DEP/DUA/1/17/17 (Normalised version)

Catherine Menzies

(1778)

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If in case of George Allen an example of Ascites in that of next patient Cath Menzies a no less manifest instance of Anasarca.

Here from nature of swelling with which patients legs affected can be no doubt respecting cause.

That depends viz on effusion of watery fluid into cellular membrane.

And although not peculiarly separated in inferior extremities yet more especially making appearance there in consequence of free communication of cells & [depending] situation.

And accordingly observed that this swelling most considerable at night.

A circumstance if not universally at least very generally happens in Anasarca

And which indeed must be necessary [concomitant] of [erect] posture through day.

Unless from influence of action as promoting absorption greater quantity of water [carried] off, than what brought by influence of gravity.

This however can only be case either in instances of very slight anasarca or where convalescent condition has taken place.

Neither however the case with our patient.

For although disease by no means very considerable yet to be considered as being in increasing state.

And from this circumstance together with nature of disease precluded from giving favourable prognosis with great confidence.

Nothing indeed in appearance mentioned in history of affection which could be looked upon as very alarming.

Yet none of common symptoms of anasarca affection here wanting.

For besides impaired appetite for solid food, here there also occurs increased inclination for liquids with manifest diminution of quantity of urine.

And what perhaps to be considered as worse than any of these irregularities of menstrual.

For inclined to consider this circumstance not as cause but consequence of the disease.

And look upon it as indicating a state of habit from which affection will have tendency to be rendered obstinate.

Hence therefore unless in consequence of [illegible] measures should not be surprised to learn that affection has in the end a fatal termination.

[Probability] however is that by due medical aid affection may be overcome

And here unquestionably first objective to discharge water already effused into cellular membrane

Evacuation of water however although first by no means most material part of cause

Is an objective of still much greater consequence to prevent return.

This however to be affected rather by regimen than by medicine.

Particularly by such diet exercise & air as has tendency to strengthen & brace the system

Evacuation may be effected either by means of natural or artificial outlets

Latter unquestionably affords most immediate [excitement] yet besides being subjected to many other [inconveniences] of no farther permanence than length of time for which discharge continues.

Hence unless in most urgent cases preference very universally given to natural outlets.

From vesicles of cellular membrane now [are] admitted that only outlets as lymph [absorption]

And by these merely deposited in mass of circulatory fluids.

Hence then evacuation by natural outlets to be affected firstly from absorption

And secondly by augmenting serous excretions

But more particularly by inducing discharge of serous from mass of [fluids] either by stool or by urine.

Latter unquestionably best fitted for habits greatly debilitated & where disease of long continuation.

But former a more expedient means of cure

And at same time a more affective means of promoting absorption.

For while this in some measure [consequence] of evacuation arises also to certain degree from stimulation of cathartic.

Cannot indeed be asserted that all cathartics possess stimulating power.

Yet this a quality at least of many of them

And particularly of those chiefly used against dropsies.

Is especially a [property] of Jalap.

This therefore the purgative which here meant to employ.

Directed it however as combined with Cream of Tartar.

From which hoped both that purgative [power] would be increased, & that some affect would be produced in way of diuresis.

But as patient did not afterwards attend us had neither opportunity of prosecuting course nor indeed of learning effects of first exhibition.