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Jul 1. The pilis have no no farther effect than that faces in his eli genti opera. His Leadach continues easter; andi complain tes of eaknesse: ut heis stili affected illi alias a the under par of his belly.
Jul 8. He has ad four Oose oolsfroin the las dos of the pilis. For ometime pasti has liadio return of the violent alii a the pit of his stomach andali the ther symptoriis are ver considerabi relieved. Continuentur siluis sed capiat grana quin que solummodo omni nocte.
ti open, althoughie alie butine everynight He continues re from an re- turn of the severe patia a the cartilago ensiformis and is ver litti affected illi any of his forme complainis.
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OBsERVATION deliυered Augus 1. With regarii to the name of the di aseo this patient, there is ome dissiculty; but a to the nature of it, I apprehend thereis litile rosa for dotibi. i much themost urgent par of his complain is apat in the abdomen, in such a siluation, that here is a possibilit oscit arisingsrom different viscera particularly memight conjecture the ea oscit to e indifferent paris of the alimentar canat. Itina either originate frona the stomach, orsrom the large flexure of the colon; ut ether it e seate in the ne or theother, that it is no fio an fixe cause, appear Do two circumstances. In thesirst place, it is no a constantiain, but re- turn oni at times and secondly, it is notconfine i to the place at hicli it originates, hut it is propagated froni thence downwardsthrough other paris of the abdomen. Tothis it ma be further added thatio fixed affection an e discovere on the ost
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accurate examinatio of the place at whichthe pati commoni begins and that thepain, o the disicharge of wind is considerabi relieve l. From his ast circumstance, e have no oni a proos that it oes no dependupo an fixed cause but, are ted evento form a probabie conjecture, is notato ar-rive a certainty, respecting the cause hichinduces it; and there can, I apprehend bellitie doub that wini confine in the alimentar canal immediately ives rise to thepain. e ma even, I imagine, o oneste further, an conclude that his indsct in inducing the assection, froni heingpent ii in the stomach. of this Dapprehend there is sufficient evidence romthe relie giveni eructations and romfarther observing that eructations are uniformiy remarhed tot the consequence of eating. consider, there re the mos urgent symptom in his case tole thesim- mediate effect of in in the stomach. Besides his, however, hecis assected withsome ther symptoma, particulari head
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ach and bivering But these are eliknown to e frequently the consequenceo an affection of the stomach: and that the are so in his case, is at ean ighlyprobabi: for the headach and vertigo are observe lini to occur hera the patri romthe wind is violent. e may theres ore, imagine consider,ind in the stomach asthe cause of at the symptoms with whichthis patient 1 assected.
For properi understanding the natureo the dis easse, however, it is necessar toconsa de from,henc the wind in the ali mentar Cana arises his e can conceive tot the esse ont of two causes Et ther it inust proceed froni latitude heingassordet for the extricationis an uncommon quantit of ir rom the ordinarymatter employed in alimen ; or it may proceed rom substances bella employed in aliment, frona hicli atri sti extri- Caled to a very great extent. In the casebei reis, there is, Dimagine, reason fors apposim that both causes in ome degree, operate. That it is in soni degre the
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essectis aliment, a be inferrei frona the Particula severit oscit during the pringseason. t is et known that then the flatulent vegetabies are employed in great est abundarice But the presumption is, that this asielther the sole nor even the principat cause otherwis it mould no occurwith the present patient in si much highera degre than withither people. e may conclude there re that here also ooki lace illi hin that peculiar state of the stomacli mos favourable for the extrication of ind. his, however, is eliknown tot the consequence of a weakened tone, hicli probabi operate principali as iviniris est a greater remor of the ood in the stomach than would othei -wis take place On his Ooling, heia, the ea natur of the discas may be sup
posed to consist in chronic weaknes of the stomach and for my wn pari, I bould have litile hesitation in iviniit the appellation os Dyspepsia. It must, howe ver be allowed that thecharacterisin mark of that affection, as
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defined by the est nosologisis, are nothere present. Bucis e conside this termas applied to stomach-ailmenis, thes hereare sufficienti marked in thelain of the stomach, attended illi flatulenc an e
plainis may however, observe, that the termination was more speedit favour
exto a very grea degre of violence Ofthis there,as sufficient evidelice in the stiverings,'eadach, and other affections of the system hicli it produced But, besides theseverity the had atready been os a considerable standing. He had been subjected tothis affection for the pace of three ears nearly to the fame degrefas,henae came unde ou care Andie had been affected With
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mith ome symptom even or the pace of eleven ear before. e might heresere imagine, that the state of the stomachwhicli,e have here supposed testahe place, Was in s me degre roote in the constitution, and that it,ould by no means beeasit removed. I mus no add that although this patient has been disinissed ree
froni complainis Ddo no suppos an entire removat of this assection to have ahenplace. ut although the cause e noteradicated, the consequences resulting romit o the system a for the timete removed, and the patient obtain by this
means a least a complete temporar Cure.
This I imagine to have been the ulmostinat too place in the caseie re os . et even his is tot rechone an objectisssome consequence and untes soni fremexcitin cause occur it a b the meanso producing even a radica cure. From sucti a temporar relie the tone of the stomachinas a belle opportunit of beingrestored than perhaps frona the use of any
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The nex objectis inquir is, How farthis relies has been effected by the means
prosecuted while the patient Was under urcares Here, on the dea hicli, havegi ven of the nature of the disiense, the reat objecti cure a the restorationis a prope tone to the alimentary canat. An this me a conceive tote effecte Mon one of
two principies ithe by thei se of suchmeasiares a immediatei acn in increasing the tone of the stomach, o by the remo-valis fuch cause a serve farther to,eaken it. It was on the alter of these principies that Phere attempted the cure and with his te employed a combinationis aloes and as foetida. From these Ilioped that in consequerice of the anti- spasmodiciower of the medicine, the windwould n longer e pent u in the fame manne aste re and that, by the stimulus whicli it ould occasion to the alimentarycanal the actionis the stomach and intestines might e so far augmented a toprevent that lo progress and detentiono the aliment hicli migh give ris to
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an generation os in I. These different intentions seem to have been fuit anfwered by this medicine for whilesit had theessect of operatinias a genti cathartic, the patient as a the fame time reed frona ali uneasmes from in i and whilethelainiecam les severe, it seemed alsolo have sinisted iis siluation sor he oonaster describe it tote eated lower in theboweis, and he had not continued the use of his medicinet for an long period whenit as entiret gone. In his siluation, Preckoned tinnecessar eithe to ut thepatienti the use of an other medicine, o to direct longe attendance He astheres ore dismissed, illi injunctions isti inouldie subjected to any return of his complainis, to iveis information fit. But Phave ince ad occasion to se hi monener than once, and he stili continues in good health.
This patient has not a far a least as can earn, been since subjecte to anyreturn of his diseasse. XXVI.
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his age, admitted Junerio. 1777, haso late been observe frequently to disia charge Orms of the lumbricous ind, whicli in genera are bout ight o ten inches in tength He complains flain in his belly an breast hicli is no constant, ut attach him, at hori intervais, with considerable violence He is re quently observexto pichiis nosse H is osten affected illi tenesmus, and hesmahes frequent attempis to disicharge urine,ith-
hein ablesto passe any. He eeps tolerably et during thenight butine is assected illi considerablethirst, and his appetite is much impatred.