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A young Lady aged nineteen years a weakly child when born. At two years
of age she had the small Pox in the natural way, & was much reduced by them; Before
recovering from them she was seized with the rickets, which keepd her long weakly. At
two years of age, & for a year or two after that, she seemd to promise better wealth, but
begun to be distressed with worms to a great degree; they keepd her in a bad habit of
Body for some years. In short she did not seem to gain any degree of health or
Colour till her menses appeard, which was at the age of fifteen. After that she
grew fast & turnd lusty, & had a good colour, yet even at this time she had stomach
complaints, & would throw up some part of her food at times, & had not near that
natural strength which would have been expected from her appearance, & indeed she
seems to inherit a weakly constitution from her mother & to be of that tempera¬
ment which cannot resist the effects of depressing passions with that fortitude which
those of a more robust habit can. --- Tho at the same time she seems to have nothing
of the melancholic temperament. -- Unluckily for her since she came to the years (↑age↑) of
being sensibly affected by these passions, repeated instances have happend to call
forth the exertion of her fortitude, what has bore so hard on her as to hurt her Consti¬
tution. -- Tho she was now & then troubled with anorexia & vomitus, it came to
no great length till June 1775 when a melancholly accident happen'd which hurt
her greatly; and it was this, a Sister of hers married & went to live about 40 miles
distant, & along with her went a younger sister, together with their father & mother
for a visit. The Lady whose case I am now relating was left at home with another
sister only. -- The parting with the married sister affected her deeply, as they were all
extremely happy with one another, & from their situations could see others very seldom.
But the severe shock was, this younger sister soon after leaving home, was seizd with
the scarlet fever & sore throat, of which she died in six days. This disease was very
Epidemic during all the Summer, which was exceeding hot. -- Such melancholly
accidents being brought her so soon & so unexpectedly, hurt her very much, & threw her
into fainting fits, then she recoverd, but from that time her Stomach complaints

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became very troubelsome. The anorexia & vomitus turnd more severe, yet she had
intervals from both. --- In November the same year she was taken ill of the same
disease which had provd so fatal to her sister, & had a narrow escape. -- Being consi¬
derably weakend by her Stomach complaints, this disease could not fail to reduce
her very low, after it took a favourable turn & she begun to take some little food,
the vomiting became very severe, & has continued so every since. There has scarce a day
elapsed from that time till now, but she has thrown up almost every thing, tho
at the same time her flesh has not at all wasted in proportion to the small quantity
of nourishment that seemingly enters her Blood; for frequently her food does not rest
five minutes on her stomach, & in general a few hours is the longest time any kind of
food rests on it; & that, I should say, is very rare. --- For common she vomits pretty easily,
& when what she has taken comes up she is at rest -- But sometimes she has very
violent fits of it which bring on fainting fits -- At these times she gets no relief
till a brownish stuff like coffee grounds is thrown up, what tastes bitter. -- What she
ordinarily throws up is sour. -- At first her Friends took this brown stuff for matter
But I have had occasion to examine it frequently, at least three or four times, but
it has no appearance of that kind. -- It seems to be mostly bile, which being pump'd
into the stomach by vomiting, is retained there, together with some part of her food,
/ owing to the debilitated state of the stomach & weakend peristactic motions of the guts, +
& by lying long on the stomach acquires that appearance. For this stuff does not
come up at every time she vomits, only when she has a very violent fit of it --
There seems to be no topical affection of the stomach, it feels indeed rather fuller
than natural, but no particular hardness. She has very little pain of the stomach
except after throwing up, & then not much, unless after the violent fits. They dis¬
order her much, & have some degree of pain & a feeling as if her stomach & sides
were bruised. These go off if her stomach continues any time sealed. She {illeg} (↑has no↑)
{illeg} (↑retching↑) when her stomach is empty. There does not appear to be any schirrus about
the Pylorus as far as I can discover. -- In that case would she not have been more
emaciated /for at present she is not much thiner than in her ordinary health/ &

