DEP/DUA/1/40/42 (Normalised version)

Margaret Mitchell

(1786-1787)

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Margaret Mitchell.

Case subject of but few observations in lectures.

But pertinence not unimportant in practice

No doubt as to disease.

Is subjected to distinctly marked [symptom].

And if account to be credited an object of [complication]

With this disease now affected for two months

And besides primary ulcers has those also of secondary kind.

For of this kind both affected at anus & throat

Hence syphilis here as constant disease.

But has not affected parts where most [obstructive].

Thus no deposit on bones.

Besides this progress not rapid

Thus upon whole favourable instance.

And such as in no long time might expect to remove by Mercury.

Of success in Venereal cases need say nothing

Long since abundantly confirmed by incontestable observations.

And unless in peculiar cases & [constantly] without hazard.

But imprudent [management] worst affects.

And with some [constitutions] can hardly be employed.

Hence often observed to [combat] remedy rather than disease.

On this account discovery of other remedies always desired.

And if equally effective of utmost consequence.

At different periods various articles proposed Guaiacum Camphor Sarsaparilla Mezereon Lobel. etc.

But after trials insufficient.

Though in certain circumstances are useful yet incapable of eradicating disease.

And in efficacy greatly inferior to Mercury.

Of late however as answering every purpose opium recommended

Not on footing of theory but experience.

First introduced in America.

Employed in case esteemed desperate with [main] view of alleviating pain.

Found however to do much more.

For under use after Mercury tried in vain complete recovery.

From this soon employed in other cases.

And alleged with greatest success.

That too in instances where no Mercury employed.

Of late subject of many publications.

Particularly different passages in London Medical Commentaries.

But most copious collection of facts Dissertation In [Theo] De Opii usu in Syphytide Observations [probably].

Pretty full analysis Medical Commentaries.

There authors both for and against.

For by some held merely doubtful & [fallacious]

And must own not without doubts.

For in syphilis efficacy of Mercury generally known

And patients anxious to eradicate affection recourse to it of themselves.

This consider rather probable as opium in syphilis said to produce saliva.

An effect never arising from it in other cases

And probably only consequence of mercury [illegible] introduced.

The rather suspected as principle example of success [Soldiers].

Well known to use great [freedom] in [use] of Mercury.

In my own practice have not employed it in many cases.

And in these, has not succeed to wish.

With some have described use from rapidity of disease.

For when this case, no time to be lost.

And highly unwarranted to delay mercury for other trials.

With others has had effect of inducing obstinate obstipation

And this incapable of obviating properly till medicine omitted.

But in third set, apparently attended with good consequences.

Hence desirous of [father] information from experience.

Resolved therefore, as circumstance here favourable, to have recourse to it [illegible]

Was however aware that here liable to [despair]

And that patient, if believed herself subject of experiment, would not follow directions.

Or at least while using medicines from us might employ Mercury obtained elsewhere.

On this account was I acknowledge guilty of slight deception.

From [directed] [report] cold etc gave reason to believe that took mercury.

And for any thing I know [illegible] goes on in same supposition.

Her being [illegible] might preclude trial

For overcoming syphilis small quantity of Opium not sufficient.

Requires both large doses & regular continuation.

But from activity caution necessary in administering

In general begun with grain i at bed times

Gradually increased by grain i a day, till [sometimes] even half a dram.

But augmentation stopped as soon as symptoms yield

And often consequence of grain VI or VIII

To this patient directed under Pill extract Opium.

Where united merely with [illegible]

A substance readily soluble in stomach.

And in no degree affecting activity.

While at same time give division of [illegible]

From this different advantages.

Probably upon whole increasing activity

And at same time preventing so considerable action on particular part.

In grain V of mass I of Opium.

Began with single grain.

Now increased till 9 in day.

[Hitherto] [here] without evident favourable alteration of symptoms.

For though some better others worse

Hence probably still farther augmented.

During course of Opium some other [medicines]

These however principally for obviating symptoms.

And not such as could act in eradicating disease.

Thus for affection of throat gargle with Infusion Rosarum.

And for ulcers Unguent Saturn.

With this to alleviate pain have combined opium

And if capable of eradicating disease may do sometime from external application.

But still cure by Opium

Besides these, since opium begun another symptom has supervened.

viz Obstinately bound state of belly.

An affection almost never failing to result from it.

Diminished indeed somewhat from [illegible].

But I own never able to see diminishment of augmented dose.

And on some occasions has even obliged to desert use.

To obviate it, here one of most powerful of purgative pills

Pill extract Colocynth cum Aloe.

If these effective, & other circumstances favourable, shall persist in use, till fair trial

For if effective, certainly valuable acquisition.

And shall I own be [happy], to witness success in own practice.

At same time, if no alleviation, but increase of symptoms, shall reckon it imprudent to [illegible] time & have recourse to Mercury