DEP/DUA/1/14/21 (Transcript version)

Robert Mitchel

(1777)

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Robt Mitchel.

With regard to name of disease some diff.

But as to nature I appreh. little room for doubt.

By much most urgent part of compl. a pain in the abdomen.

In such a situat that possib of its arising from diff. viscera.

Partic mayigh conject seat of it to be in diff. parts of alim canal.

May either origin from stomach or from large flex. of colon.

But whether from [one] or other [these] not from any fixd affect suff. [appar] from two circum.

In first place not a constant pain but returning at times.

And secondly, not confind to place at which origin but propag. from [there] downwards through other parts of abdom.

To this may farther be added that no fixd affect to be felt.

And that pain on disch of wind consid relievd

From this last circum not only have proof that does not depend on any fixd cause, but led even to form probab conject, if not to arrive at certainty respect. cause which induce it

And can I appreh. be little doubt that wind immed gives rise to pain.

May even I imagine go one step farther.

And may conclude that this wind acts in inducing the affect as pent up in stomach.

Of this I appreh. sufficient evid from relief being afforded by eructat.

And from those eructat which are constantly observd to be conseq of eating.

Consider then most urgent sympt in this case to be immed effect of wind in stomach.

Besides this however affected with some other sympt.

Partic headach & shivering.

These however well known to be often conseq of affect of stomach.

And that are so in this case is at least highly probab.

For observd only to occur when pain from wind is violent.

May therfore I appreh. consider wind in stomach as cause of all symptom [with] which patient here affected.

For properly understanding nature of disease however [necessar] to consid from whence wind arises.

This can conceive only the affect of two causes.

Either latitude afforded for extricat in uncommon quantity from ordin alim

Or aliment introd into stomach from which furnishd in superab. quantity.

Here I appreh reason for supposing that both causes in some degree operat

And that in some measure the affect of aliment, may be inferrd from partic severity during spring.

Well known that then flatulent vegetables employd in greatest abund.

But presumpt that this not sole cause.

Otherwise should not occurr with pres patient to much greater degree than with other people.

May conclude therfore that with him there took place that pecul state of stomach fav extric of wind.

This however well known to be conseq of weakened tone

Probab. operating princip as giving rise to greater [remov] of food in stomach than would otherwise take place.

On this footing then real nature of disease may be supposed to consist in chronic weakness of stomach.

And for my own part should have little hesitat in giving it appellat of Dyspep.

Although at same the the charact. of that affect as defind by best nosol not here pres.

But if consider term as applied [more] to stomach ailments these here suff markd in pain of stomach attended with flatul & eructations.

Any observat on prognosis here now in great [measure] conprecluded

For patient already dismissd free from complaints.

May however observe that termin. here more speedily favour. than expected.

Did not indeed consider affect as in any degree danger. but was appreh. that should find it ted.

For although sympt not numerous had proceeded to very consid degree of violence.

Of this suff. evid in shivering headach & other affect of system prod.

But besides severity had already been of very consid standing

Had been subj. to it for space of three years to nearly same degree as when came under our care.

And had been affected with some sympt even for space of 11 years before.

Might therfore conclude that state of stomach here supposed to take place in some measure rooted in constit.

And that would by no means be easily removed.

Must now add that though patien dismissed free from affect. do not suppose [such] removal to have here taken place

For without cause being eradicated, conseq. resulting from it on system may for the time be removed.

And by this means patient obt at [least] [complit] tempor. cure.

This must own utmost that imagine to have been effected in case before us.

Yet even this to be reckond an [objec] of [great] conseq.

And without exciting cause may be means of prod radic cure.

For from such tempor. releif tone of stom better opport of being restored.

Next then obj. of inquiry how far this effectd by means pros. while patient under our care.

Here on idea given of nature of [disease] great object of cure restorat of proper [tone] to alim canal.

And this may conceive affectd on one of two principles.

Either by use of such [measures] as immed act in encreasing tone.

Or by removal of such accid as serve farthr to weaken it.

Was on [latter] of these principles that here [accounted] cure.

And with this view employd a combin of Aloes & Assafoetid.

From these hoped that in conseq of antispas. power wind would not be put up in same manner.

And that by stimulus to alim canal action so far augmented as to prev. [remov] of food giving rise to generat of wind.

[These] diff intent seem to have been fully answerd by this med.

For while had effect of operating as gentle cathart, patient at same time freed from uneasiness from wind.

And while pain became less severe seemd also to have shifted situation

For in as far as remaind seemd to be seated lower in bowels.

And had not cont use for any long period when entirely gone.

In this situat reckond it unnecess. either to put patient on use of any other med or to direct longr attend.

Was therefore dismissd with injunct to return on recurrence of affection.

But have since had occas to see him [often] then cure cont in good health.