DEP/DUA/1/41/12 (Normalised version)

Betty Micheson

1787

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Betty Micheson. February 25. 1787.

Of this patient also have seen but little since last spoke of case

And to what before observed now not much to be added.

From obvious swelling conjoined with scarcity of urine could have no doubt in considering affection as principally anasarca.

And although of short standing had evidently gone to considerable height.

This manifestly apparent from extent.

For not only considerable in inferior extremities but also in abdomen.

And indeed in some degree over whole body.

But still more from cough & dyspnoea.

For in these evidence of effusion in cellular membrane of lungs.

Of affection of system also evidence in state of stomach

For with intense thirst not only impaired appetite but also frequent vomiting.

Same also indicated by state of pulse

For quick & small.

A condition though not uncommon in anasarca yet in general only in advanced [part] of disease.

While these however common symptoms of considerable disease others somewhat uncommon.

As such may particularly mention tense state of swelling.

Gave you will observe considerable resistance to pressure.

And did not easily bear impression of finger.

From this might perhaps at first sight seem probable that depends on some other cause than water.

For want of pitting on pressure a mark of [illegible] & [illegible] or large collection of fat.

And must always be case, either where fluid cannot be expelled from cells or immediately regains situation.

This however not in general at least case with water.

Hence commonly readily yields to pressure & retains mark for some time.

But this it may be observed not necessarily consequence.

For water itself if not altogether at least nearly an [incomp.] fluid.

And therefore more ready to give tense swelling than even air.

Must always do so where not ready passage, from distended cells into empty one.

Or where state of cellular membrane is such as to give resistance to distension of cells.

Hence chiefly occurs where disease but of recent date

Where has taken place as immediate consequence rather of some accident than of general condition of system.

And where happens with those possessing considerable vigour.

To this cause then want of ready passage from one cell to another would here ascribe tension of swelling as well as not easily [bearing] impression of [fingers].

To similar cause also perhaps to refer another peculiar severe pain in abdomen.

Though not improbable that these in part at least connect with [cause] inducing Anasarca.

For here inclined to adopt opinion of patient, that consequence of want of menstrual.

This discharge had you will observe ceased to appear at usual period.

And patient had now arrived at that stage of life when commonly leaves females.

This however known to be on several accounts with them very [ticklish] period.

And among other consequences from want of accustomed evacuation one not least common affection of anasarca kind.

In this view then case of our patient might be considered as a common occurrence.

While at same time never without considerable danger.

For if attempt cure by restoration of discharge often most excessive haemorrhage.

Any by these affection ultimately very much increased.

From this circumstance then [formerly] expressed great doubt as to prognosis.

And as now unacquainted with state of case can offer no farther conjectures respecting it.

In treatment here consider it as first objective to evacuate water.

For from this had reason to expect most immediate relief of urgent symptoms.

And without this no means of radical cure could on any principle be prosecuted with prospect of advantage.

Was with this intention that had here recourse to Cream of Tartar.

An article in such cases particularly advantageous as combines both purgative & diuretic powers.

And here the rather indicated from scarcity of urine.

For though purgative most immediate discharge yet more permanent & less debilitating evacuation from diuretic.

Especially in cases where natural discharge deficient.

From these considerations then seemed in every point of view proper.

And indeed know no one from which in such instances, so much benefit may in general be obtained.

Here however imagine that additional benefit from some combination.

And with view of increasing purgative power added small proportion of Jalap.

For by itself requires considerable dose to operate as brisk cathartic.

And Jalap before employed by itself with advantage.

But while this employed as [adjunction] added Zingib as corrigent.

Cream of Tartar very apt to [excite] great coldness at stomach.

Where therefore as with our patient tendency to vomit some aromatic required.

As such [illegible] [illegible] Cinnamon or Cassia [most] grateful.

But Ginger while cheaper no less active.

This combination taken to extent of Tea spoonful four times a day.

At first no considerable effect as purgative.

But after few days, probably from accumulation in intestines brisk catharsis.

While from beginning effect of increasing urine.

Under these evacuations soon favourable change in affection.

Dyspnoea much relieved, swelling greatly fallen.

And therefore directed continuation in hopes of complete removal.

But since that have seen nothing farther of patient.

And not improbable that desertion the consequence of recovery.

But at same time after what already said of [ticklish] situation of patients at this period of life dare hardly offer any conjecture.