DEP/DUA/1/40/64 (Normalised version)

Mary Morison

1787

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Mary Morison. January 27^th 1787.

Formerly pronounced disease complex.

No reason since for altering opinion.

On contrary complexity rather increased.

For now symptoms with which not less affected.

And probably unconnected with any other part of complaint.

When applied for assistance complaint most distressing affection of arm.

And this inclined to think of Rheumatic kind.

Had not occurred in consequence of any particular accident.

Yet chiefly appeared under form of pain & swelling.

Well known most common [appearance] in Rheumatism.

Especially as here from situation sex age & other circumstances no suspicion whatever of gout.

With Rheumatism however [appearance] of some tendency to paralytic state.

For uncommon weakness of arm

And considerable diminishment of power & failure of motion independent of pain [occasioned].

This however very commonly consequence of Rheumatism.

Or rather a stage of that affection.

For consider Rheumatism in its progress as exhibiting four different states.

viz Inflammation Irritation Atonia & Paralysis

Latter indeed in general only consequence of long continuation.

But at same time cannot be considered as supervening at any determined period.

And probably more consequence of peculiar nature & situation of affection than of continuation.

Here then consider Paralytic tendency as consequence of Rheumatism.

Or rather Rheumatism as verging to state of Paralysis.

But at any rate whether connected or not here same evidence of Paralytic as of Rheumatic affection.

For while one indicated by pain & swelling other by diminishment of power of motion & vigour.

From this part of complaint no [reason] to apprehend danger.

At same time could not confidently look for speedy recovery.

Rheumatic affections indeed in acute state a good deal under power of medicine.

But in atonic still more in paralytic often obstinate.

And particularly apt to be renewed from slight causes.

Here however had not resisted powerful medicines.

And as far as Paralysis at least but of recent date

Hence entertain hopes that might be able to overcome it.

And from progress made to recovery now still more reason to entertain this opinion.

Cannot however say same with respect to other affection.

For although pain of arm most distressing yet was not even at beginning most [dangerous] part of complaint.

More reason to be alarmed for pulmonary affection.

Had long been subjected to severe cough

And some reason to doubt whether was not Phthisis.

Here some grounds of presumption both from appearance & age of patient.

Had a good deal of delicate look with which Phthisis most frequent.

And was at 25^th year a period at which Phthisis very common

Also often affected with symptoms indicating some degree of hectic fever.

Cold, hot & sweating fits

And pulse considerably above natural standing

Still more suspicious circumstances in having once been affected with bloody expectoration.

Must be allowed that there alarm.

And that Phthisis often fatal where disease for long time with fewer symptoms.

For as have already oftener than once observed an insidious complaint.

And often considerable progress where little suspected.

Or at least where by no means distinctly marked.

Hence then here not without apprehension.

And must own that apprehension not yet removed.

But originally inclined to view this part of complaint as catarrhal.

And although now more doubtful yet still rather disposed to same opinion

For if disease [sometimes] insidious in other instances, much alarm where no Phthisis.

Many instances of Haemoptysis where yet completely recovered.

And these patients not afterwards [illegible] from catarrh.

When Phthisis from Haemoptysis, in general follows, as almost immediate consequence.

Or at least with recurrence of Haemoptysis if formerly recovered from it.

In general produces Phthisis of ulcerous kind.

That is vomica of considerable size.

Hence fixed pain, constant dyspnoea, & inability of sleeping unless in particular position.

None of these however in present instance.

Matter expectorated appears without any mixture of pus.

Nothing if cleanness of tongue concomitant even of slight mixture of [illegible].

And in secretion of mucus at lungs sufficient cause both for cough, dyspnoea & other symptoms.

From these considerations then still inclined to opinion of being catarrh.

Yet from [observations] continued now [somewhat] more [suspicious] than formerly.

And would not at all surprise me if at length terminates in fatal Phthisis.

According to this have all along had view in treatment.

But before speaking of practice necessary to take notice of still another occurrence.

For to these affections which had when come under care, another apparently different has supervened.

Our patient during course of attendance from accidental fall received hurt on knee.

And from this, though at first little inconvenience, yet soon considerable pain.

These however less distressing than two other symptoms now [supervening] & [attendant] to this cause.

Viz. Frequent fainting fits & severe vomiting.

Of these have not had any very distinct or accurate account.

And may be much doubted, whether in any degree connected with cause to which attributed.

But whether connected or not, am I own, from description given, disposed to look upon them, as affections of Hysteria kind.

As being more alarming than dangerous.

And as what will probably terminate in no long time.

