DEP/DUA/1/32/09 (Transcript version)

Ann Wright

(1783)

---

Ann Wright. June 6^th

In case of this patient a collect of many diff. sympt.

Still however some reason for thinkn that whole connected.

Compl. with which has been longest affected & which still most distress are stom ailm.

These partic manif by distens & pain, flatul. acid, nausea & some times vomiting.

This however though formerly freq. now we are told but rare occurr.

And reject of food at pres. rather under form of ruminat.

Rising from stomach in mouthf. as it were from inverted persistal. motion.

In all these common charact of dyspep.

And although not an essent have also at least very common concom of that disease in bound belly.

But besides dyspept sympt others also in case before us.

At least are such as do not commonly occurr in that affect.

As of this kind may mention erupt to which subj.

Red pimples we are told often app over whole body.

Seldom however of any long cont.

And indeed accord to acct. rarely remain out for more than few min.

That such cutan erupt may be altogeth unconn with any affect of stom is indeed true.

At same time as little doubt that freq. origin from that cause.

And this connex often partic markd by two affect being obs. to altern with each other.

Here then from freq connex. as well as transit nature, reason to presume that this compl. dep. upon the other.

But besides these still third set of sympt.

Affect viz of breast.

Of this kind are freq. short cough, distress. dysp. & sense of tightness about breast.

These sympt in common to sever affect.

And partic are the attend. not only of catarrh but also of Phthisis.

With this patient cannot I think be altogeth without appreh of Phthis.

For tall & slender make, narrow chest, long neck, & fair though florid compl, indic that habit with which Phthis most common.

Besides this well known that Phthisis a very insid disease.

And that in many inst. has made very consid app. before giving any alarm.

Hence then if in end found subj. to this affect would not be wonderful.

Yet to me seems most probab. opin. that has not at pres. at leas taken place.

For in that case should not expect to find pulse at natural stand.

And during space of three years the period for which has been liab. to cough, should have expected that would have arisen to much greater height or even alr. proved fat.

Upon whole then sever circum much against supp. of Phthis here.

And more prob. that pectoral compl of a diff kind.

In my opin some ground for conject that these as well as erupt also depend on affect of stom.

For from this cause by no means uncommon to find both cough & dysp.

Have every day examples of this inordin action, proceeding from irrit of other parts, as well as lungs.

And while not unfreq. from irritat at liver, still often at stom.

From stomach affect also dysp. no uncommon sympt.

Partic where flatul consid.

For from disten of stomach free desent of diaph & conseq. free expans of lungs prev.

Not improbab. [thence] to be referrd in pres. inst.

And in short that all sympt to be attrib to Dyspepsia.

With this view of case judgem of event more fav. than if consid pat. as lab under compl. of affect.

For in that case would probab require diff modes of cure.

And one not success. combat. till anoth fully overcome.

But suppos that dysp. the origin & cause of whole still [canno] look upon affect as slight or what will be easily remov.

For dyspep. in most inst rather an obstin disease.

And partic so when before [attemp] to cure allowed to be of long standing

Or where has contin notwith that [there] had recourse to

With our patient however is at it [were] a constit compl.

For although arrived to 25^th year has been subj to it almost from infancy.

And during that period many diff modes of cure tried in vain.

Thus circum then cannot I think look for speedy recov.

And perhaps not even for radic cure.

Yet reason I think to hope that by prop. means compl. may be somewhat allev.

And that by allev of affect of stomach other sympt will be mitig.

For accompl. this is in first place necess to correct [most] urgen sympt. & to [prev] arising to [great] [heig].

Of these what cheifly claim atten are the costive & flatul.

For not only of themselves distress to pat. but augm morbid condit on which affect depends.

But not suff. merely to counteract causes augm weak & irrit state of stomach.

Is necessary also what will encrease vigour.

And by this means can with greatest confid expect that return of costiv & flatul. will be [prev].

These gener. intent will suff. expl. pract. to which with this patient have had recourse.

When first came under care prescr. for her the pil. Foetid cum Aloe.

These consist of equal parts of Aloes, Assafoetid & Soap.

And usefully answer intent answer intent of at same time obviat [costiv] & expelling flatul.

Where however patient ill to [move] a single five gr. pill will seldom answ. the purp.

For you will obs. cont. little more than single gr of Aloes.

Aloes however taken as purgat do not operate in prop. to quant.

And where grain or two suffic to move belly taken to extent of scruple or even upwards will seld. do more.

While again where action of intest canal readily encr. by Aloes even very inconsid quant. will do more than wishd.

This according app. to have been case in pres inst.

For even from one pill at bed time not merely effect of opening belly but some degree of purging.

And that too although patien before very costive.

Was therefore obliged to empl. them in still smaller doses quantity.

But with this intent in place of dimin dose directed that should be taken less freq.

To quantity viz only of single pill every second night.

While by this means hoped that costiveness & flatul would be obv. had recourse also to a med with view of strength tone of stom.

For this purp. empl. you will observe a combin of bitters & arom.

Subst. possess one or other of these powers, but partic such as have then naturally conj. gener. known by name of stomach med.

And have long been success. empl against such compl.

Of all vegetab. bitters empl as stomach in few a more pure or more powerful bitter than Gentian

And is accordingly prim active artic in Infus. Amar.

Comb. howevr with small prop of Orange pill & Corriand seeds to give aromat flav.

But this aroma in many cases usefully encreased.

For from action of aromat on stomach, digest promoted, & remova of food prevented.

Thus then less chance at least for occurrence either of [acidit] or flatul.

[illegible] useful aromat however few formulae better suited than Tinct. Aromat of Pharm.

A combin of Cinnam Cardam & Angellica.

Accord in such stomach compl as pres, am almost daily in hab of empl. a combin of Inf. Amar & Tinct aromat.

Sometimes conjoining them in equal proport.

But more freq. as with pres pat using using former to double quan of latter.

From this combin in many [formr] cases have I think seen best effects.

Cannot however say that in pres inst there such have yet taken place.

After contin indeed for space of eight days was less affected with acidit.

But still much distressd with other sympt. partic flatul & headach.

And even at last report these affect contin still much as before.

By this however have not been discouraged from farther use of the med.

And still hope that by persist in use ends in view may be accompl.

Still find however, that even from dimin dose of pills, belly more moved than could wish

For though taken only to extent of single pill every 2^d night had daily sever stools

With such pat however while nothing of more conseq than obv. costiv nothing more prejud than purging.

Hence then of import to obt a remedy which will merely prod regul disch by belly.

As this however seems not to be affect of Pil. Foetid cum Aloe have intermitted use.

And if costiv does not return shall attempt cure by mixt with Inf. Amar. alone.

With this view you will observe since omitting pills have encr. quant.

And in this course mean to [persist] till have had full opport of judge how far can be effect.

If however costiv returns must employ some artic with view of obv. it.

And if patient still [much] distress with flatul. may for this purp. try assafoetid alone.

Or at least use it under form of simple pil. foetid consist of mixt of equal parts of Assafoetid & Soap.

Or in place of Inf. Amar may employ a mixt of Tinct. Amar with small addit of Elxr ex Aloe & Rheo.

If these med unsuccess. future pract must be accom to app. which shall then take place.