DEP/DUA/1/35/32 (Transcript version)

Cath Muir

1784

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Cath. Muir. July 19. 1784

In history of this patients case many sympt. are enum.

And some of them, such for example as pecul. kind of pain with which affected, & which [referrd] to region of stom, rather uncomm.

At same time have not, as far at least as I am able to discov. the exact charact. of any affect describd by nosol. writers.

In Dr Cullens syst. can have however no hesit in assert. that appr. most nearly to defin of Dysp.

But at same time as far as can learn at least has been entirely free both from vomiting & even nausea, two of leading sympt of that affect.

But even from defin itself app. that Dr Cullen does not consid whole sympt there ment as by any means essent.

For obs. that pauciora vel plura saltem concurrentia, constitute this disease.

And indeed disease must be defind in this vague manner, if under gener. title of Dysp. are to incl. all those affect. which in comm. lang. known by title of stom compl.

And when consider how apt these are, to run as it were into each other, perhaps only with prop to be viewd as one genus.

At same time must be admittd that on partic occasions app under very diff modif.

And these too in some cases at least remaining in regul & perm manner without any app. charact others.

Hence then some apolog at least for other nosol. who have consid stom compl as constit sev. diff genera.

For in their syst. will find that Anorex. Cardialg. Gastrod. Nausea Vomit. Flatulent. each consid as separ & distinct genus.

And although often occurr in combin & success yet as have already obs. sometimes perman separ. & distinct.

When this the case then afford at least ground for distinct of genus into diff spec.

And to disease of pres patient may I think with prop. give name of Dyspep. Flatulent.

For although ultim from irrit & aton state of stom yet no doubt that flatul immed cause of most urg. sympt.

To this, are, I think, not only to referr flatus & eruct. but also all pains to which she is subj.

That this the cause even of pecul pain of stom. resemb. prickin of lancets can I think admit of no doubt.

This demonst. by ascent of this pain from stom to throat.

And still more by relief from it on eructat.

From this no doubt that pain the effect of distens from [flatu.]

While again this flatus evid retaind by spasm strict to which oesoph. subj.

And from this I appreh. to expl. eruct. being followd by disch of water from stom.

A conseq. very freq result from resolut of spasm.

To flatul. would also referr pain of breast as well as of stom.

And would even attrib to same cause the Dyspn. to which she is subj.

For nothing more common than that distens of stom should affect diaphr.

This however may naturally suppose will be partic the case when laid in horiz. post.

And when consider that spasm [contract] as well as [distent] from flatul propag. all the way from stom to throat, not surpr. that should often be referrd to [breast]

Upon whole then app that notwith num sympt. yet all these to be consid as affect of an irritab & debilit state of stom. giving rise to [illegible] flatul.

And this again in its turn prod pain, dysp. & all other symp

Hence with suff. prop. may be consid as an example of Dyspep Flatulenta.

On this idea then both of name & nature of affect. both Prognos. & pract. to be founded.

With regard to lattr however may be obs. that as patient already dismissd from attend. observ. in some degree superseded.

May only remark that from time she came under care saw nothing in case which could be consid as alarm or danger.

Dyspep in gener. much more a distress & ted affect. than one which has freq. fatal concl.

When this does happen is cheifly conseq of exhaust from excess vomiting.

And although with our patient loss of flesh & strength yet still at least entirely free from vomiting.

While with respect to pain to which subj. from freq. [change] of situat had demonst. evid, that did not proceed from any fixd [cause]

When this the case however although one of most distress, is yet one of least danger. sympt.

And when arises from flatul often without much diff at least to cert. degree counteracted.

Hence then hoped that might soon be able to obv. most distress part of affect.

And that in no long time might be able to dismiss patient at least with consid allev of affect.

An event, which accord has now taken place.

But although this has taken place, yet very far from consid affect as cured.

For many accid, to which patients freq, sometimes unavoid exposed, by which such compl. again liab. to be renewed & aggr.

Such for example as irregul. in [diet] flatul. food, abuse of warm liquors &e.

Hence then should be by no means surpr. to find her again applying for assist. subj to all former symp

But for pres at least, so far free from affect, that should consid contin of med as not only unnecss, but even improp.

For very few med, from habit use of which, inconv at least is not [entaild] upon syst.

Hence then in state of relief which patient had obt. consid it as advis that these should be entirely omitted.

While at same time still looked upon them as the means by which that relief had been brought about

In treatm of this case, consid princip morbid affect. as depend on irritab. & relaxd state of stom. became obj of most import. to restore due tone & vigour to stom.

But as more urgent sympt, the effect of flatus pent up in alim cana became also an obj of import to expell flatus & relax spasm by which retaind.

These gener. intent led to partic pract. to which recourse was here had.

Began treatm you will obs. by prescr. for this patient the Pil. Foetid cum Aloe.

A formula which as have already oftener than once had occas to remark, consists of equal parts of Alo. Ass. & Soap

To this artic in cases of flatul. partic if comb. with bound state of belly have freq. recourse.

And indeed am acq. with few, or rather none, from which in such cases, equal benef. obt.

A power of relax spasms in alim canal is in partic manner the prop of all foetid gums.

And of these, Assafoetid unquest the most powerful.

While at same time, with antispas, unites consid degree of stim power tend to expuls of flatus.

These affects prod, when given under form of Pil. Foetid simp. formed made merely be conj Assafoetid with Soap, & where whole virtue attrib, to assafoetid.

In this form also from influ on intest canal has some effect as moving the belly.

But purgat power inconsid only when taken to extent of but few gr.

And to this dose in most constit limited from influ on stomach.

Hence then in flatul accomp with dyspept sympt, often benef. from conj. with Aloes.

For in that affect, bound state of belly a very comm occurr.

And when occurring never fails to aggrav. other sympt.

While however dysp. sympt encr. by flatul, are also unif agg. by every artic induc brisk cathar

Hence small prop. of aloes which have in gener. affect of giving merely single motion, often attended with best conseq.

Was therefore with view of obv. [unreas]. from wind, & support regul disch by belly, that had here recourse to this med.

But while directed the Pil. Foetid cum Aloe advised also the Infus. Amar.

This need hardly obs. is a simple watery infus of Gent. at least with addit only of small prop. of Orange skins & Corr. Seeds to give slight aroma.

And such a quant of Spt as will preserv. infus, for some length of time.

As water however, fully extracts powers of Gent. look upon it as one of best of Veg. bitters.

And these in gener. well known to be prod of most benef conseq. in restor tone & vigour of stom.

Thus remove morb. irritab. prom digest, counteract acid, & indeed obv. almost all sympt of Dyspep.

From use of these med, patient soon derivd very consid relief.

For while pills had no more affect than that of keeping belly gently open, to empl. of these am I own disp very much to attrib relief from flatul. which soon receivd.

While to bitter infus would ascr. restor of appet. & allev of all other affect.

After therefore [had] contin in [this] state for some time reckon farther attend unnecss & farther contin of med for pres at least, inadvis.

For if again subj to return, by interm for some time better chance of obt. simil relief.

And upon whole pres case affords example of benef of Assaf. & Gent in Dyspep. [Flatulnta].