DEP/DUA/1/39/30 (Normalised version)

Martha Anderson

(1785-1786)

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Martha Anderson. April 8^th.

This patient but for short time under care.

And now therefore almost nothing to add to what formerly observed with respect to case.

Symptoms as enumerated in history of case of considerable variety.

In cough & pain of breast, have pectoral symptoms very common both in catarrh & phthisis.

And may perhaps be considered as some indication of latter that considerable pain under sternum with sense of weight.

Especially as well known that Phthisis a very insidious disease.

And that has often made considerable progress while yet under form in no degree alarming

Hence even state of pulse here 65 in minute & want of other hectic symptoms no security.

But pectoral complaints whether catarrh or Phthisis, were at least not most distressing part of ailment.

Still more affected with stomach ailments

From these under form of Cardialgia acid eructations, & flatulence very great distress

And this also not a little augmented by globus hysteria.

With either pectoral or stomach ailments may suppose that headache connected.

For with this also are told was almost constantly affected.

And well known that a very frequent attendant of both sets of symptoms mentioned.

But besides these three still a fourth occurrence to be mentioned in this case, swelling of hands & ankles.

This we are told particularly observed towards night.

But at same time from anything we saw or could learn from patient not of oedemata kind.

While this of transitory nature had no marks of any effusion in cellular membrane.

Hence neither to be [referred] to solids nor to serosity.

Consider therefore as merely consequence of some increased accumulation of blood in vessels, particularly veins.

A circumstance not unfrequently producing such where [from] want of due action of vessels [impression] of blood more free than egress.

And probably connected only with other ailments as being effect of general bad health.

But while symptoms thus diversified still probable that all from same cause.

From history of case will observe that Catamenia have not appeared for three months past.

And well known that from want of regular menstrual most numerous & complex symptoms arise.

Here then not impossible at least that may be source of whole complaint.

But even supposing this to be case still another particular to be attended to.

Of material consequence to determine which whether amenorrhea Idiopathic or symptomatic

For when latter case though induces various symptoms yet to be combated only by removal of primary affection.

But among other particulars, is often what may be called symptom of pregnancy.

And while obstruction from this cause patient frequent variety of other symptoms particularly unease at stomach.

Often pretend that obstruction from other causes, when wish to conceal pregnancy, or to procure abortion.

And often to cover deceit pretend symptoms with which in no degree affected.

Wherever therefore even possibility of pregnancy this circumstance to be had in view.

And till evidence that this state does not exist no prudent practitioner will think of having recourse to active medicine.

In case of this patient must indeed acknowledge that saw no circumstance giving suspicion of pregnancy.

At same time as knew nothing of her could as little say how far might not be deceiving us in account given.

For this reason & especially as subjected to no urgent symptoms resolved for some time at least to do very little

But principally to look on till should be able to form more decisive opinion as to nature of affection.

Accordingly at first merely prescribed for her a few aloetic pills.

These, probably from operation as stimulant to rectum, have affect in some cases as giving tendency to menstrual.

But father imagine that as opening belly might alleviate some other symptoms particularly stomach ailment.

As found however that notwithstanding operation sourness still continues, directed also Pulveris Cretacea.

But since that have seen nothing farther of patient.

Hence precluded from opportunity both of forming decisive judgement of disease & future practices

And therefore farther observations unnecessary.