DEP/DUA/1/29/12 (Transcript version)

Ralph Johnstone

(1782)

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Ralph Johnstone

Respecting disease of this patient not altogeth without doubts.

But whatever disease may be sympt with which he is princip affected such that must consid it as a very alarm affect.

Here first at some loss to determ whether can consid patient as subj. to one disease only or to a complic of affect.

And 2^dn whether simple or complic still more at loss with regard to cause of those sympt. which evid constit at least prin. part of affect.

Can be no doubt that these are stom compl to which is subj.

Most distress sympt, pain at stomach sickness & vomiting.

These sympts, as have already had occas to observe, when treating of anoth case, are the great [const] of that affect which modern nosol. have disting by title of Dyspep.

Where viz even most distress. stom compl. take place from mere loss of tone & depr. action but without what can be calld a local disease.

In case before us would not pos affirm deny that patient may not be liab to any other affect.

In case before us this may be sole disease to which patient subj.

At least would not pos. venture to affirm the contr.

For unquest every sympt [which] here occurrs even to much greater degree of severity has sometimes been obs to take place without any local affect.

Yet from all circum of the case cannot help being susp. that an affect of this latter kind, does occur with pres. patient.

Of this, the mixt of blood in matter vomited, affords strong presumpt.

Same also may be inferrd from long & unif contin of affect.

And no less from constant soreness of left side encr. on press.

All the circum taken togeth are such as give at least some evid of a local affect.

And if does not here take place, must yet be allowed that more of those sympt which comm indic it, than to be found, in many inst where has really happ.

On dissect often app. that schirros. has realy [existed] in stomach where much less strongly markd during life of pat than in pres. case

Upon whole then disp to consider stomach compl. in pres case as proceeding from shirros. in stom. that visc.

Prob. about pylorus.

Still however must be admitted that if exists has proceeded to no great extent.

And accord only cert. mark by which can pron on pres. of such a state, local hardness viz still wanting.

With this view of princip affect next to inquire whether any other disease.

Are informd that since pres. compl. began patient affected with some other sympt. which not commonly at least connected with other disease.

viz. Severe shooting pains in voiding excrem.

And these observed to be slightly streaked with blood.

This however app. however may have proceeded from some slight haemorrh. affect at time.

Or perhaps merely from that constipat to which patient subj.

But whatever cause has now we are told ceased.

Hence then need not at pres. at least be farther subj of consid.

But viewing patient as subj. to stom compl alone still at loss respect progn.

A necess conseq of doubt as to nature of these

But on any suppos. cannot view affect as slight.

If more dyspepsia from long contin of sympt. from vomiting & from pain, may inferr that affect will be very obstin.

If on other hand, as I own am inclind to suspect, be realy schirr. will prob notwith every endeav we can employ prove fatal.

By no means however in such a state as to prev. attempts to cure.

Nor even suppos affect to be such as now suspect to preclude hopes of recov.

In attempting this, have you will observe, proceeded from begin on idea of schirros.

And accordingly had recourse to a remed. from which must own am for my own part I own disp to enter. some expectat. Cicuta

Am very far indeed from consid it in light repres. by Dr Stork.

On other hand can as little adopt the opin of those who hold it to be altogether ineffic & even insignif.

To this influ which it demonst as affect the head is I think a suffic obj.

And in my own exper. have met with many cases both of schirrous & cancer nature, in which I think evid prod of good effect.

At same time am inclind to think that many, nay most cases of this nature are incurable.

Hence then even freq want of success no argum against future trials.

Here Cicuta empl under form of powder.

And have begun use to quant of gr XV in day.

With intent if no obj shall occurr of grad encr. it.

Have ordered it as united with small proport of Magnes.

Prin with intent of giving proper form.

But also in some degree with view of obviating costiveness & correct acid.

And while well known to have former of these affects operates prin as laxative when [illegible] in stomach to be destroyd.

Here however such a state giving great uneasiness to patient.

Hence both requir to be obviated to encreas prosp. of obt the effect of gentle laxat from Magnes.

At same time belly so bound that did not expect would be of itself suffic.

Hence therefore ordered also the employm of Aloet. Pills.

Influ of both these & magnes as obviat costiv has been no more than suffic.

On this course then for some time at least is intent to cont patient.

Encr. quant of Cicuta & regul laxat accord to circum.

If after prop trial no mitig of affect takes place, or aggrav of sympts, & no circum occurs to [alarm] opin of disease hopes of recov. will be still less than before.

In that situat have next thoughts of trial of electricity.

Prin in way of drawing sparks from region of stomach.

And partic from any part to which pain more espec. referrd.

If both tried in vain, may either look upon schirros as irremov. or idea of affect as a mistaken one

And unless some circum shall occurr to give diff view of it [endeav] then probab. employd merely to palliate.