DEP/DUA/1/13/09 (Normalised version)

May Taylor

(1777)

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May Taylor.

With regard to case of this patient must acknowledge myself much at loss.

Was under care last summer in Royal infirmary¹ for nearly same complaint to which at present subjected.

Then after trial of various medicines found principal part of affection to be obstinately fixed.

And in other respects disease subjected to changes by which plan of cure laid down was interrupted.

By these means when finished attendance at hospital remitted her to ordinary [physician] in a situation even worse than when came under care.

And at distance of ten months has again become patient with affection nearly in same state as formerly.

Must still observe that of nature of patients disease can by no means form any decisive opinion.

At same time see no particular which can now lead me to alter sentiments before delivered.

Now as formerly most obvious part of affection is swelling in different [places] of system.

That takes place to no inconsiderable degree in face may be distinctly seen on first view of patient.

But still more remarkably in hands which enlarged to very great degree

And this enlargement extended a considerable way up arms.

That this enlargement must be consequence of some deposit abundantly evident from considerable changes which suddenly take place.

After long continuation which has already had can conceive it only consequence of deposit of one of three matters

Water Air or Fat.

To all three some objections occur.

To supposition of water may be objection that swellings do not as is very generally the case retain mark of pressure.

To supposition of air that less elastic & without any crackling noise.

To fat that occurs in more local manner than that could be supposed to do.

That to feel much more tense than that substance.

And that while health of patient in other respects would not lead us to believe augmentation of this [particular] undergoes more sudden changes than could be considered to happen from fat.

After all then reckon supposition of water of the three the most probable.

And would account for its not retaining marks on pressure from peculiar state of cellular membrane.

Especially when this state conjoined with high degree of distension.

For here to be remarked that when by any means swellings much diminished impressions are retained.

Which consider as strong corroborative proof of opinion formerly delivered that swellings of anasarcic kind.

True indeed not now accompanied with scarcity of urine

A circumstance which when patient last under care reckoned strong proof of effusion of water

Still however attended with difficulty of breathing.

A symptom with regard to which formerly much at loss.

Now very little more satisfied than was before.

Then threw out these different suppositions on which imagined might be accounted for.

Is often affect of serous watery effusion in cellular membrane of lungs.

And that this might have produced it in present case reckoned at least not impossible.

To this however some objection that anasarcous affection here not general.

And was I own more disposed to refer it to another cause.

Deposit of water viz in cavity of [breath] or affection known by title of Hydrothorax.

Could not indeed be refused that of this affection several diagnostics wanting.

Yet from considering, insidious nature of hydrothorax, indistinct narrative of patient & sudden affection of breathing on horizontal posture, was most inclined to adopt this opinion.

Now however am I own disposed to reckon it the least probable.

For had such an affection taken place would ere this time have been more distinctly marked.

On contrary patient now free from symptoms giving greatest room for suspicion.

Now therefore in as far as affection of breathing depends on water am disposed to consider it as proceeding merely from an anasarcic affection.

But must at same time observe that now more than before disposed to give credit to third supposition which before suggested

That vizr both anasarcic affection, & affection of breathing may proceed from same cause.

And may be affect of morbid state of blood vessels about heart retarding circulation.

And cannot help thinking that supposition of a diseased affection of venous cavity [sup] giving obstruction to course of blood would account for all symptoms.

For look upon affection of menstrual occasioning stomach complaint etc as merely consequence of diseased habit thus induced.

With this view of disease will not be imagined that entertain any sanguine hopes of cure.

And if any truth in this conjecture utmost that can expect to do will be merely to palliate symptoms.

May even be doubtful how far shall be able to obtain this end.

And need not surprise us should patient be even suddenly cut off by an affection which at present seems to threaten no danger.

If however be merely anasarcous from cause most generally inducing such affections, may be able considerably to palliate or even to cure this patient

And indeed on this supposition must I apprehend proceed in treatment

For whatever cause of effusion of water, is by discharging this alone that can expect either to relieve patient or to pave way for prevention of future affections.

Measures hitherto prosecuted then chiefly meant with one of two views.

Either to promote absorption or to evacuate serosity.

Was with first of these intentions that had here recourse to electricity.

And with last employed purgatives & issues.

But besides this have also occasionally employed remedies for obviating particular symptoms

Such for example as Infusion Japonica for vomiting with which affected.

Under these medicines different symptoms at least somewhat mitigated.

Vomiting has left her, menstrual flux has returned, & swellings considerably diminished.

While therefore appears thus far favourable shall not probably think of altering plan of cure.

And as chief affect in discharging water seems to have been obtained from issues without pushing other measures is intention to persist in these.

Or at least only to conjoin gentle means of promoting absorption.

For till complete discharge obtained should reckon any measures for strengthening tone very improper.

If however shall get entirely rid of swelling is intention to put her for some time on use of Peruvian Bark.

Yet must esteem it very uncertain whether patient will ever be in condition for this.

And in a case so doubtful as present can speak with very little confidence of future plans of cure.

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.