DEP/DUA/1/20/03 (Normalised version)

Agnes Heggie

(1779)

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Agnes Heggie

For name of disease of this patient will I apprehend in vain consult systems of modern nosologists¹.

Principal if not sole complaint of patient is pain of breast.

Seat of this pain immediately referred to sternum & parts below.

And although sore to touch yet at times suffers much more considerable aggravation without any manifest cause.

While from very slight causes, walking in particular or any other quick motion aggravated to such degree that patient incapable of continuing it.

From severity has effect even of inducing profuse sweating over whole body.

When occurs to such degree not surprising that should occasion affection of breathing

And that should not be entirely confined to breast itself.

Here however course which [pain] takes a circumstance deserving notice.

According to account of patient strikes from shoulder into arm particularly affecting biceps muscle.

In this state however is seldom of long continuation.

But if does not entirely cease at least soon returns again to situation more tolerable.

In state of complaint now described very little or rather no resemblance to any of those affections in nosological systems [comprehended] [under] general orders of Dolores Pectoris.

Nor indeed does it as far as I know resemble any of those genera [described] by greater part of practical writers.

To those however who have read histories lately given of that disease now known by title of Angina pectoris must appear that in many of [most] essential particulars there occurs [strictly] [resemblance].

That this disease equally common in ancient as in modern times a supposition at least highly probable.

Yet seems always to have been confounded with other affections

And to have passed under general title of pain of breast.

Of late however pointed out as separate & distinct genus of disease.

First probably by Dr Heberden of London in the transactions of College of Physicians of that [place]

In several different papers of that work has given distinct narrative of symptoms in cases of that affection.

And of late his observations confirmed by those of other physicians of great eminence who have also favoured the [public] with histories of the affection.

Particularly the late Dr Wall of Worcester & Dr Haygarth of Chester, Dr Fothergill Dr Percival

On this subject also will now find some observations in introduction to Theory & Practice of medicine² written by late worthy & learned Dr McBride of Dublin.

Nothing respecting it indeed in first edition of his work.

But in that published in Ireland in 1777 a chapter on this subject.

And besides observations of other writers has there given not only result of his own experience but also of Dr Smyth.

From comparison of all these histories with present case will find that in instance before us have every characteristic mark of this affection.

Nature & seat of pain, manner of attack, degree to which occurs & place to which propagated all correspond exactly with description given.

And although of opinion that Angina pectoris may occur, without pain extended to biceps muscle yet when this circumstance does take place is strong characteristic of disease.

The present case then, can have little hesitation in considering as being an instance of that affection

And although all the succeeding [writers] following Dr Heberden have hitherto given it title of Angina Pectoris, yet with view to introduction into nosological system may give it appellation of Pectoralgia or some similar compound.

While however give this name to the disease must be allowed that not altogether without peculiarities.

Of these indeed must judge almost solely from descriptions of others not from own experience.

For present but second instance of this [affection] which have met with in my own practice.

And first by no means distinctly marked.

In present instance may be pointed out as in some measure a singularity that here occurs with female.

For in almost all the other instances upon record has affected men only.

But still greater singularity in this case in frequency of attacks.

When first came under care subjected to such returns twice [thrice] or even oftener in space of day.

Such frequency of return has indeed occurred in some other cases & as excited also by [slightest] cause particularly motion.

But such appear only after continuation of disease for many years.

With our patient however has subsisted for few months only.

Shows therefore an uncommon degree of severity

But farther to be observed that in this case there occurs also another circumstance rarely to be met with.

Pain viz to the touch on pressure.

Do not observe this circumstance pointed out in any history of the affection.

Would seem to [argue] some local disease.

Which however if we except the case treated by Dr Haygarth as far as [dissections] have yet gone has not been discovered.

On contrary in cases of some patients dying of the affection, particularly in one opened with great [attention] by that accurate anatomist Mr John Hunter as morbid condition whatever to be discovered.

Hence then although such may occur in present case yet probably not essentially connected with the affection.

If however does exist even as concomitant circumstance will still increase the danger of the affection.

And from this joined to other [particulars] cannot here give favourable prognosis.

In by much greater part of instances of this affection, unless where patient cut off by supervening disease has at length had fatal termination.

And that too often in very unexpected manner.

With present patient this particularly to be dreaded as has soon arrived at very great height.

At same time cannot be represented as an affection which has [never] admitted of artificial cure.

Must indeed acknowledge that am acquainted with no rational principle on which this to be attempted.

Nor have any of those authors who have written of it, as far as any knowledge attempted to point out such.

But in Dr McBrides observations are informed that this disease has oftener than once been successfully treated by Dr Smyth of Dublin.

And history in particular given of one case treated by him in which by means of an antimony & an issue a complete cure obtained.

On this authority then was induced to have recourse to these practices in present case

But in place of employing antimony wine of Huxham directed patient to use of crude antimony.

Which of all the different modes of exhibiting it reckon the best were to be employed as an [alterant].

As in this state unquestionably has influence as entering circulatory system while at same time less apt to occasion sickness at stomach.

In Dr Smiths case, issues [illegible] [illegible] thighs.

But here thought it more advisable to order application of blister to the back from which drain afterwards to be supported by epispastic ointment.

As thus while benefits from discharge hoped also for good effects, from derivation from seat of affection.

Cure by this means if to judge by what has happened in other instances not to be expected for considerable length of time.

Unless perhaps as disease has more suddenly than usual arisen to great height so may more suddenly cease.

And indeed alleviation of symptoms apparently obtained, already more considerable than could have expected.

For both frequency & severity of pains for space of two weeks past considerably abated.

Hardly however to be expected that complaint may not again be considerably aggravated.

But should this even be case, shall still wish to persist in present course for some length of time.

And must own that if proves ineffective am much at loss what measures next to be tried.

Is however one of those affections in which should be inclined to hope for some good effects from use of those tonics operating as Antispasmodics.

And should wish to give trial to Cuprum Ammoniala or Calx of Zinc.

Which I imagine might at least be tried without inconvenience.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) David McBride, A methodical introduction to the theory and practice of the art of medicine (1777).