DEP/DUA/1/21/28 (Transcript version)

James Chalmers

(1779-1780)

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James Chalmers.

Affect probab. somewhat compli

But upon whole singul.

And in my own pract have not met with an analog. case

Of sympt with which affectd by much great part as Cough, Dysp. Borborygm. gripes pain of stom &e very common occurr

But with these a pecul sympt conj which have never before observd.

viz Convuls. sonor. affect resemb Hic

Of this, every Gent. who saw patien at time of visits, able to form distinct idea.

But does not admit of being descr. by words.

Have [indedd] in rep. given name of sigult

And to this greater resemb. than to any noise have before observed

Yet at same time could be no doubt, even from pecul noise alone, that diff.

And somewhat interm between noise of Hiccup & eruct.

And if noise most simil to latter progr. rather resemb. former.

For by no means of instant nature of Hiccup.

Hiccup & eruct however well known morbid affect of diff organs.

And while one from inord action of alim canal, latter other from Diaph.

Here matter of doubt which partic concernd.

And perhaps may be offerd as conj that both some share.

Patient during [attacks] sensib of something rising up from stomach.

And not impossib that after cert. [height], might induce inordin action of diaph.

If however, from either by itself should be inclind to look upon it as from inordin action of alim canal.

At least this rend most probab from other sympt.

Partic borborygm & gripes.

But whatever organ immed affectd no doubt as to nature.

That an inordin action of Convuls. kind.

And formd part of pat. disease if not most painful at least most distress.

Here however many other sympt also occurr.

Partic those indic affect of alim canal borbor. gripes, & [sense] of pain in belly.

Highly probab. that these also origin of Dyspnea.

For this well known always in some degree, effect of disten of intest or stomach, with wind.

And not imposs. also from same cause to acct for cough.

For to be observd that not catarrh, but merely of dry tickling kind & without expectorat.

Besides these at times also affec with headach

This at least a less uncommon occurr. than anoth partic.

Const. sense of coldness in extrem part feet.

To these farther to be added that patient very much aff. with dej of [Spirits]

In all these sympt taken togeth can by no means consid us as having infal diagnost of any dis.

Yet any one acquaint with hist of hypochond. must be sensib that all these & many other sympt freq. oc.

And that although appear very great diversif yet cheifly charact by affect of alim canal, & state of mind.

To genus of hypochond. then might perhaps with greater prop. be referd than to any other.

And patient of that habit of body in which Hypochond most freq occurrs.

For in dark compl., rough coarse skin, & black hair, have at least common extern marks of melan. temp.

But here though disease really in nature hypoch. yet affect most obv. markd by anoth. circum.

That is pecul. singul or [eruct] with which pat affected.

And although not perhaps most import. yet most stricking feature in pres. disease.

From this then would rather [choose] to name it.

And from what already said of nature consid it as more affect of alim canal than of diaph.

Hence then not to be referrd to genus of singult.

All cases of inordin action of intes canal with flatul whether merely eruct borborigmi or flatus actually disch upwards or downwards. Mr Sauv. has referrd to one Genus Flatulentia.

And among other species very full descript of Flatul. Hypochond.

To this as he describes it case of pres. patient more near resemb. [than] to any other genus

Consider this title [then] as more applic to case when came under care than any other.

At same time look upon it as essent. hypochond.

Yet must already again repeat as [defin] that is a modif of that disease which have not before met with.

How far this pecul in any degree to be attrib to an accid to which patient subj not long before came under our care may at least be stated as quest.

From accid. cut in hand, to which from profess as a wright exposed had very consid loss of blood.

To such extent even are told as to induce fainting.

This however with some habits much more read induc than with other.

And would app that with this patient great dispos to it.

For accord to comput occurd from disch not more than ℥XVI.

Still however whether to judge from effects, or quantity must view it as consid.

And when consid gener influ on such habits can have little doubt that remark encr. of affect to be attrib to it.

Probab. even had great influ in giving hypochond, form here assumd.

Yet that not to be consid as sole cause conseq of may concl. from having exist even for years before this accid happ.

And probab like other inst of hyp. more from origin constit than from any partic excit cause.

After this opin as to nature of affect cannot here be supp to give fav progn of every part of affect disease

Probab. even that from all his sympt will not be entirely free [at] any future period of life.

Yet from begin had hopes that this would not be case with regard to most urgent part of affect Sing. or [illegible]

Expt that in no long time should be able to free our patient from this most distress. compl.

