DEP/DUA/1/11/02 (Normalised version)

Mary Rankin

(1776-1777)

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Mary Ranken.

Disease not altogether without ambiguity.

Many symptoms indeed evidently indicating dropsical affection.

And from swelling of abdomen, difficulty of breathing, thirst & scarcity of urine might conclude her to be affected with ascites

Probability is that this really the case.

But here a very essential circumstance wanting.

No evident fluctuation.

Almost constantly observable where depends on water

Or where even dependant on other fluid matters as blood pus or like.

Would naturally lead to inquire how far reason to suspect swelling from any other cause

Especially as no appearance of effused water at any other part of system.

For although pure ascites may exist by itself yet is for most part conjoined with other dropsical affections.

Here two other suppositions respecting cause of swelling naturally present themselves.

Sometimes happens that such swellings from solid material as in Physconia.

But to this supposition two insurmountable objections

First from progress of disease

In physconia very generally begins at particular part

And from thence extended to other parts of abdomen

But in present instance though increase gradual yet more uniform.

And no particular local hardness ever discovered.

Besides this in Physconia swelling never liable to sudden changes.

With our patient however considerably less at some times than others.

Hence for this supposition little foundation.

Another supposition that may depend on Air

From this also well known that a disease induced the tympanites

But of this affection also most characteristic symptoms absent.

Particularly neither gives sound nor crackling of air

Nor is any relief afforded by discharge of wind.

Upon whole then still most probable that depends on water.

And want of fluctuation may arise from different circumstances

Such for example as water being contained in hydatides.

For of dropsical affection thirst & scarcity of urine give strong presumption.

Yet would be by no means surprised to find it turns out of complicated nature

Neither entirely depending on water nor increase of solids but partly from both.

With this uncertainty cannot suppose that will be much disposed to favourable prognosis.

Youth of patient somewhat indeed in favour

And still more so that has received temporary relief from increase of quantity of urine.

But these circumstances excepted most others against patient

While thus uncertain of nature of disease reason to dread some local affection.

And from pain of belly can prognosticate nothing favourable.

From continuation of disease also may conclude it of stubborn nature.

Although but 8 years old has been observable no less than 5.

And probably of even much earlier date

For may consider as symptom of it thirst with which affected from time of nursing

Besides has already resisted power of several medicines.

If therefore admits of speedy & fortunate termination will I own be more than expect.

May seem strange that neither in history nor prognosis have taken notice of a circumstance particularly mentioned in case viz the worms.

These however do not suspect to have any connection with present disease.

Although now a less frequent affection than formerly yet still no very rare occurrence.

And often without much inconvenience although at times indeed productive of most threatening & most anomalous symptoms.

With our patient chiefly appeared during a fever.

A time when often observed to be discharged.

And would seem that from morbid affection situation becomes uneasy to them.

Is however from thence improper to conclude that worms the cause of the fever.

And in present instance would consider them as merely accidental.

Has indeed even of late discharged one

And not impossible that may still be others in bowels.

Would even admit that may either be cause of some symptoms or may aggravate them.

Yet do not consider them as any dangerous part of affection

And hence unless from future occurrences will not perhaps claim attention in cure.

With regard to general plan from what said will conclude that sentiments not very determined

Have however begun treatment on what reckon most probable supposition.

That viz of Dropsical affection.

And here mean first to attempt discharge of water by natural outlets.

Of these chief are by stool & urine.

From first most immediate & sudden discharge

From last evacuation with least debility to patient.

Hence can be persisted in with more regularity & for longer time.

This therefore chief objective in present attempt

Yet wish also in some degree to conjoin others

With these intentions have put patient on use of two different medicines viz

Cream of Tartar & Squills.

The first while purgative at same time powerfully diuretic.

Last intended solely with latter view.

If from these can obtain copious discharge with diminution of swellings & at same time without debility may go far to recovery of patient.

At same time in dropsical affections consider evacuation of water as least important part of cure.

And in numberless cases find it much more difficult matter to prevent return.

May be necessary therefore in order to secure good affects to have recourse to Bark & other tonics.

But can by no means promise that shall ever be able to come this length in cure.

And may soon even be satisfied that present plan is not to be persisted in.

Evacuation may be greater than patient able to bear.

Or may take place without diminution of swelling

In either case will be prejudicial & would be improper to persist in it.

What measures may then be disposed to adopt own that cannot at present even conject.

Shall probably however try some medicines more immediately tending to increase tone of alimentary canal.

Such for example as what called Carminative & Stomachicus.

Yet must at same time observe that future plans of practice in great measure regulated by situation in which shall find patient when present trials concluded.

With continuation of present course however mean to conjoin friction to abdomen.

And to induce to continuation for sufficient length of time shall probably order it to be done either with some oil or some soft powder.

But without expecting from these any other affect than that will lead to perseverance in friction.