DEP/DUA/1/33/20 (Transcript version)

James Marshall

(1783-1784)

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James Marshall Janr 10^th

From hist. of this patients case will obs. that prin sympt were borborigmi, flatus & acid eruct.

But above all pains in abdom

Can be little doubt in referring most if not all these sympt to same cause.

To uncommon collect of wind in alim canal.

And can have no hesitat in consid it as an ex of that affect to which greater part of nosol & pract writers have given name of flatulent.

Flatulent indeed not consid as a genus by every systemat.

And partic has no place in syst of Dr Cullen.

Cannot however repres him as having omitted it.

But has [comprh.] it under his genus of Dyspep.

In my opin however these gener. are conj with improp.

No doubt indeed that sympt of flatul & stom compl. often conn

And that very apt mutually to induce each other.

But at same time, may & freq do exist separ.

Many sympt of Dyspep. wanting in most cases of Flatulent

And on the other hand often stomach compl to great degree where little or rather no uneasiness from flatul at least in intestin canal.

Accordingly in case before us though some, yet but inconsid conjunct.

For although acid eructat, yet neither Anorexia, nausea, vomiting nor pain of stomach.

While again chiefly markd by borborigmi & severe pain over whole abdom but partic about umbilicus.

Hence therefore notwith freq. conj. yet as well entit to be consid as separ genera, as occas flatul, & perman tympan.

On these grounds then with view to distinct from Tympan on one hand & Dyspep on other, give to this affect name of Tympan.

But although uncommon [extric] of air, immed cause of princip sympt. yet for understanding nature of affect, necess to have in view cause from whence this arises.

That very gener. depends on want of due tone in alim canal.

Which however commonly conjoind with dispos to inordin action

And indeed on such action not only the borborigm, but the pain also in part depends.

For although princip, yet not entirely the effects of distens.

But in whatever manner this as well as other sympt may be prod. can be no doubt that affect itself no less common than troublesome.

May however add, that more troublesome than danger.

And although not always in our power to remove, yet can in most inst. at least relieve this affect.

And although True indeed that after once induced yet apt to be again renewed from slight causes. Yet entertain hopes of fav. conclus.

Or at least of such remission that patient may be dismissd from farther attendance.

This the rather to be expected from relief which has already been obs. to have since came under our care.

For as will obs. from reports though some superveening sympt had occurred yet was at one time, almost entirely free from those ment in hist of case.

Since that indeed, has again been subj to recurrence.

An event to which reason to [appreh] will again be subj on future remiss.

And that the rather as diet, from rank in life, more spare & consist more of farinaceous matter, than suited for his affect.

But at same time, to meas already empl. am inclind to attrib relief which patient has exper. since came under our care

By same pract simil & even more perman. benef may be obt.

Or if in this disapp. others may be adopted to improve advant derivd from it.

Here for immed ease of patient is in general first obj. to bring about expuls of wind, both by encr. action & by remov. obstr. to it.

But of no less conseq. to employ such meas as will encreas tone of intest canal & to remove causes weakening it.

Was with view of fulfilling these intent, that had recourse to pract here directed.

Began treatm you will obs. by direct for patient, a mixt of Rhubarb & Magnes.

To first of these artic, was in some degree led on general principle of juvantia.

For will observe, that before came under our care, had been in habit of empl. it.

And partic with the good effect of obviating costiv.

As answer even this intent then, had reason to expect, both that would remove obst. to passage of flatus, & encr. tenden to that expuls.

But besides this from astring [qual] unquest operates as encr. tone of intest canal.

While by bitterness, must at least have some effect, in destroying acid a cause very much weak. tone.

From sympt of acid eruct. howevr hardly imag, that would be prod of this effect to suff. degree

Hence you will observe was led to conjoin Rhub with Magnes.

Which of all the absorb. where acid to be destroyd, & at same time disch by belly prom, is unquest the best.

This combin directed you will observe, to be taken in Peppermint water.

An artic not merely empl as a [illegible], but with view also to active powers.

For no doubt, that has powerful & immed influence, as tend to expuls of wind, at least as far as lodged in stomach.

While therefore Rhub. & Magnes source of more perman benef. from this [expect] that patient would derive immed relief

In these views expect to certain degree at least were not disapp.

For use attended with consid relief both from acidity & flatul.

Had however but little effect in moving belly.

And still a good deal distressed from wind which seemd princip lodged about infer part of alim intest canal.

From this led to direct in conj with med formerly empl. the use of Pil. Foetid cum Aloe.

A formula consist of equal parts of Aloes, Assafoetid & Soap.

And from which with patients lab. under flatul have seen most remark benef. derived.

For while aloes move belly, Assafoetid while which has some effect in this way has also powerful influ as remov spas strict, by which both flatus & excrem retaind.

Under these med patient soon obt very consid relief

And after short contin was almost entirely free from all sympt with which affected when came under care.

But at this time were informed of a new occurr which consid as deserv. some attent.

Disch viz of some ascarides by stool.

These indeed from acct given, but few in numb. & appar. not prod of any uneasy sympt.

Worms partic ascarid often lodged in intest without prod any bad affec

And this might prob. have been case with our patient.

From what cause now manif by disch. cannot pretend to say.

Not improb. however that in some degree conseq of Foetid pill.

For assafoetid well known to have very powerful influ in killing & exp. all worms.

And is one of those anthelm active powers of which carried through whole intest canal.

Hence reaches even rectum where ascarides commonly situated.

This therefore addit reason for contin use.

Though princip led to persist in empl. with view to expuls of flatul. & obv. costiv.

And as reason to presume that more ascarid still remaind directed again these a more powerf med.

Use viz of inject of Lime water.

From situat of ascarid, very generally merely at rectum, most anthelm rend [effete] before can reach them.

Hence then, those artic in general best effect, which immed applied

And of all inject I have tried, have found none more effic or more safe than lime water.

How far had here any good effect cannot pretend to say.

Not improb. that before commen of use whole had been disch.

For since began empl. none have been obs.

But after intermiss of Magn. & Rhub. again subj to consid return of pain

From this therfore led to [direct] repetit.

While from absence of sympt of ascarid, lime water omitted.

Under use of this med pains from flatul. again consid dimin.

But from empl. in conjunct with pills, had now in general five or six loose stools every day.

Here however to be obs. that while with pat subj to flatul, [constip] to be [dreaded] severe purging no less so

For has unquest very consid tenden to weaken tone of intest.

And never fails to leave patient worse than before.

Omitting foetid pills therefore, have now directed contin of Magn & Rhub. alone.

And under use hope that patien may soon be in situat to be dismissd.

If this howevr not the case, shall endeav to strengthen tone by vegetab. bitters & aromat.

The infus amar, Tinct Aroma Elx Saer. or the like.

But in this must be much directed by circum in which shall hereafter find patient.