DEP/DUA/1/17/06 (Transcript version)

Alexander Oman

(1778)

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Alexr Oman.

With regard to disease of this patient must acknowl. myself much at loss.

Equally in dark both with respect to name & nature of affect.

And must own that have never before met with any case to which could by any means be consid as simil.

Affect accord to descript given consists in viol attacks of pain unif arising from partic part in abdom.

This pain so sever that becomes unab. to stand and therfore must either through himself down, or grasp some support.

In these few sympt disease to which subj may be consid as solely consist.

For other partic enum in history rather conseq of fit than any thing else.

Such for ex as profuse & gener. sweat sense of weakness in abdom, & lowness of Spts. inactivity &e

That pain in abdom by no means an unfreq. occurr is indeed true.

And as seated in alim canal may [arise] from same gener causes prod it elsewhere

Partic inflammat & spasmod affects

To both intestin canal perhaps as much subj as any other part of syst.

Yet in inst before us very great doubts as to its origin either from one or other.

That cannot be of inflam. nature is in great meas. demonst. from various partic.

But especially from suddeness of attack

From frequent recurrence.

From short duration while is severe

And from great length of time for which has now subsisted.

A period viz of upwards of twenty years

Besides therfore that sympt of inflam wanting, here sever. circum in the disease irreconcilab. to that suppos.

Must here be allowed that many of those partic pointed out as obj to inflam. in some degree argt in support of opin, that pain here occurring of spasm. kind.

Partic observed that with such often very sudden attack, very great severity & very short durat.

Is however in but rare cases that have not farther indicat of it than merly in [pain]

When occurs to intest is in general not [static] but propag. through tract of intest alim canal.

Where patient liab. to repeatd attack very rarely at least that has [com] from same spot.

And lastly from suppos of spasm can hardly explain const of pain for so great length of time.

For here to be observed that although not always subj to severe attacks yet never entirely free from pain.

Even suppos then that spasm. affect here occurrs must yet imag. that acts in conj. with some other circum.

And what that is must own am totally at a loss to conject.

Can only conceive it howev to depend on one of two causes.

Either pecul morbid sensib at part, or pecul. local stimul.

But to which should rathr attrib [must] on am totally at loss to conject.

May perhaps be consid as in some meas obj. to local stim that no disease condit at part discov. by exam.

On other hand some argt in [support] of it from const uneasy feeling.

And from what happened to patient at very early period of disease.

Acct [viz] which gives of having at very early period of life disch. ball long redish colourd worms.

This descript will apply to none of usual kinds of worms const commonly observd in intest. canal.

And what variety of other kinds may be [harb.] there.

How far may be able to secure for themselves perm lodgem.

Or what sympt they may induce impossib to say.

If therfore could suppose any pecul kind of worm still pres in intest. might expl. all diffic sympt

Yet must be allowd that this [supp] liable to many diffic

And were it even from nothing but uncommon nature alone suff. to create great doubts.

Must then concl. that respecting [partic] cause of pain in this case am totally in dark.

And was cheifly with view of observ. whether any circum should afterwards [occur] by which might be illust. that here selected it selected this case as subj of treatment here.

From this however of late precluded by want of due attend on part of patient.

And since gave up visits here as has shifted resid in town have not been able to find him.

Had he however cont to attend us expect of necess could have been by no means great.

After durat of disease for by much greater part of life, & for period at which most remark changes occur in syst from inf. viz to Manhood, cannot now look for natur cure.

Or at least if does occurr will in all probab. be effect merely of some very accid circ

If however thus little ground for expect natural, not more foundat to look for artif cure.

Before patient came under our care had been under direct of most [emin] [pract] & by there advice had tried very great variety of med.

Had therfore very little ground for expect that from accid or random trial, should have been fortun enough to accompl. cure.

Even this however not altogeth to be desp. of.

And in cases where totally at loss [resp.] nature, hold that even such trials where no [reason] to dread bad tend. never to be neglected.

Should not therefore be aston to find that after pres affect has resist skill of so many regul pract, is should yet removed by some empyr.

