DEP/DUA/1/14/04 (Normalised version)

Grizel Craig

(1777)

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Grizel Craig.

This patient has already oftener than once subject of Lecture with me in other courses

Was first my patient about twelve months ago in Royal Infirmary¹.

And but short time since several had opportunity of hearing me make several remarks on case as treated in Collegium Casuale² during winter.

On these different occasions complaint not precisely the same.

In one case considered her as patient principally for dropsy in other for Amenorrhea.

And on both occasions had at least temporary removal of complaint.

Evident however that by no means a radical cure.

For when came at present under our care had as it were conjunction of both.

From which led to conclude that opinion before entertained that affections viz unconnected was a mistaken one.

And although at different times have appeared separately yet now disposed to refer both to same cause.

And not improbable that a morbid condition of the uterus may give rise to the dropsical affection

For here to be observed that though dropsical affection in form of anasarca yet with some peculiarities.

Anasarcic swellings indeed more frequent in inferior extremities than anywhere else.

But after subsists for any length of time seldom so completely confined to any one part as are in case before us.

For except by apparent fullness of countenance have had no indication of swelling on any other part.

Urine not affected to any remarkable degree

And unless when accidental catarrh repeats easy

Would argue therefore rather some local cause acting on inferior extremities than general hydrocephalus diathesis.

And when consider that most [material] function of uterus, menstrual discharge, evidently affected may lead to suspicion of disease of that viscus.

And when known that scirrhous in other viscera product of dropsy may unquestionably arise also from uterus.

But besides what already mentioned another peculiarity may here be taken notice of

That is state of pulse.

Here for a dropsical affection uncommon [question]

Which when happens in dropsy is usually consequence of irritation afforded to system by disease of some viscus.

From all circumstances taken together then some reason for presuming that a local affection of uterus to be considered as cause of both diseases.

But in what that affection consists a matter of difficulty to determine

Nor can we pretend to conject with any great degree of probability.

Whatever course may be with regard to existence of two affections already mentioned there can I apprehend be no doubt.

But besides these some room even for suspecting third [affection]

In weakness of legs & difficulty of walking have appearance as if tendency to paralysis.

For hardly to be imagined that should have had these affections to so great degree from all swelling that here occurred.

Unless debility augmented by an affection of medium through which all motions [passed] viz Nervous fluid.

Must however be allowed that in impeded motion here occurring no certain proof of paralysis.

And no evidence of affection of other great function depending on nerves viz sensibility.

Loss of motion indeed may completely take place without loss of sense.

But more frequently are connected.

And at utmost can assert that if paralysis does here occur is to slight degree only.

Even on this supposition however must still look upon disease to be a complicated affection

And after manner in which have already failed, no room for expecting speedy or effective cure

Must own that entertain very great doubts how far that will ever be affected.

And on whole disposed to think that all our endeavours shall in end prove abortive.

By this however would not be understood to mean that think there is little [prospect] of our being of service to this patient.

Should originating cause of affection remain measures may yet be taken giving relief.

From measures already taken have obtained at least temporary removal of swellings & considerable augmentation of strength of limbs.

And have little doubt that either by plan at present prosecuted or by other [measures] also may at least for some time be [restrained]

But whether in any of these ways [relief] will be permanent is a matter of much [greater] doubt

And if conjectures respecting local affection of uterus be well founded can hardly expect that will be the case.

At same time where dropsy in different forms consequence of worst local affection former may be removed while latter continues.

From this then would infer that temporary removal of dropsy neither proof that does not proceed from cause suggested, nor evidence of cure of affection.

Yet apprehend that this as well as restoration of menses are objectives more immediately to be aimed at.

For are not only great sources of immediate distress but are farther the affections when as already observed can chiefly expect to [illegible]

While at same time even chance of removal of originating cause to be expected only from long continuing course.

And must own that with patient so long subjected to disease should have even some doubts as to propriety of attempt.

Of the two particulars already mentioned consider dropsy to be most urgent.

And here great objective was reabsorption & discharge of water already effused in cellular membrane of inferior extremities.

Action of absorbents augmented by many different measures

Few however more effective than those producing evacuation from the system by [serous] outlets

As from these therefore conjunction of two affects requisite thought such practice the most advisable in present case.

Of all evacuants employed in dropsy preferable perhaps to be given to Purgative or Diuretic

First most immediate & certain

Second the least debilitating.

When this patient formerly under care with a dropsical affection employed as purgative the Electuary.

And operation then productive at least of temporary cure.

Would naturally therefore seem to indicate repetition of employment.

But as patient debilitated by longer continuation of disease thought at first of trying more gentle measures.

And was with intention of obtaining [affect] both of gentle purgative & diuretic that had here recourse to Cream of Tartar.

Which that might be product of [illegible] in stomach from refrigerant quality, united with small proportion of Cinnamon.

In affects of this prescription were not [disappointed]

For from use, urine considerably augmented & frequent loose stools induced.

Consequence was that swellings very soon disappeared.

And medicine as tending in some degree to induce unnecessary debility was omitted.

Since that however on threatenings of return have again had recourse to use

But employed it to less extent.

On total disappearance of swelling shall again [intermit] use

But while continues to produce some good affects shall not probably think of changing medicine.

That is of having recourse at least to any other evacuant with view of discharging [effused] water.

But from this can expect little as tending to removal of Amenorrhea.

And although not immediately sensible of inconvenience from this yet restoration an objective of attention.

For hard to say how far obstruction alone may not even be cause of dropsical affection

And suppose this not to be case yet restoration of due discharge by menses may be means of preventing return of dropsy.

For restoration of menses when this patient last under our care had employed electricity.

And then disposed to attribute to it reappearance of this flux after obstructed for very considerable time.

Was naturally led therefore to have again recourse to same remedy.

That electricity in some cases a very powerful means of restoring menses can admit of no dispute.

[Practitioners] however differ much respecting [mode] in which operates.

Into this subject however cannot here propose to enter

May only in general remark that hold action of uterus to be a condition necessary to menstrual discharge.

And imagine that electricity operates either as immediately restoring action or disposition to action.

In same manner as where paralytic affections often [restore] capability of action in other parts of body.

Can hardly venture to say that electricity in case before us has yet been product of desired effects.

Yet since patient put upon use of it has at least had show of menstrual discharge

And not without hopes that at next period may be more abundant.

Am therefore encouraged to persist in use

And this the rather from supposition [that] tendency to paralytic affection in limbs themselves.

If however in the end this mode of restoring menses found ineffective many other measures with same view may be tried.

With this intention may employ Rubia Tinctorum Tincture Melampodium etc.

But if as suspect local affection of uterus has in reality taken place, [although] may produce temporary restoration yet will never again be able to obtain regular or proper discharge.

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Explanatory notes:

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

2) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.