DEP/DUA/1/27/08 (Transcript version)

Mary Downey

(1781-1782)

---

Mary Downey

In hist of this patients case numer collect of sympt.

And no room for doubt that affect of complic nature.

Here partic, complic which would natur referr to alim canal, to head & to lungs.

Of these most obstin & distressing of the formr kind.

Appear not merely under form of affect of stomach but likewise of intest canal.

Chiefly however distress in former.

And there appears under form both of pain, of sickness & of pyrosis.

Such sympt commonly consid by practic writers under gener title of stom. compl.

Most of nosol. however have formd them into diff gener. of disease

And if here were to follow these syst. should consid patient as subj to almost as many diseases as there are here sympt of affect of alim canal.

Cannot help thinking therefore that D. C. has acted with greater prop. in referring whole to one genus.

That viz of Dyspep.

For under this compreh. Dyspep Apepsia, Anorexia, Nausea, Vomitus Flatul &e of other nosol.

When however so many reduced to one genus, in some meas except as running to other extreme.

And includes affect not only diff in appear, but also in mode of cure.

Besides this term Dysp. cannot with prop. be applied where there does not occurr diffic of digest.

And perhaps would be better if were confined entirely to those case where with this, there occurs also som degree of diffic of breathing vomiting

Where neither of these occur [howev] often patient very distress from wind in stomach.

And that too even when funct of stomach can hardly be said to be disturbd

For occurrs princip when stomach empty & when flatul makes way from intest.

Have often long therefore been inclind to think that flatul. should constit a genus of disease

And if this a proper gener. name of disease, must consid pres case as affording example of it.

As constit this affect here may consid pain & sickness at stomach borborigmi, pyrosis, & bound state of belly.

These however you will observe by no means only sympt in pres case.

Besides these patient also no inconsid degree of distress from headach vertigo, & tinnit aurium.

And here natur occurs as quest, whether headach to be consid as an idiopath, or symptom disease.

On this subject would not pretend to decide with cert.

Yet of the two rather inclind to former latter opin.

Well known that sympath. between head & stomach very great.

And that stom compl. one of most common causes of headach.

Here then from degree to which former subsists may readily suppose that is prod of latter.

To this conj. the rather led, from observ. that attended with vertigo & tinnit aurium.

For although these may undoubtedly also attend idiopath headach yet can be no doubt that even more freq the prod of impress on alim canal

And partic of that impress arising from distens of stomach by wind

Here therfore inclind to consider affect of head as merely symptom of flatul.

Perhaps also same in some degree case with respect to pect. compl.

At least distens of stomach by wind often prod of dyspnoea.

But from this cause, very rarely happens that cough induced.

Pres. therfore in this inst. against that suppos.

But besides this several other part also against it

Partic differ of duration.

Stomach compl. have contin for sever years.

While pectoral compl only of three weeks standing.

And then ascribd to expos. to cold.

May then both from durat & cause consid it as recent catarrhal affect

And as being totally unconnected with affect of Stomach.

This then idea of nature of affect here to be treated.

And from what have said may suppose that did not entert same opin as to termin of every part of it.

Of all sympt. affect of alim can seemd to be most obstin.

And had reason to dread that would be most diffic to overcome.

This the rather to be appreh as patient not in situat of life to empl. that mode of cure which have always found to be most effect.

For in this affect when appear undr pres. form, much more to be done by diet regim than by med.

Partic by avoiding flatul. veget diet, & by free exercise in open air.

To these however highly probab. that circum of our patient very ill accomod.

And without these attempts in way of med could by no means have full advant.

Did not therfore expect that even if direct had been exactly compl. with patient under our care, could have compl. recov.

Yet hoped that by obviating some of most urgent sympt, might at least have given immed relief.

And that thus might in great meas, if not entirely have mitig headach

With regard to pect compl. had also hopes of being of service.

Catarrh yet a recent affect & not very severe.

And imagind that with tolerable caution, might even of itself have tenden to fav. termin.

To this indeed season of year unfav.

And perhaps also habitat & clothes of patient.

Not wonderful therfore if should run on during whole winter.

And that the [rather] has had done so on former occas.

A circum giving even reason to presume that might at last termin in chronic state of that affect.

Upon whole however expect were that in pres inst, mitig might be obtaind.

And on this idea began pract [with] patient.

Here as have already obs. consid flatulent as being most urgent compl.

And this to be radical overcome by restor prop vig & due action to alim. canal.

This however to be effected only as work of some time.

And although tonic med, such for ex, as Peruv. Bark. Veget bitter & like, might be used with some [pos] of advant. yet more to be expected as already observed from diet & exercise.

While these however, very great influ as removing morbid condit giving rise to flatul. still more immed ease to be expected from expuls of air [alread] extric.

And for this purpose nothing of greatr conseq than promot free disch by belly.

Provided at the same time such artic empl, as have tendency to remove those spasm strict of alim canal, by which air retaind in it.

Was with view of accomplish. these intent, that had recourse to princip med here employd.

Use viz of Pil. Foetid cum Aloe.

These pills comp. of equal parts of Aloes, Assafoeti. & Soap.

Latter artic intended merely to give form.

From aloes expected effect of gently moving belly.

And to extent here given, looked for that to such degree, as would give no inconven to patient.

For to be observed, that although in such compl. benef from moving belly yet strong cathart, always attended with bad conseq.

Assafoetid even to quant. in which enters these pills, in some degree oper. as cathart.

But still more useful from conj of stim & antispas. power as tending to expuls of wind.

Accordingly from this formula have in simil inst, often reapt best effect.

And here expected that patient would derive from it at least consid temp advant.

But besides this had recourse also to anoth med. viz Mist Mucilag

Of this med the active basis is mucil of G. Arab.

And intended merely as demulc. to take off irrit at fauces.

But till that be case if shall ever happen farther observat as to future treatm altogeth unnecss.

Under this hoped at least for some mitig of cough.

And with these might probab. soon have dismissd patient, althou not radic cured, yet consid relievd.

That this however has been the case, can by no means pos pretnd to say.

Nor do we even know, whether patien has taken any of med ordered for her.

For since these were first deliv to her, has not attended weekly [reports].

Am however inclind to think it more probab, that dissert. has proceeded, rather from her having obt. temp. relief, & consid farther attend as unnecess. than that has arisen from any other cause.

If this conject well founded only chance of seeing her, is from recurr of affect.

And in this way patients of themselves giving up attend freq return to Disp

>+