect.

And well known that from this cause is a freq. sympt. in hyster. hypochond. & all the tribe of Nerv. disease.

That with pres. patient a sympt of hypochondriasis might readily conclude from othr affect to which patient subjected.

In hypochond in general consider most obvious part of the disease to consist in the mental affect.

And do not know whether Mr [Samson] has not followed most proper arrangemnt in referring it to the Vesaniae.

That in case of the patient an error [illegible] occurrd could admit of no doubt.

Patient himself even sensib of being affected with const depress of spts when no occas for it.

And besides this labourd under great appreh of sudden death whenever attackd with palpit.

Is how partic case wit hypochond patients to be greatly alarmd with their own danger.

In so much that term applied to [every] imagin illness.

Here then had distinct evid, of that state of mind which constit greatest part of hypochond.

But besides this manif subj. also to those affect of alim canal by which in great measure characterizd.

This disease very generally defined as being attended with Dyspepsia.

But sympt of that affection in place of arising from weakened tone [which] case when Dyspepsia an idiopath affect. are in hypochond. conseq. of torpor or rather perhaps of pecul. sensib.

That here whether from this or any othr cause action of alim canal impaird demonst. from flatul & eruct with which patient affected.

To proof resulting from symptom may be added that patient at that period of life & of that tempr. most disp to the affect.

For although hold that may occur at any age & with any condit yet most common with melancholic temprm & at adv. period of life.

While however have evid marks of former here, in dark compl. hard rough skin & large superficial veins disease occurrs with a patient who has already passed 61 year of age.

From these circum then evid arising from sympt. is at least corrob.

And upon whole disposed to think that very little reason for doubting that pres. patient subj to hypochond.

And that too without any complic or peculiarity.

On this ground am far from viewing affect to be of that danger tendency which patient suspects.

For consider it to be of itself a [distin] very rarely if ever proving fatal.

And many inst where patients subj. to it even to high degree have lived to great age.

With our patient though palpit [cons] yet in no other respect the least threatening appear.

And even palpit though giving great alarm to patient himself yet so little from any powerful cause that even [illegible] by press. at part.

Although however from these circum consider disease as free from danger yet must add that have very little expectat of being able to cure it.

Age of patient & contin which has already had, for space viz of 10 years may be consid as very strong circum against cure.

And even in most fav situat a very obstin affection.

Utmost therfore that here expect is to mitig compl.

And this hope may in some degree be able to obtain.

Yet take it for granted that from unavoid accid. patient will be subj. even to severe returns

These however may I appreh. be in some degree mitigated

And by prop management even [rendrd] less freq.

Respecting gener. princip of cure [howev] must own that am much at loss.

Can be little doubt that as far as disease depends on [illegible] part of system is a Nerv. affect.

And from many circum. probab. that connected with state of Torpor.

From which [with] dimin of sensib. [there] occurrs a pecul. kind of it.

And in conseq of this all inordin & [anom] affect with which the disease remarkd to be attended.

On this suppos. radic cure as well as mitig of princip sympt. to be expected only by restoring nerv. energy to natur condit.

Hence probab are to explain advantage of various measures acting partic on nervous system.

Such for ex. as change from cold to warmer climate, tepid bathing, [camphor] & in short whole tribe of med. encreasing mobilit of Nerv. power.

With pres patient had recourse to one of these which consider as by no means the least powerful.

That is the Assafoetida.

This hold to be a very powerful nervous med of stimul. kind.

Besides which conjoins properties of an antispasmod.

From first property then expected might be service as mitigating palpitat.

And from last hoped that would releive those affect more immed dependen on wind in the bowels.

Here chose to [exhibit] the Assafoetida rather in fluid than solid state.

As by this means expected more immed action on Nerves of stomach.

And employd Tinct. Fulig in pref. to Tinct Foetid on acct of [meast.]

On this med our patient has cont. ever since he came undr our care.

And I think not without good affect.

For although still subjected to depression of spirits yet attacks of palpit at least [confessedly] less freq.

And belly while belly kept regular less affected by sympt from wind.

While therfore nothing more urgent is intent to persist in use of this med.

And hope that may afford as much releif to patient as expect to obt.

But if sympt should become more distressing may perhaps subsist to assafoetida the use of camphor.

Or may conjoin camphor with course already employd.