DEP/DUA/1/32/31 (Normalised version)

Grizel Douglass

(1783)

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Grizel Douglass.

Now for second time my patient for affection to which before subjected.

And look upon affection as being in nature singular.

At same time is not so rare that have not oftener than once in former practice met with other [ones] of it.

And there too appearing under forms threatening greater obstinacy than present.

But although have met with several instances of this disease yet must own am at loss what name to give it.

Nor among numerous genera introduced into nosologies¹ & practical systems by Sauvages & others do I [know] to which can with propriety be referred.

With view to cure however this less material than the ascertaining nature of affection.

And on this subject if cannot arrive at certainty may at least form probable conjecture.

Here disease entirely consists of enlargement of one leg

Can proceed only from one of two causes.

Must depend either on solids or fluids. With respect to former would not positively assert that even bone may not in some degree be affected.

And this conjecture [rendered] probable from examinations of such legs by dissection or after amputation.

Here however, both from size, & from method in which extends above knee viz to under part of thigh can have no doubt that if at all takes place but an inconsiderable part of bulk.

Must therefore suppose that principally depends either on fluids or softer solids.

Perhaps no instances where is not in some respect dependent on former of these causes.

For hardly possible to conceive that such affection of solids can take place without some effusion of fluids.

But in instances formerly treated from fixed state, firm feel, obstinate nature, & other circumstances have had reason to conclude that principally an enlargement of solids.

And probably more of cellular membrane than any other.

For certain that [nervous] [accrat] of this most ready means of enlargement.

And as great reason to believe that immediately depends on effusion of [coagulated] lymph can easily conceive how may be product of different accidents.

But without entering into consideration of these may here observe that look upon present enlargement as depending to considerable degree on this cause.

At same time to greater degree than in most instances I have met with, combined with enlargement from water.

For although much more firm & hard feel than any swelling [from] anasarca yet on strong pressure leaves very considerable pitting

Farther proof also of water in consequence of some change from horizontal posture.

For observed that in the morning leg easier & swelling less than at night.

These circumstances then led to more favourable prognosis than could give in most similar cases.

To this the rather encouraged from what formerly happened.

For when this patient with same ailment was before under care at the dispensary, affection from measures then employed although not altogether removed yet very much diminished.

Nothing in case when came last under care which could lead to entertain less favourable hopes.

And must own still expect that may be able to obtain mitigation of affection for this patient.

At same time little progress now made for space of month.

Reason therefore to fear that will be more obstinate than formerly.

Yet in as far as cure to be artificially accomplished must I think be conducted on same principle.

Here whether depends on solids or fluids, no doubt that only [chance] by which can probably be removed is Lymphatic system.

By these have unquestionable evidence that even firmest & hardest parts of body even earth of bones, may be taken up.

Before this can be affected however probably requisite that should be [brought] even to fluid state.

Hence much more readily to be expected of matters previously in this condition.

Is therefore I apprehend by increased action of absorption from leg that [chiefly] to expect alleviation if not removal of this affection.

With this intention, as formerly have had recourse to a topical application to leg itself.

An ointment viz formed of crude Sal Ammoniac united with axunge.

From mode in which this to be applied expected at least to reap benefit of friction.

But expected also farther increase of action from topical stimulation to [external] [vessel]

While from this however [expected] local augmentation of absorption was proper also to afford ready outlet for matters thus absorbed.

And for discharge of watery fluids none more ready than urinary [excretion].

As means of augmenting this therefore had recourse to dulcified spirit of Nitre

Which as far as my own experience goes, although not most powerful find to be one of easiest, most [expedient] & [illegible] [illegible]

And where has effect in this way is also powerful means of increasing action of absorption in general.

For this the effect of every considerable drain from system.

As by this means demand on [abs] vessels is augmented.

Hoped therefore that from increase of absorption & augmentation of urine matter taken up from leg would be thrown off by kidneys.

And indeed formerly, from same medicine, of this there was highest presumption from copious sediment deposited by urine when increased in quantity.

Repetition however has not hitherto been product of desired effect.

And as did not even [increase] [quantity] of urine, have in conjunction with Spirit Nitri ordered infusion of Juniper.

Since diluent added to former [measures] quantity of urine indeed augmented.

But without that appearance of sediment indicating discharge of matter taken up by absorption.

And although now continued for several weeks no change on leg.

In this situation begin to be [apprehensive] that at present not adequate to affection.

If therefore no favourable change by next report have thoughts of employing other measures.

And particularly electrical sparks drawn from effected limb as means of promoting absorption.

With same intent also, may use topical vapour bath.

And internally have thoughts of employing infusion of Digitalis.

In these however regulated by circumstances

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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.