But besides [chance] in this manner was at least also a possib circum. that during course of patients attend some partic might occurr serv. to illust nature of the dis.

And that then on prin diff. from what had hitherto been followd might yet hope for be able to bring about recover even on rational & dogmatic plan.

Of both one & other chance howev will now probab. be deprivd by desert of patient.

Perhaps therefore now almost unnecss to say any thing either with regard to remed employd or meas which might afterw have been tried.

May only in gener. observe that accord to acct given us cheif remed employd before patient came under our care were [evacuant] & sedat.

And on conject which have vent to prop. would naturally occur as very [ratn] pract

On any suppos. first indic with a view to removal of cause giving pain, last with intent of allaying it after excited.

When reflected however that such meas. pushd to great extent without success, imagine that ought rather to make trial of other.

And as could not learn that patient had used tonics was prompt to employm of these.

Even on suppos of local cause pain pain might yet be supported by pecul irritab. state which tonics cap of remov.

Is I appreh. as remov. such irritat. that sometimes at least success in cases of Epilep. even where affect depends on fixd & local cause, as exostos of scull or like.

Here notwith conject possib that might even be no local cause did exist.

And that, as in some inst of Epilep might solely depend on pecul mobilit which from which action induced even by ordin stimul in intest canal.

These then consid which at least led me to think that trial might at least be made of Pil. Caerul.

And if found prod of no good effect was at least appreh of no bad conseq.

For in many other inst have before used it not only with safety but with manif. advant.

Need not observe that in Pil Caerul. the active ingred. is Cuprum Ammon.

Nor need add that all prepar. of Cupr of very consid virul.

Possess indeed very remarkab. tonic power

Yet all so highly stim. that excepting [pres], in which metal brought to saline state by ammon. salt none vent upon [illegible].

Even this, in small doses will with most people excite nausea

And with some no inconsid degree of [vomiting].

Yet Ascribe it however rather to pecul in patients stom than any thing else that in extent to which here given excited severe vomiting & loosness.

Such a conseq. however alone suffic to induce to intermiss of use.

But besides this farther reason for it from anoth accid occurr.

For patient became then also subj. to a catarrhal affect.

Was solely with view to this last, partic cough & hoarseness, that had recourse to Mist Oleos.

And after catarrh sympt somewhat abated again intermitted use.

After this put patient on the Pil. Gum. which consid cheifly as formul. for introd of Assafoetida.

And in such state too that will act more on intest canal than on stomach.

From this I own entertaind no very high expectat.

And indeed from what already observd will perceive that could entert high expectat from no remedy.

Yet led to [treat] of pres on two grounds

In first place might I imagine be of service as counteract pecul. morb [sensib]

Might allev pain from operat as antispasm.

And that from this source to consid extent at least immed arises may be inferrd from [ease] often given by small quantity of Spt. taken when pain most severe.

May farther observe that in another case in some respects at least simil. to pres. found pil Gum of greatest [service]

And these good ground for pres. that operated on princip now ment.

But besides this farther known that Assafoetida to no inconsid degree possess power of killing many spec of worms.

And among others those commonly pres in intest canal.

Had then some expectat. that might here operate as anthelm.

Since first directed however have seen nothing farther of patient

Of effects therefore can say nothing

And as probab. that may not see him again perhaps unnecess to suggest what future meas. might here be taken.

If howevr shall again return to us will I must own be my wish to push use of Assafoetid somewhat farther.

To try exhib of it not only by mouth in other forms but in othr ways also

And partic in way of inject.

In this [latter] mode trial might also be made of introd of smoke of Tobacco into intest canal.

And if these [abortive] would not be improp. at least to see effects of a Mer course.

From these meas if any truth in idea given of disease some chance at least of reaping benef.

And the rather throw them out from imagin since as far as can learn have not hitherto be used.

Is on this ground rather more, than on any opin whatever, that would suggest trial of anoth mode of cure.

That is electricit.

While a mode of cure perfectly innocent [will] [contin] succeed in cases where little expected.

And the rather encour to such suggest in pres inst from being persuaded that not less affect in removing morbid [than] in restoring lost sensib.