DEP/DUA/1/11/04 (Normalised version)

Janet Brown

(1776-1777)

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Janet Brown

Seems to labour under complication of affections

And of these some which if not fatal shall I am afraid find very obstinate.

Of all her complaints most distinctly marked is [circulome] tumour in right Epigastric Region.

And is in all probability cause of some of most troublesome symptoms.

While from progress already made still farther danger to be apprehended.

What nature of this tumour cannot positively say.

High probability however that depends upon enlargement of some of abdominal viscera

And indeed little room to doubt that is an affection of the liver.

A bowel well known to be frequently affected with swelling, cirrhosis & its consequences.

From this would account for painful tumour

And from pressure on diaphragm probably prevents easy respiration during night.

While consider this however as most material part of complaint would by no mean view it as only part.

Is also distressed with affections of stomach.

And that these unconnected with tumour may certainly be inferred from being of much earlier date.

At same time by no means improbable that may now be aggravated from affection of Liver.

As cannot fail to have remarkable effect on state of circulation.

Must however observe that are not told of this having been the case.

From which may draw additional [argument] as to being unconnected.

But besides both these is also frequently troubled with another complaint viz severe headaches.

This also imagine totally independent of tumour in abdomen.

Would not however say that has no connection with dyspeptic affection.

Well known that sympathy between head & stomach very great.

And that morbid conditions alternately affect each other.

Notwithstanding this however have some suspicion that headache in present instance of a different nature.

This chiefly led to suspect from seat of it.

And from not being observed to be most severe when stomach complaint most urgent.

Reckon it therefore as probable that is of that kind of headache which depends on Rheumatic affection of chronic nature

And these, except perhaps purely nervous headaches, take to be of all others the most common.

From this idea of patients disease then would consider her as labouring under three affections.

In this case will not wonder that should be somewhat puzzled both with respect to prognosis & cure.

With complaints of head & stomach must own that am not much alarmed.

At same time suspect that shall find both to be obstinate.

But with affection of liver not merely reason to dread an obstinate complaint.

Here also great reason to apprehend that affection will be dangerous.

True indeed often cirrhosis affection of liver without proving fatal by themselves.

Thus for example frequently induce dropsical affections.

But even then disease can often be [palliated] for considerable time.

And other instances where still less considerable consequences.

Often when product of acute disease remains for life in station condition without any inconvenience.

Thus for example is a frequent occurrence in fenny countries as consequence of intermittent fever.

These familiarly known under appellation of ague cake.

And those affected with it pay little regard to it.

Seems however in present instance to be much more serious affection.

And disposed to think that [uniformly], &, comparatively speaking, speedy increase threatens greatest danger.

What will be mode of termination reckon very doubtful.

Apprehend however that greatest reason to dread will at last land in suppuration.

And that patient may fall victim to hectic fever induced from absorption of pus.

What generally distinguished by name of Tabes hepatica.

Though this however most serious yet often will not be most urgent part of complaint.

Hence in practice will not altogether engage attention.

Especially as must own am much at loss to think how to be overcome.

While continues in present state however some attempts to be made to radical cure.

For if suspicions well founded may in short time be in situation to be despaired of.

Here must acknowledge that know no remedy capable of removing cirrhosis or cancer of internal viscera.

Of late indeed cicuta & some other of tribe of poisons introduced as infallible [against] this affection.

Yet greater part of practitioners already convinced that by no means entitled to character that has been given of them.

And am myself one of those who reckon that wherever operation possible never from any expectation from these to be a [moment] delayed.

Yet far from looking on Cicuta as a medicine perfectly inefficacious.

And wherever operation inadmissible, think that at least merits trial.

On this account have thoughts of trying it in present instance.

From other complaints however am very apprehensive that shall not be able to persist uniformly in use for any length of time

And without such cannot be reckoned to have fair trial.

In administration of cicuta some caution necessary

Is one of those remedies strength of which varies very considerably.

And some patients able to bear much greater quantities than others without inconvenience.

From narcotic powers however requisite in every case that should be begun with small doses.

And only by gradual increase that can fix proper dose.

Used also in different preparations.

Principally however powder & extract.

Here have prescribed conjunction of both in form of pills.

And have directed extract of seeds [which] manifestly more powerful perhaps also more certain than leaves.

At least is unquestionably so with respect to Narcotic effects.

If other symptoms will admit of use of this medicine mean to give it fair trial.

If not have thoughts of attempting radical cure by means of Mercury.

And with this view shall wish to [illegible] it into system in least acrid state.

That is not in saline form but merely as rendered active by trituration or calcination.

With both of these may probably [conjoin] friction with camphorated oil.

Not indeed that expect very great [effect] from it.

Yet must observe that look upon camphor to be one of most penetrating topical applications with which acquainted.

And am inclined to think that often serviceable as removing tumour in consequence of restoring circulation from stimulation.

To this however if have recourse to mercury internally may perhaps [substitute] mercurial unction externally.

Besides these still another medicine which am desirous of trying in obstinate tumours.

Although must observe that consider present to be unfavourable case for [such] trial.

For in such state of progression that could not with certainty determine affects.

Medicine to which I allude is Electricity.

Is one indeed of which in such cases have had no experience.

But lately favoured with history by an ingenious Gentleman in Ireland of a lady cured of an obstinate tumour of breast by accidental stroke of thunder.

This account have had confirmed in such manner that cannot be smallest [reason] to doubt accuracy of observation.

And a priori disposed to think that remedy has great chance of answering.

But perhaps very unnecessary to plan out so many schemes for attempt [removal] of this tumour.

For if progress be not soon stopped shall probably have it in power to try but few of them.

And at any rate will be necessary to bestow great part of attention on other complaints.

On presumption that headache from cause mentioned will be most effectively alleviated by guarding against exciting causes as cold.

And by supporting drain from neighbourhood.

Is with this view that have ordered blister

And wish to keep up drain for some time by epispastic ointment.

Stomach complaints chiefly to be alleviated by counteracting acid when occurs

And by obviating costiveness.

These views will explain to you intention in prescribing magnesium.

And in ordering aloetic pill.

Should these prove ineffective may [employ] other means of palliating complaints both of head & alimentary canal.

Yet with regard to either alleviation of symptoms must be object principally in view.

And cannot expect to restore patient to health without removing tumour.

This as already observed consider to be by much most material part of complaint.

Hence in all remedies employed with other intention is constantly to be had in view.