I was furnished with the particulars of the following case, through the kindness of James Thomson, Esq. of Primrose, near Clitheroe. John Chambers, aged 19, a carpenter at Clitheroe, in Lancashire, was in the habit, during the hot weather of July 1814, of refreshing himself whilst at work, by eating a quantity of unripe plums, of which, at various times, he ate several quarts, and generally swallowed the stones, under the erroneous notion entertained by the lower classes in that neighbourhood, that they would assist the digestion of the fruit. A fellow workman of Chambers, aged 30, pursued the same practice with impunity. Not so the unfortunate subject of this communication, who about Christmas began to complain, but still pursued his occupation and worked, with some interruption, till February 1815, when he applied to Mr. Coultate, of Clitheroe, for advice, complaining of pain in the abdomen attended with diarrhœa. The abdomen on examination felt tense but not much enlarged, nor had he any feverish symptoms. When in the workshop, he used to lean against the bench, pressing his stomach hard against it, which, he said, afforded him great relief. Medicines of an astringent nature were first prescribed, which seemed for a time to be of service, but the diarrhœa ere long increased, extreme emaciation took place, and a hard circumscribed tumour was discovered on one side of the abdomen, which, from the thinness of the abdominal parietes, Mr. Coultate could distinctly feel was an alvine concretion. Clysters were then administered, castor oil given, and the abdomen ordered to be rubbed with oil, under the idea of pushing the concretions forward, but in vain; the patient daily became more and more emaciated, and after about three months attendance he died, on the 6th of May, completely worn out. His appetite was good, or rather almost voracious, even to within a very short time of his death. He always felt himself worse after meals. His stools, especially for some weeks before he expired, were like blood and water. He was confined to his bed for about three weeks before he died. On opening the body, the concretions were found lodged in the arch of the colon, three closely compacted together, rather high up on the left side, the fourth considerably lower, approaching the termination of the colon. The coats of the intestine were much thickened and formed into a sort of pouch, where the concretions lay. The peritoneum was but little inflamed, the other viscera were healthy. The concretion which lay by itself was sawed asunder by Mr. Coultate, and contained a plum stone in the centre. The body was opened in the presence of the friends of the poor boy, and under circumstances which, unfortunately, prevented Mr. Coultate from making so minute an examination as he could have wished, and from pressure of business and other unavoidable interruptions, he did not at the time note down all the particulars of the case; but on referring to the prescriptions, he says that it does not appear that Chambers ever took the smallest quantity of calcined magnesia or its carbonate, during the whole of his attendance. He had frequent doses of sulphate of magnesia, castor oil, and rhubarb; and during the latter period of his illness opium was often administered. Chambers's usual diet was milk porridge twice a day, viz. at breakfast and supper; the milk thickened with oatmeal His dinner commonly consisted of meat and potatoes; he rarely took any other kind of vegetable, and always ate oat cake at his dinner. In the afternoon he ate oat bread, and cheese, and drank beer; so that he never took a single repast without oatmeal in some shape or other. During his illness he occasionally had oatmeal gruel, and sometimes a little beef or mutton broth, into which it is usual in Lancashire to throw, whilst preparing it, a spoonful or two of oatmeal. He was also requested at this period, to live a good deal on milk and vegetables.
Trigger factors mainly from the environmental type are reported by adolescents with migraine
