DEP/DUA/1/19/22 (Transcript version)

Robert Morris

(1778-1779)

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Robt Morris.

Am much at loss to say whether case of this affect patient affords example of compl. very singul or not.

In history of case as introd into our regist some partic. which exhib an assemb of sympt by no means freq occurring.

And if cause disease really proceed from circum to which patient himself inclind to ascribe it may look upon it as a very uncommon compl.

On other hand however reckon it [not] improbab. that sympt in disease of this patient not a little aided by his own [illegible] of mind

Is not indeed arrived at that period of life, when affect with tendency to Hypochond. most common.

Yet can be no doubt that many of his compl. effect of flatul.

And if can suppose

Of this suffic evid from propagat of pain from one part of alim canal to another

And from relief which disch of flatus affords.

Besides these in disagreeable taste in mouth & bound state of belly farther evid of affect of alim canal.

And if can suppose that with [this] there occurs that state of mind which takes place in hypochond. by which patient disp. to magnif every part of affect not improbab. that affect may be solely of this nature.

To this conject the rather led from cause to which patient attrib it.

Had occas it seems near 12 month ago to lift a dead person body

And ascribes compl to which now subject to inspirat of air at that time disch from mouth of dead person.

That such foetid air may have operated as cause of disease do not deny.

But at same time would cheifly susp. it as giving origin to affect of febr. nature & with [putres] tenden.

While on other hand is an accident of that nature on which a hypoch. would readily dwell.

And which would strike imagin as giving rise to affect of most danger. tenden.

Although Can however be no doubt that to such accid numbers daily exposed without any inconven.

Yet Must however be allowed that besides sympt. indic affect of alim canal patient enum others not common in Hypochondrias.

Repres. himself as being affected with const. & severe pain at appar part of sternum.

And this also as being attended with Dyspnoea & sense of heat.

Sympt which would more readily suppos to be conseq of tumour or some simil accid local affect than from any other cause

And impossib to say that to such, even cause even mentiond by our author patient may not have given rise.

While again such an affect may have had begining about that time from some other accid. escap observ of patient.

From all these circum then room for some suspic.

Yet at same time to be observd that some appear even of this pain being connected with affect of alim canal.

For are told that partic aggrav when from flatus sense of ball in throat imped respirat.

And that allev. both by eructat & by smoking tobacco.

Circum both of which against suppos of local affect.

For in both cases must naturally ascrib relief to removal of distens & of [illegible] [structure].

At least is most probab. on latter princip that to acct for releif afforded by Tobacco.

While again no room for doubt as to princip on which relief affordd by eructat.

Upon whole then inclind to consider it as most probab. suppos. that disease consists princip if not totally in affect of alim canal.

And this conj. with melanch & timours state of mind leading patient to repres. ailments as more distress. than really are.

In this state of uncertainty however must be very diffid with respect to [Progn]

At any rate however in some respects rather unfav as otherwise.

If conject which dispos. to adopt nearest the truth must at least consid as an affect which reason to appreh [will] be tedious.

And if any ground for suppos of local affect may even be dangerous.

While at same time neither in one case nor other is there any [remedy] from which can expect any remarkab [affec] in cure.

Meas therefore at first directed intended rather with view of palliat sympt. & that might have opport of being more thoroughly acquainted with affect than from hopes of prov benef as erad the compl.

Prescribd for him at first a mixt of Tinct Amar with Elx ex Aloe & [illegible]

First long in high esteem against [effus] of stomach.

In so much that has obt name of Elx Stomach.

In as far however as allev compl of that viscus, can be little doubt that operat dep on influ as bitter & aromat.

And as former may be consid as most active ingred, while at same time in largest propor. now with prop. named Tinct. Amar.

In the Gentian, the artic which [enter] this formul in greatest quantity, have one of purul & strongest of the Vegetat. bitter.

While same power also power also [to] consid degree though conj with aromat in [illegible]

While In [canella] alba entering comp solely intended have an artic intended for encreas aromat flav.

And cochineal with no other view than to give colour.

In as far however as gives red colour & therefore when vomited apt to give [suspit] to patients of blood reckon, it no advant.

But from other artic bitters & aromat have basis of remedy which may [readily] suppose will operate from encreas. tone of stom & stimul to action.

And powers in this way sometim at least encreased by [menstr.] employd.

Here indeed may observe that same artic freq in use against stomach comp when acted upon by watery menst.

For infus amar of Pharmac. formd of same artic although indeed in less proport.

But in formula here employd the menst. used is weak [vinous] [spt]

From this indeed extent to which bitter & aromat can be thrown in more limited than where watery menst.

But at same time Spt itself unquest acts as stimul excit action of stomach

And perhaps as means of allev stom compl. too freq employd in [pure] state

From use first begun in this manner, many brought to state of habit dram drinkers.

Of this however unquest less hazard where used as basis of bitter Tinct than where taken by itself.

And hence do not consider it as a circum giving water infus [pref] over Sp

While with latter have advant of the menstruum.

Here however bitter or stomach Tinct did not constit greatest part of med at first ordered.

Was conj. with another [compos] also very freq in use

And which in my opin deserv. consid as a med great use. Elx [illegible] Aloe & [Rhoei] or as commonly calld the sacred Elix.

Artic on which action of this comp. dep. fully expressed in title now given to it.

For proport of Cardam seeds which [enter] it meant merely as corrigens.

In combin of Rhub. with Aloes, have what with many an useful purgat.

And can be no doubt that operates as such when given in large doses.

But when exhib in smallr quant. while gently opens belly at same time encreases tone of intest canal.

Was such affects than here [expectd] from it.

And while in latter way hoped that would encrease power of other stomach imagind that on former footing might be means of affording great relief to patient

And would not only obviate costiv to which subj. but as prom disch of flatus, give to more consid degree that relief which derives from such an [occur] when taking place without any med.

During course of first week did not reap from this med all the benef which I own I expected.

And from this some ground for suspic that disease that disease [sought] [illegible] merely consist in affect of alim canal.

But at same time even to extent to which here given not without affect.

For had both some influ in moving belly & in allev compl of stomach

In freq. eruct however & in sense of ball rising to throat had still evid of inordin action of alim canal.

And might therefore concl. that no inconsid part of remaining compl from this source.

Still however complaind partic of fixd pain on sternum as before.

While formr part of compl then led to contin of med before prescribd, consid this also as now merit some attent.

If indeed as have conject might be case depend on local cause & that situat internally could have but little expect from [med] soon prod [eff]

And indeed if really any local affect, that such affect was seated internally, rend prob. from want of extern appear.

Still however consid it as not an imposs. suppos. that might be either a muscul. pain or that might depend on integ & [membr] extern to thorax.

And if this the case expectd at least some degree of tempor. allev from extern frict with camph. oil.

Than which perhaps possess few more penet topic applic.

Consid it therefore as advis to recom such a trial.

As from this without any hazard, might at least have some farther opport of judging of nature of affect.

But when directed this meas. though also of doing somthing farther with [view] to affect of alim canal than conten of stomach with purgat.

And imagind that might be in good meas freed from one of most distress sym of which now compl. sense of ball vizr rising to throat from counteract inordin action by antispas.

As such had here recourse to Assafo under form of Pil. Gummos.

But what has been affect of these last prescript have not yet learnd.

And in this state of uncertainty had can hardly venture to say what other meas would prosecute should pres fail of afford relief.

Opin howevr of dispos of patient gives reason to appreh that may not see him here again.

But if should return could only pros pres or simil palliat course till more satisf of nature of compl.