DEP/DUA/1/46/22 (Transcript version)

Jean Thomson

(1789)

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N^o4 Jean Thomson at 48

Formerly repres case of this pat as being an ex of Dyspep.

And from what have since seen of it, no reason to alter opin.

For of sympt. entering defin of that disease, as given by best nosol. greater part here evid occur.

And indeed are what gener known by title of stom ailm.

These however as constit not only dyspep, but likewise Diapepsia & Apepsia of nosol. supp. to occur without any local disease, either of stom or other parts.

Accord Dr Cullen in his definit after enum common sympt. has added Sine alio vel ventriculi ipsius, vel aliarum partium morbo.

For consid as a pure idiopath disease.

Must howver be allowd that perhap no inst of Dyspep. without what in one sense at least, may be calld loccal disease of stom.

And prob even that affect of diff kinds may give rise to all sympt.

May arise from morb. condit in state of action, of that viscus.

From morbid condit in state of sensib.

From morb condit in state of [illegible]

Or finally from morbid condit in state of fermentat.

And that too the conseq merely of a pecul assim ferment, going on in stom acting upon all alim matters entering stom.

But most freq. merely conseq of a general relaxed & aton state of the stom.

And this I own am inclind to conject is case with pres. pat.

One circum however which may be supp. to create doubt with respect to it.

That is injury to which was subj. at time when affect began

Then we are told receivd injury on breast in conseq of fall.

And not improb that as much a lesion in region of stomach as of breast.

This though hardly to be supp. that would prod idiopath dysp., may yet give rise to diff dis of stom.

And among other not unfreq for such injur to prod schirros.

But from schirros when affect any part of stom, but partic either [cardi] or pylor may distress sympt.

And it must be allowd not a few of these occurring in pres. case.

But in such cases, other sympt commonly obs. not here taking place.

Thus for [exam] swelling & hardness discov, if not externally, at least by feel.

In most inst consid degree of fixed pain.

Contrary to what here takes place uneas & vomiting still more read. from solid than from light & fluid food.

And vomiting upon whole a more const & more distress sympt.

From all these circum then, [inclind] to consider it, rather as idiopath dysp. than as dep on shirros or other affects of injury.

And on this ground progn of two by much most fav.

For schiros a disease very [rarely] overcome.

And if happens at Cardia, still more at plylorus, not unfreq fatal.

This event at least, if opin of pres disease well founded, but little reason to dread.

At same time must be admitted that in many inst a very obstin compl.

And such have here reason to expect both from long contin which has already had, & also from encr. severity.

May however still reasonably hope that patient may be benef. by prop remed.

And with this intent may chiefly expect benef from such as are capab of encreas tone & vigour of stom.

From these however but little to be expected if care be not at same time taken to avoid whatever can dimin vigour.

And not unfreq. necess to have recourse to such artic as obv urgent sympt.

Partic Espec those, such for ex as bound state of belly, which have partic tend to encrease & support the affect.

These diff intent, it will readily occur, much more to be answ. by diet & regim, than by med.

In this compl. greatest attent necess, with respect to diet.

All flatul & [illegible] food, partic to be shund.

Diet of solid & nutrit, rathr than of weak & watery food.

And never to be introd into stom, in watery warm state.

Such diet not only proper for dinn but also even for breakf & supper.

And has been alledged, that some with whom disease before very distr. compl. cured by breakfasting or rather living almost entirely on beef stake.

But from every attent in way of diet perhaps still less to be obt than from air & exercise.

Nothing tends more to induce this affect than sedent life.

And of all remed, that can be had recourse to, exercise in open air, partic riding on horseback, perhaps the best.

With these direct however, resp. diet & regim, lower class seldom have it in their power to compl.

And hence an addit cause of obstin of disease.

How far, direct on these subj, given to our pat, will be carried into execut, cannot pretend to say.

But indep of benef. from this course as far as is empl, may expect some addit benef from med.

With this view, had here in first place, recourse to Pil. Stomach. Ph. Ed.

Perhaps more prop. namd, Pil ex [Kino] & Aloe.

For on these two, activ may be consid as prin depend.

But besides this, cont also a prep of Gum Myrrh.

And what perhaps to be consid as still more active, a propor of essent oil of Mint.

In these two, partic the last, have what furnishes useful carmin stim.

That is, a med tend to expuls of flatus.

But two former, while have also this affect, operate still more as purgat.

Neither however to any great degree

And in quant. to which in general taken, partic under form of these pills, serve merely gently to open belly.

While one of them, Rhubarb from astring power, though laxat in first inst, tends rather to bind belly afterw.

And this merely as conseq of [illegible] alim canal.

Thus then app that diff grounds on which may expect good affects, as stom from this artic.

Hence can readily understand, not only name, by which disting, but also foundat of freq use in stom ailm.

In my own pract, have in such inst, very often had recourse to it.

And although some pat. with whom Rhub in every form, very apt to give great uneas. yet have in many inst empl it with adv.

Here however cannot say that prod of wishd for effect.

For after use, became subj to consid sickness at stom & gripes.

These affects patient herself disp. to ascribe to pills.

And not imprbob. as have already hinted, that may here have been conseq of Rhub.

For, although in my opin, a very excell med, yet with some pat, occas very great distress.

Prob. affect of some pecul idiosyn of habit.

And this observd to hold, not merely with individ, but even in some inst with whole families

In so much, that with none of them can Rhub. however strongly indic, be used on any acct.

But besides sickness & gripes here also anoth effect, attrib to pills.

In place of bound state of belly, there now occurrd, consid loosenss.

And one state of disch, no less to be avoided than other.

For while sympt always aggrav. by constip, are likewise unif rend worse by looseness.

And indeed that this should happen, not more surpriz, in one case, than in other.

Nay evac undr form of catharsis, will most readily operate, as augm the atonic state.

This affect, might perhaps inded have obv. merely by dimin dose.

But if, as conject Rhub cause of sickness & gripes, would have had little influ in dimin these.

And as pat seemd to have taken prejud against med reckond it more advis, not to persist in employm.

In place therefore, of Pil Stom had recourse to mixt. consist of equal parts of bitter & aromat Tinct, & Mint Water.

From these need, hardly obs. that without purgat power, might expect nearly same affects as former.

One of them Tinct Amar. formerly denom Elix Stomach, as pecul adapted to stom ailm.

And has for its basis Gentian one of [purest] of vegetab bitters, oper. as very powerful tonic to stom.

In other, a combin of some of most [grateful] & strong of vegetab. aromat

While mint water, from essent oil diffused in it, operates as useful [dilut]

This combin, have empl in many cases of Dysp.

And I think, very rarely, without at least some tempor. benef.

From the time, that began [use], gripes & loosenss ceased.

Perhaps prin conseq of former med being given up.

And addit evid of conj of patient, that to be ascribd, to it as cause.

But besides this, stomach ailm also somewhat allev.

This then suff. inducement, to contin use.

And if progr to [amend] contin shall prob. go on, with this med alone

If however has not desired affect may conj with it, or subst. to it use of Colomb. root or Peruv Bark.

Or may here make trial of the Cortex Angustura, comb. bitter & aromat to high degree.

But in these must be regul by pres situat of pat.