DEP/DUA/1/26/10 (Transcript version)

Robert Wilson

(1780)

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Robt Wilson.

When formerly under our care disease introd into regist in following terms.

R. W. at 23.

Is affected with vomiting about an hour commonly after meals, though sometimes it will happen in few minutes. What he discharges is commonly a clear acid liquor at other times part of his food little changed. He complains of great pain at the scorbiculus cordis, violen palpitations, Borborigmi, headach & a very great discharge of flatus by the mouth. The pain in the scorbiculus cordis & region of the stomach is much encreased when his stomach is full; & when empty he says he feels an inexpressible want, somewhere about his heart. He is attackd also with a sense of cold which is at first confind to a spot about the size of his hand, between his shoulders, but soon extends over his body at which time he is threatned with deliquium animi

Pulse & heat natural – Respiration somewhat impeded. Belly bound urine regular, but it often varies in colour

His complaints began about the month of April & he imputes the pain to a hurt he got in carrying too heavy a load at which time he says, he thought something was broke or torn within his breas

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After reading this hist for [illegible] opin which at pres entert with regard to this patients affect may not be improp. briefly to [state] idea which then had of this compl.

This opin as already remarkd formerly deliv in lect

Then observd that

In case of Robt Wilson great diversity of sympt.

And besides what ment in hist several others also have had taken place since from time that came under care before subj

Partic a cutan affect. with which at times very much distressd.

How far, all sympt to be consid as belonging to one disease, a matter of some doubt.

Not impossib that unconnected.

Yet lookd upon it as more probab suppos. that all sympt of same affect.

And that notwith rank of patient, & period of life in was subj to Hypochond.

Hypochond it is true princip an affection with those who have passed prime of life

And more freq with those who by situat enab. to brood over compl than with others.

Yet that no situat absol. suff. to counteract it, app from many inst.

And with age of pres patient [altho] more rare than at after periods, yet not unfreq. occurs.

Must therefore, determ pres by sympt.

In case now before us read by much most numer [train] of sympt of the dyspep. kind. or in other words stom compl

Not only affected with uneasiness after meals, & pain at stomach, marks of want of ready digest; but also with with borborygm. flatus, vomiting &e.

And besides reject of food often disch of a clear coloured fluid.

These at same time attended with bound state of belly.

In that train of sympt now ment. have common constit of dysp. strictly so calld.

And if no other appear in case should without hesit consid it as examp. of that affect.

Will partic observe that corresp very exactly to defin of Dysp. by Dr Cull.

But while these sympt. disting constit dysp. to be observd that occurr also in hypochond.

In so much that this affect def. by Dr Cullen, Dysp. cum lang, torpor, [illegible] & [illegible]

And although variety of other symp in hypochond. yet will still be allowed that stom compl, & mental affection most distress.

Here however although admit that stom compl. same app. in dysp. as in hypochond, yet would not be [und] to inferr, that morbid state on which depend precis of same nature.

For well known that as affect state of digest in partic, same app. from very diff, nay opp. causes.

But whether this observat well founded or not little doubt that such app. in way of stom compl. as here occur mentiond equally in common to both.

To inquire therfore how far in other sympt. charact of hypochond.

And from definit already given should natur first look for state of mental affect. occurr in this disease.

Here however situat does not enab. us to form prop. judgem.

For condit of mind to be known only by those who have freq opport of obs. patient.

And from all such, we are here entirely excluded.

Cannot therfore with confid say that such exist.

Yet some ground for susp such state of mind, in cause to which pat referrs affect.

Affect attrib by patient to carrying heavy load.

At that time imag. that something broke or torn within him.

That intern rupt. may be conseq of very viol straining no one can deny.

Yet had it happ. in pres. inst, must have been immed prod, of very diff conseq, from what have here taken place.

Hence little doubt that entirely imag of patient.

Indicat therfore of that state of mind partic with respect to compl with which Hypochond attended.

But while stom compl. & mental affect great constit of hypochond; many other sympt though less freq, yet often occurring in this [diseas]

And of these not a few in inst before us.

Have very common & what on many occas very distress sympt of this affect. in palpit to which patien subjected.

Same also may be observed with respect to headach.

But a sympt still more charact than either in that pecul. sense of cold, which at times began in [back] from thence prop. over whole body.

And attended even with such uneasy feelings as to threat deliq. anim.

Such affect may indeed occurr in diff diseases.

But is none more freq than in hypochond.

Seldom that disease takes place without unequal generat of heat local & partial coldness

Or rather perhaps what may more prop be stild unequal gener of heat.

And while occurs in various forms in none more freq. than that here describd.

In more inst than one of most distinct markd hypochond, have seen affect of this kind proceed even to such length that actual deliq. anim induced.

Consid this partic then as afford if not certain proof at least strong presumpt of hypochond. affect.

Besides what already mentiond [might] also point out if not as charact. at least as common sympt of this affec disease, affect of respirat occurring in pres. case, state of disch by [urine], belly &e.

And upon whole sympt at attack of affect such as to afford strong pres. evid of this compl.

In app since from time patient came under care nothing to lead us to alter this opin.

And may even obs. that superv. sympt. rather favour sentim as otherwise.

This partic the case, with regard to itchy erupt. which had since superveend.

For among other affect from which proceeds, is not unfreq. concom of hypochon.

Reckond it therfore more probab. that in case before us, proceeded from this, than other cause.

And notwithstand diversity of sympt in affect consid whole as what justly entit to name of hypochond.

With this view opin of name of disease will readily suppose that could not entert sanguine expect of speedy termin.

For hypochond affect well known to be in nature most obstin.

May be consid therfore Might indeed have been consid as some object to suppos. that patient [alrd] dismissd free from compl.

A circum which may be consid as now supersed farther observat on prognos.

But notwith situat am at that time, then obs. that was far from consid patient as cured.

Had little doubt that on future occas perhaps even through future life will be subj to returns of compl.