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Age 56-57. — For 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting; on two occasions prolonged during months.

[pencil insertion in margin:] Extreme secretion of saliva with flatulence 

Vomiting preceded by shivering, hysterical crying dying sensations or half-faint. & copious very palid urine. Now vomiting & every paroxys of flatulence preceded by singing of ears, rocking, treading on air & vision. focus & black dots  All fatigues, specially reading, brings on these Head symptoms ?? nervousness when E. leaves me.

(What I vomit intensely acid, slimy (sometimes bitter) corrodes teeth.)

Doctors puzzled, say suppresssed gout  Family gouty.  No organic mischief, Jenner & Brinton.

Tongue crimson in morning  ulcerated— stomach constricted  dragging. Feet coldish.— Pulse 58 to 62— or slower & like thread. Appetite good—not thin. Evacuation regular & good.  Urine scanty (because do not drink) often much pinkish sediment when cold — seldom headach or nausea.—

Cannot walk above 1/2 mile— always tired— conversation or excitement tires me most.

Heavy sleep — bad day.

Eczema — (now constant) lumbago— fundament— rash.

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Always been temperate— now wine comforts me much— could not take any formerly.  Physic no good Chalk & Magnesia. Water-cure & Douche — Last time at Malvern could not stand it

I fancy that when much sickness my stomach is cold— at least water is very little Warmed.

[in Emma Darwin's hand:] I feel nearly sure that the air is generated somewhere lower down than the stomach & as soon as it regurgitates into the stomach the discomfort comes on—

[in Emma Darwin's hand:] Does not throw up the food.

Instruction — How soon any effect? long long continue treatment?

[endorsement not in Darwin's hand:] Charles Darwin 20 May 1865