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some degree of hardness felt about that part? -- The other abdominal viscera
appear to be sound, & no signs of her Lungs being any ↑way↑ affected. - She is not hectic
Her pulse so much in the same way as when she was best, regular & nor low or weak,
nor is it much encreasd in quickness even by violent Vomiting. - She has no thirst.
Sleeps commonly well. She rises ordinarily between ten & eleven forenoon, & goes
to bed about ten at night; keeps up all day, & can walk the room slowly, her Joints
are feeble indeed. - She is more apt to have the violent fits of Vomiting in the
morning, than any other time of the day, if she takes any food before she gets up.
When this happens she is so much disorderd that she is obliged to keep her bed
most of the day. - Her menses are regular & have been so since they first appeard,
for a while past rather copious, but not to a degree to hurt her health. - During
the fits of violent Vomiting she ↑is↑ much distressd with belching of Wind, at other
times she is not much troubled with it. - She is naturally of a costive habit,
but since she had the sore throat - the violent vomiting came on, even to this day,
she has seldom if ever had one stool but what has been procured by glysters and
laxatives, - almost every kind of food or drink, in small or greater quantity,
equally excites vomiting; in general what is solid keeps the stomach longest, tho
it strains her more to get it up again. grog / brandy & water / is the drink that
seems less nauseous. - Her spirits are in general tolerably good. At times they
are a good deal depressd which is not to be wonderd at, considering that she is not
now any better than some months ago. - I think the severe fits of vomiting are
not quite so [some?] (↑straining↑) now as they have been, but in other respects the vomiting is she
same, it is rare if she keeps one meal till she gets another ↑her meals are very slender having no appetite↑ -- For three or four
years past she used to have a severe cough in the spring, which was removed by
Blooding & other cooling applications. She was free of it all Summer, & might
in Winter have an accidental cold. Her mother tells me that these spring Coughs
have hurt her greatly. She has had none this spring, nor is her lungs /as I have

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said before/ any way affected at present. --
Her disease I think /with submission/ is Dyspepsia, & in my opinion seems Idio¬
pathic proceeding from a debility of the general System & the tone of the Stomach in
consequence lost or greatly weakend. -- I cannot discover any appearances to
determine it symptomatic, as you will see by the above history. -- unless (↑If↑) it has
any (↑no↑) relation to the Dyspepsia hysterica, it has none to any other of the sympto-
matic kind as far as I can discover. - Any reasons for dismentioning the Dyspep.
hysterica are, that She is of a temperament in which the nerves are very ir¬
ritable, & during the time she was distressed with worms she had pains in her
Bowels & fainting fits as I am informed, whether these pains proceeded from
convulsive motions of the alimentary canal, I know not. - She has indeed now
at times pains in her bowels; whether these are owing to her costiveness, or to mo¬
tions of that kind I am doubtfull. - Further during the violent fits of
Vomiting those appears to be spasmodic affections of the upper orific of the
stomach which retains the air ↑in the Stomach↑ at times, so as to make her gasp, & cry she is
like to lose her breath. These spasmodic affections may be communicated farther.
I mention these things with no other view than if it (↑they↑) can throw any more
light into the nature of her complaints. All is submitted to your superior
Judgement. I may be wrong in my apprehensions, & will impatiently wait
for advice which I can safely follow. -----

The method I have taken in her Case is as follows. -- when she was seized
with the sore throat I would not attend her, being situated at a great distance and
otherways necessarily engaged; I was wrote her complaints as well as her friends
could, but I could not from that learn them with any degree of precision. The
sore throat was then mostly over & the vomiting come on. - apprehending
that the putrid diathesis, which discovered itself in most who had that disease,
might not be overcome, & being generally of service nor strengthening the tone

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of the stomach, I orderd her the Decoction of the Bark & and Spirit of Vitriol, at
the same time advising them to keep her Belly open by Glysters, thinking that the
most advisable method to answer that purpose, as it might besides be of worse effect
as nourishment, as she vomited so much. - I also advised such a diet as timid
to me most proper, {illeg} forbidding the Vegetables
of difficult digestion & those apt to create acidity --- This regimen she followd for
some time, as it was a considerable time before I heard any distinct accounts again,
& even then I was not acquainted with many particulars what would have been
very necessary to be known. - Being inform'd that the bark &c. had no effect
for restraining the vomiting, I advised the bark to be laid aside; suspecting now
an inflammatory diathesis of her blood I orderd a tea cupfull of Blood to be
taken to know whether it was so or not, & it was found to have what is calld
the inflammatory crust. - She now used the acid alone & at times a few of the
Aloetic Pills as a laxative. - I have frequently thought of trying to take more
Blood, but so many objections start to me, that deter me from the tryal. - I can see
her greatly weakend, & by no means a fit subject for trying Experiments of that
nature on. For if she is not relieved by Such a tryal, her complaints must be ag¬
gravated - at this time I advised to give her Camomile tea to drink when they saw
her vomit up the brown stuff to assist in carrying it off, but at no other time. - As
the tone of the Stomach depends greatly on exciting the action of the extreme vessells
I advised a flannel there to be more near her skin & her extremetys & even her body
to be rubbed twice a day with a coarse cloth or flesh brush, & farther to give a
Stimulus to the system I advised a Blister to be applyed between her shoulders,
& that it should be keepd open whith it is as yet, this was done principally
because she was not for having any more blisters, & I imagined they might have
been of service. She has also had the emplastrum calidum at her Stomach.

