DEP/DUA/1/15/06 (Transcript version)

George Fife

(1777-1778)

---

George Fife.

Little hesit in pronoun that dis of this patient somewhat of complic. nat.

For evid effected with sympt between which in ordin cases at least no connex

And what render. it very probab. that no connex in pres. inst. is that affect of very diff durat.

Of these howevr that of longest standing the least consid.

When came under our care by much most consid part of disease the affect of back.

Cheif compl. freq. attacks of very viol pain there.

But from prog no doubt that [seat] of this pain in cavit of abdom.

And that even derivd origine from an affect of alim intest canal.

While at same time of that transit nature which serves to shew that no fixed affect.

And in greater part of nosol sys at least might with strict prop. get name of Colica.

In syst of Mr Sauv. to genus of colica numer species referrd.

Of all these however no doubt of reducing pres. case to head of colic flatulent.

For that arises from wind sufficiently demonst. from local but tempor swelling moving from one place of abd to another.

Although howevr thus charact. of colica according to nosol. arrangement would hardly in judging from gener hist give it that appellat.

For with respect to durat at least very diff from what usually case in Colica

With our patient seldom of that contin occurring in colica

And attacks much more freq. than with those even habit disp to colic.

Have therefore some scruple in giving it that appellat in common acceptat.

And perhaps may in such cases conduct pract with greatr safety from view of nature than name.

Have already observed that consid pain to be more immed effect of wind in intestines.

From distens which gives suppose spasmod affect to be induced.

And from air thus confind circum swelling.

While at same time by progress. motion of spasm. affect. swelling changes [place]

And from contract on one hand & distens on other pain excited.

Taking this view of case howevr still recurrs as question by what means wind here generated.

This would presume to depend on two circum.

Torpor of bowels giving rise to [remova] of fecul matter.

And atonic condit admitting of extrication

Is somewhat at least in favour of this suppos that patients belly partic bound.

And that when most costive [symp] to highest degree.

This then short view of scientif name & of nature of affect.

But besides this of some conseq. to every one engaged in pract to be acquaintd also with vulg. names.

And in this respect case before us gives room for a remark.

When patient came under care his own acct. was that was afflic with windy gravel.

A term which in this part of country at least will often have occas to hear.

And which must seem to you very absurd if with gravel connect idea of compl. from calcul.

Term gravel howevr promis. employd wherever either affect of urine, or even without that pains resemb. [neph] ones.

Both one & other howevr readily prod of wind in bowels.

And is to such affect that vulg appellat now mentiond has been [given]

From our acct then would seem to have been not improp best in pres case

Thus far of most matter part of compl.

But besides this in hist. of case anoth partic also mentiond perhaps little connectd with formr.

That is gross foetid expector.

From this however are told neither affected with cough nor with Dysp.

Circum which I must own create some doubt as to nature.

Although said to be gross & foetid little reason to pres. that any other than mere mucus.

For here no indicat of any intern suppurat or proofs of affect of it.

And that mucus will put on not only appear but smell also of pus can admit of no doubt.

As disch from mouth howevr may be [furnished] from diff. sources.

May fall down upon throat from diff cav. surrounding nose

May be brought up by inverted motion of gullet from stomach.

Or which of all most common may be brought from lungs.

Hence question from which of these sources here arises.

To suppos of descent from [illegible] may be obj. that in order to this course volunt effort necess.

To suppos. of [coming] from lungs object that without cough or Dysp.

And somewhat in favour of stomach being source that patient subj to other affect of alim canal.

Yet very rarely that as comes from stomach of consist & odour here [mentiond]

On whole then still inclind to suppos that is from lungs.

But may observe that is a part of comp from which hitherto little inconven.

And has not therefore been subj of practice.

Unless put on diff appear. shall not probab. think of paying much attent to it

Hence at pres not subj of farther remarks either in prognos or practice.

With respect to prognos. am disposed to consid disease of pres. patient as in great meas. free from danger.

At least whatever may be finally event hope that will be so as long as cont. under our care.

Of affect of alim canal indeed many in end proving fatal.