Of this however, will be better able to judge, after knowing affect of remedy prescribed.

And after learning more distinct & particular account of appearance.

In case thus complicated will naturally be supposed that remedy employed with different intention.

And this indeed might be inferred from remedy them.

Began by directing Unguent Terebinth

Basis the Oleum Terebinth a peculiarly active & penetrating stimulant.

Here united to Axunge employed merely as excipient

In proportion of ℥i of form to ℥i [illegible]

Entirely directed against affection of arm

And on supposition of Rheumatic affection promised some advantage

At least in such have often I think employed it with considerable benefit.

Not indeed in inflamed stage.

But in that of Atonia.

And here useful in same [measure], as in cases of sprains, after inflammation overcome.

For which need hardly remark, long employed, both by Physicians & Farriers

After use for week little effect in alleviating pain.

But thought that moved fingers more freely.

This however if at all consequence of medicine, probably effect merely of friction.

Although however had not yet produced much effect, yet nothing to lead to discontinue use.

Especially as did not prevent other practices

Accordingly at succeeding report, had recourse to electricity.

Of reputation of this article in affections of paralytic kind need say nothing.

Not indeed successful in every case

But under proper administration where paralysis curable often succeeds.

And perhaps hardly possess a more powerful or penetrating stimulant.

On this principle often also useful in affections of Rheumatic kind

Especially when have degenerated to state of atonia.

From this therefore reason to expect still more than from Unguent Terebinth.

And from [conjunction] hoped for good consequences against affection of arm.

But from neither could any influence be expected on cough.

And this still continued to give great distress.

With view to mitigation had recourse to mucilage julep with proportion of Laudanum.

Which while prevents action of irritating causes, also renders effect of irritation less powerful.

Under electricity & ointment soon considerable relief from affection of arm.

Not only diminishment of pain & swelling but restoration of free motion.

From mucilaginous mixture however did not reap equal benefit

And with continuation of cough belly bound.

For mitigation necessary to obviate this symptom.

Accordingly while persisted in mixture [directed] composite powder of Cream of Tartar.

P. ae of Cream of Tartar & Sulphur.

In general operates as easy & gentle laxative.

But here not attended with desired affect.

And while constipation continued became affected also with vomiting.

As means of obviating former had recourse to aloetic pill.

While with view to latter directed mixture of vitriolic acid.

An article from which in such cases have often seen best effects.

Influence of pills as opening belly not very considerable.

And after accustomed to them for some days, ceased to have any influence

While at same time, some return of pain of arm.

This was disposed to attribute to want of ointment, ordered to be omitted.

While therefore ordered renewal increased dose of pills.

But from this quantity thought excited sickness.

And as now no uneasiness from costiveness ordered intermission.

At that period, was for some time, almost without any complaint.

For both arm & cough very much relieved.

But then accidentally exposed to cold & wet.

And on this fresh aggravation of pneumatic affection.

From this led to repetition of mucilage julep.

And now with former proportion of Tincture Thebaic added equal quantity of weak Vitriolic acid

A combination to which have often recourse.

And I am inclined to think with advantage.

Particularly in instances where tendency to vomiting.

But cannot say that this here the case.

Had indeed no return at this time of vomiting.

But no alleviation of cough, which particularly distressing in night.

From this led with continuation of mixture to order larger dose of opium at bed [time]

Accordingly directed ten grain of Pill Thebaic containing one of Opium.

And apparently with good effect.

For at succeeding report, found cough much alleviated.

But now informed subjected to present train of symptoms.

Had we are told in consequence of fall received hurt on knee.

And although at first, product of little unease yet soon followed by considerable pain.

And to this followed symptoms more alarming.

Particularly frequent fainting fits, at same time attended with severe vomiting.

These symptoms as already observed, inclined to consider, as chiefly of Hysteria kind.

For this at least most natural supposition, with respect to deliquium.

Accordingly directed practice with that [view]

Ordering mixture with Tincture Thebaic & Vitriol Aether.

At same time must allow that while had seen nothing of these faintings had no such accurate description, as to enable me to form certain judgement

And shall in some degree be guided in opinion by effect resulting from medicine as well as by future accounts.

And according to circumstances will be directed in future practices.

With respect to knee however not same uncertainty.

And in hopes that by anodyne balsam directed for it pain may soon be removed.

And that will likewise continue free from affection of arm in removal of which Unguent Terebinth & Electricity seem to have had good effects.

Cannot however say that in combating other parts of affection, have yet made any great progress.

And in future practices must be very much regulated by circumstances.

Particularly by evidence that may [hereafter] occur either of Phthisis or Hysteria.