And if does not again return, which probab. will not happ. [unless] from some partic cause induc. it, may consid it as already termin.

This however must acknow. has not been effect of our med.

For this patient among other sympt of this disease seems not to have wanted one pointed out among pecul. charact. of it by Mr Sauv.

When treating of obstin of disease observes that freq. proceeds from pat

For seldom that can [subm] to cont under [care] of one person.

Saepius, says he et medicos & method medendi mutant.

Prob from such dispos. that our patient after few weeks attend put him under care of a benev lady, the widow of a Clergyman, who is I may say a celeb. pract. at this place.

This by no means first patient who has been tranf. from my care to hers.

And in my turn too have sometimes had occas to treat patients after had appl to her without success.

Nor surpr. that should be so, when consid that one of prin disease for cure of which is celeb. is epilep.

What her med is I do not know.

And indeed have never even exam or even seen it.

Am ignor. also of any well [vouchd] cases in which attend with des. effect.

But have met with several in which has had fair trial without success.

From this however would by no means inferr that inact. or useless.

For conv. that while some cases of Epilep curab. others not so

And that of these admitt of cure, recov. sometimes to be brought about by one med sometimes by anoth.

From all that have seen therfore am by no means warranted to draw any concl. against remed empl. by this Lady.

Whether that which exhib to this patient was her specif for epilep or not, I cannot tell.

But whatever was, little reason to doubt that with our pat. had good effect.

From time that began it affect of convuls. kind became much more slight.

And after no long contin has we may say entirely left him.

In this state then look upon prognos as to this part of compl. as superseded.

And consider patient as cured of this ailm by med which this lady has exhib.

How far med thus remov. one part of affect may really have [aff] in comb. others, cannot pret to say.

Do not however imag. that [num] train of sympt to which otherwise subj & which have now cont. for long period, will thus be removed.

And this I appreh not to be expected from any med whatever.

After relief therefore which pat has now had, unless from some nerv occurr. shall reckon farther attend here unnecess.

And at pres. recom it to him to cont. attend only that may be more certain as to relief realy [receivd].

Although as have already [observd], am not disp to attrib this, even in any degree, to med which we directd for him, yet may not be imposs to make few remarks with regard to them.

And at least to expl. footing on which diff pract. directed.

When patient first came under care directed for him mixt consist of equal parts of Tinct Fulig & Tinct Arom.

Both these I consid as active artic.

With respect to first however do not think that virtue to be attrib to artic from which derives name.

Look upon it rather as being active & not [ineleg] prepar of Assafo in Liquid form.

And this consid as being one of most powerful antisp of stim kind.

With respect to aromat Tinct. can be no doubt that effic from essent oil of veget. partic of Cinnam [illegible] it, as extracted by Spt menst.

And even by itself in cases where flatus affords stimul to inord action of intest, often best effect

On this ground cheifly induced to advis it in pres. case.

And hoped that from conject should have derivd salut & even immed effect.

In this however entirely disapp.

Only manif effect a sense of heat in stomach.

Probab. conseq of aromat & of menst even of Spirit menst. which taken to consid extent for dose.

But with this sense of heat sonorous spas affect neither less freq nor less severe.

While formr circum therefore some obj to encrease of dose, from latter want viz of success was led to think of trial of some other meas.

And had next recourse to two artic which in gener at least very powerful agents on Nerv. energy.

Camphor & Vitriol Aether.

Both these hold also to be very active antisp & of stimul kind.

And here exhibit in such doses that from either if well adapt to case might have expectd good conseq.

But in place of relief under [these] affect seemd rather to be aggrav.

This indeed not manif a conseq result. from Aether.

For on being taken only obv. effect the induct of freq. eructat.

And that not in pecul manner but of natural kind.

In as far therefore as consisted in expuls of flat from stomach migh be reckond salutary.

But from pills, while sense of heat excited in stomach, pecul distr. symp became manif more severe.

This can only say, is contrary to what have obs. in many cases of obstin singult.

For in such have found from Camp in diff forms most benef. effects.

Here however aggrav of compl. led to interm use, & to trust to Aether alone.

With view of giving every chance augm very consid dose to be taken internally & directed also extern applic.

From use in latter way alone have often seen most distress fits both of Singult & Vomit almost inst [chec]

On this however contin for sever days without any manif benef.

And was in this situat that empl prescript of Lady which have already spoken.

Under this affect soon so far dimn that other trials superseded.

And if at next report contin free from affect. shall consider any farth attend here as unnecess.