Yet is only in conseq. of general [extrem] of system

And of this at pres. at least no indicat

While however consider it as not threatning danger am far from thinkin that will be easily removed.

Perhaps no part of syst to which more diff to restore tone when lost than alim canal.

And especially so when has subsist for any length of time.

With this patient, already manif to consid degree, for space of two years

Must therefore own do not expect that shall be able to free him from it.

Yet hope that may be able at least to allev his compl.

Partic by counteracting & prev accid which would serve to augm. them.

In this & simil. compl. great obj in cure unquest is to restore due sensib & vigour to alim canal.

And this to be effected.

1^st By such remed as tend to encrease these press powers in [intestin] tube.

2. By avoiding & counteracting all accid serving to weaken sensib & vig.

With first of these intent various remed of tribes of stim, tonics, & astring employd.

And will have effect either as acting on alim canal system in gener. or on alim canal in partic.

But greatr part of med. most powerful in lattr way exceptionable on 2d prin mentiond.

That viz of augm causes serving still farther to weaken tone.

Of these no one perhaps more powerful than bound state of belly.

Which while effect of want of due sensib. operates as powerful cause of atonia.

As thus distens of bowels both by faecul mattr & wind.

On this acct therfore internal use of astring or even tonics seldom advis.

And what cheifly to be relied upon are those acting on syst. in general.

Such for example as cold bath or [exercise]

Former indeed not hitherto much in use with this intent.

But in many cases may I appreh be employd with safety and advant.

Latter where circum of patient will admit of it hold to be best remed which in such cases can employ.

Especially where circum of patient will admit of his taking exercise freely in open air.

And perhaps in this manner horse back prefer. to most other modes

Rank in life of our patient howevr does not admit of any such recomm

Must therfore be content with enjoin exercise on foot as far as can conven be taken.

And to endeav. to give opport to natural powers of syst. to restore tone as much as possib.

With this view [then] cheif endeav must be counteract such circum as to support the affect.

Have already observd that cheif of these, state of constipat to which patient very liable.

Is entirely on this footing that only remed which have hitherto employd has been used.

Have already observd that cheif circum aggrav. the affect. is bound state of belly.

And in conseq. of this distens of intest by wind prod spasmod strict retaining it.

These then sympt cheifly to be had in view.

And to be obviated by support regul. peristal. motion, & by removal of spasm

Is on these intent that have here put patient on a med consist of aloes & assafoetid.

First intended to act as purgat, 2^d as antispas. and conseq. carmin.

That is, in this mannr disch. wind.

In choice of purgat in such compl. as pres. great diffic.

For while constip worst effect, bad conseq. also from looseness.

And although from freq. stools immed ease yet in end aggrav affects

For most part even followed by still greater constipat.

In such affect therefore a great [desd] to discov. a purgat by which belly may be kept easy or at utmost gently open.

And what fulfills this intent with one will by no means succeed with another.

Is often requis therefore after one purgat has faild to try anoth.

And when can find one suited to constit of patient will have more effect. in allev. sympt than any other remed which can employ.

In case of pres. patient chose to begin with use of aloes.

Which of all purgat perhaps best accomod to cases of habit costiveness.

And with pres patient seems to have answered to wish.

By this means while belly kept open pain greatly relievd.

And returns of severe fits partic less freq.

Which perhaps in some degree to be ascribd to antispas. effects of Assafoet.

As from this retent of wind in great meas. prev.

Thus far then [endeav] in pres. case have succeeded.

And am I must own very doubtful whether shall be able to be of much farther service to him

By contin course on which have put him may I hope be kept [easy.]

And by avoiding flatul. aliment will at least cease to be exposed to causes aggrav. atonia of bowels.

Hence better opportun for system even of itself recov. natural state.

Espec. if patient can at same time enjoy benef. of exercise & free air.

But besides this may perhaps also do something towards aid restorat of due tone by internal med.

And with this intent may conjoin with add to pres. course the use of bitters conj with aromat.

At same time, do not imagine that farther practice on this case will afford much instruct

And has I appreh. already afforded example of benef. to be reapt in such circum. from obviating tendency to constipat & to spas. affection.

In this situat then shall not be unwilling to dismiss him.