DEP/DUA/1/34/36 (Normalised version)

Jean Johnstone

1784

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Jean Johnstone April. 17. 1784

Concerning disease of this patient am very much at loss.

Consists of considerable diversity of symptoms probably little connected with each other

Of these the first mentioned is general swelling of abdomen.

When consider that this tense to the feel, & not only without colour but liable to sudden aggravation particularly at night, reason to presume that arises rather from wind than any other cause.

At same time no mention of borborygmi of eructation, or of flatus giving relief to countenance this supposition.

But besides this another symptom still more distressing to her probably not connected with present.

A pain viz a little to left side of Scrobiculus cordis.

This in some degree constant but at short intervals suffers very considerable aggravation.

No circumstance attending this pain [which] throws any light upon nature.

And must own that totally at a loss to form any probable conjecture with regard to it.

Nor indeed do I see any other particulars in case with which can suppose it to be connected.

Unless perhaps be somewhat of same nature, with those pulsations observed on right side of Trachea & left mamma.

Though these indeed of themselves at least without pain.

And besides this in their nature somewhat singular.

For neither of them synchronised to the pulse.

While pulse 126 strokes [incrementing] the pulsation at side of Trachea when most distinctly marked only 112.

But besides this both very irregular.

With regard however to these pulsations may be remarked that had not attracted notice either of patient or her mother.

Could not therefore learn of what duration they were.

And what of still more importance whether constant [or] not.

Would be improper therefore to offer any conjecture respecting them till have opportunity for father observation.

And of this now very little prospect as patient who resides at some distance in country is we are told unable to attend here.

Upon whole then must acknowledge myself much at loss both with regard to name & nature of this affection

And hence cannot pretend to offer any conjecture with regard to termination.

Must however acknowledge that am by no means without [apprehension] of danger.

And here would not be at all surprised if an event suddenly fatal should occur.

And if found on examination by dissection that pain proceeded from an aneurysm or some similar local affection.

At same time must observe that no circumstance here taking place from which can on any probable grounds allege that an affection of that nature does occur.

And notwithstanding early period of life would not be surprised if should yet appear that all her symptoms depend on an affection of hysteria kind.

For this well known to put on various appearances & to imitate different diseases

And particularly in this way, often occurs prior to appearance of menstrual discharge.

But this opinion also can offer only on footing merely of vague conjecture.

And with view to practice here can do very little unless in way of obviating symptoms.

Is therefore solely with that intention that practices hitherto employed have been directed.

With a view to state of appetite & other affections of stomach had here recourse to the Infusion Amarum.

And to try what effect opium might have as allaying pain at Scrobiculus cordis as well as in preventing recurrence had recourse to Pill Thebaic.

These taken to extent of grain i of opium in course of day.

From neither one nor other however, did it appear that any benefit was to be derived.

For while she herself, in such situation that unable to attend us at next report were informed that all her symptoms very much aggravated.

In this situation of disease & in state of uncertainty as to nature, thought it more advisable to make a trial of a different medicine, than to persist in use of what had hitherto employed with so little affect.

And on idea that affection as have suggested might be of hysteria kind had recourse to simple foetid pill.

While trial innocent on different grounds promotes some advantage.

For besides some chance of [countering] pain at Scrobiculus cordis, if swelling of abdomen from flatulence may have effect of diminishing from producing discharge of flatus.

But with regard to future employment must be entirely regulated by effects.

[If] [attended] with benefit may persist in use increasing quantity.

And at the same time endeavouring by more accurate observations of the disease to form more decided opinion of nature

If however either no effect or aggravation of symptoms much at loss what measures shall next take.

May perhaps however make trial of Aether or some other of stimulating antispasmodics.

But in this our conduct [must] be very much regulated by account which receive of patient.