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Notwithstanding of this method I was wrote that the vomiting still continued
& became rather worse & that it had thrown her into fainting fits, I thought if
it was not at times checked it might have bad consequences. I therefor sent her
some Liq. Laud. to give ten or twelve drops at first; & to increase the dose as ↑it↑ became
Necessary, informing them nor to give it but on urgent occasions which I pointed
out to them. - The opiate relievd her of the vomiting at the time, & gave her some
respite but it could not remove the cause. -- Since I saw her which is within these
five weeks, the symptoms do not differ from the above description; To correct the
acidity she has got magnesia alba & lime water; as an aromatic as times she
gets the aq. minth: piperit. --. I have seen two or three violent fits of vomiting
in which I thought it adversable to give an opiate to gain a temporary relief.
I am loth to give it except when necessity calls, as it tends by repeated use to weaken
the stomach. These fits of violent vomiting are preceeded by no remarkable symp¬
tom ↑to warn their approach.↑ {illeg} At times that brownish stuff may be so dissengaged as more readily
to come up at one time than another. -- When it appears, then she gets camomile
tea & water to assist in bringing it up. It would be in vain to give opiates in that
Case ↑to check it↑ for if they did check the vomiting at that time, it would only be laying the
foundation for a more violent fit afterwards.-- After that stuff, to appearance is
thrown up & the stomach does not settle, & she like to be chookd with wind. I give her
the opiate. It is but seldom necessary. -- I have proposed her taking Tar water, but
she declines ↑it↑. She takes the acid spirit of Vitriol, & I am to give her Bitters. I gene¬
rally stop their use for a while, after they have been taken for some time. - with
the view of restoring the tone of the stomach, whenever the weather becomes mild she
is to ride much on horseback. She has been out once or twice but the intervals are
so long & the time so short that she can stay without doors, that it has had no effect.
She uses the Chamber horse much. I have endeavourd as much as I can to avoid
the remote Causes of loss of Tone. But there is one Cause & a material one which it
will be very difficult to obviate. - I mentiond before her being of a temperament

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that is strongly assisted by depressing passions. In such a confined Society as
we have here Causes ↑to excile these↑ must be ocurring frequently when almost every one is
in some way or other connected. -- It may appear something odd that in two
months time, I should advise medicines to correct a putrid diathesis & advise these
to be laid aside on a suspicion of the contrary. To account for this, she has often been
seen to turn ill colourd & lean in a very short time, & in no longer time has become
plump & full. This happend to her particularly during the time she was distressd
with the Worms. -- I am strongly impressd with the opinion that sailing would be
of service in her case. - I have proposed that when the weather turns warm, for
her to try a sail now & then, between which & riding she may be agreeable a¬
mused & benefited. Probably a longer sail would be of use. -- The excretion by
Urine has been all along rather scanty & high coloured, probably owing to the small
quantity of Liquids that rested on her stomach ---------

Since writing the above she was seized with a fever of the continued kind. It is
ten days since she was attacked, but no appearances of a crisis. The day preceding
that on which she was taken with it, she had a severe fit of Vomiting in the morning.
She got up in about two hours after, but being unable to sit, she lay down above
the bed without any cover but her body cloths, nor would allow of any other. She
lay for a considerate time in this way. - Next day she was very feverish & has
continued so since. There is an infectious fever in the house, whether it is owing
to that Cause, or to excitement of the system brought on by the cold she got lying
above the bed, I cannot positively determine. - For two or three days after she was
seized, she had a troublesome dry tickling cough, that is (↑has↑) now gone off - likely for her
she has as yet had very little vomiting since the fever began. She has only retchd
two or three times tho she has drunk a good deal; two days ago she had three stools
in the twenty four hours without any means used to promote that evacuation. At
times I flatter myself with the hopes that this Fever may work happy effects

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on her Constitution. At other times I am very apprehensive above the consequen¬
ces. I am afraid she has not strength to bear it out. --