DEP/DUA/1/41/18 (Normalised version)

Agnes Turner

1787

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Agnes Turner March 10^th. 1787.

Formerly expressed great doubts respecting case of this patient.

These not removed by anything that have since seen.

In place of being diminished upon whole rather increased.

For while disease equally anomalous as before has now very much changed appearance.

And now evident that former conjectures were ill grounded.

Formerly remarked that was [illegible] no decided evidence of Dropsy.

But some indication of it in swelling of abdomen & legs.

Especially as conjoined with state of urine

And with sense of coldness in [illegible]

Besides these indeed many other symptoms.

Prickling sensation trembling of hands etc.

But with complications of various kinds dropsical affections not uncommon.

And conjected that affection might terminate in formal instance of that disease.

Now however appearances of dropsy [have] altogether disappeared.

And that too without any remedy which could have been supposed to give removal if tendency to disease had existed.

Hence conclude that for this suspicion little foundation.

Appears also that not [more] for another particular.

Suspicion viz of pregnancy

With regard to this our patient herself expressed uncertainty & [inclined] to [contrary] before

Was a married woman not past period of bearing children.

And had seen nothing of menstrual discharge of three months.

Besides which affected with frequent vomiting a very common appearance in pregnancy.

Could not indeed consider pregnancy as by any means cause of symptoms.

For to many of these had been subjected even for space of two years.

But imagine that pregnant state might have considerable influence in modificating complaint.

And the rather to be suspected as she considered all complaints as aggravated after a former pregnancy.

When delivered of delicate child dying in few days.

At any rate whether pregnancy in any degree connected with complaint or not if was present would necessarily [restrict] in use of medicines.

And want of menstrual with vomiting at least sufficient grounds for some [supposition].

This however was soon satisfied also without foundation.

For after under our care for some time menstrual discharge returned.

And that too without any medicine employed for restoration.

And without any mark which could be considered as indicating abortion.

Hence then no foundation for former supposition.

At present appearance considerably different, from what [was] when came under care.

As far at least as can learn from report of others.

For of late patient has been in such state as to be unable to attend us.

This has in great measure arisen from condition of legs & feet

What at first appeared under form of particular prickling & coldness in these now converted into acute pain

And that too little or nothing mitigated by any remedy we have employed.

Of nature of these pains at loss what judgment to form.

From situation & circumstances of patient might naturally conclude them of Rheumatic kind.

But began at least under an uncommon form.

And derived no relief from [these] practices, giving in general at least some mitigation of symptoms in Rheumatism

While reason to suspect that somehow connected with affection of alimentary canal.

For subjected to frequent returns of vomiting.

But besides this were informed of inordinate actions still more alarming.

Were told as appeared from report of 17^th of February, that patient subjected to convulsive fits continuing for almost space of a day.

These according to account given us put on somewhat of appearance of Epileptic accession.

But have had no such accurate description as to enable us to form any proper judgment of them.

Serves however at least to show an anomalous appearance in course of affection.

And indeed of this throughout whole case abundantly evident.

Hence after treatment for two [months] as much if not more at loss than ever to form probable conjecture.

Have sometimes been inclined to conjecture that pains here rather of gouty than rheumatic kind.

In this case indeed many objections to supposition of gout.

Such for example as age sex & [status] in life.

For while case with females & labouring poor, seldom occurs till after 34th year.

But to all these some exceptions.

And such a singular exception may occur in present instance

Yet must confess that to this conjecture chiefly led from anomalous [nature]

And of all diseases with which acquainted perhaps no one putting on more singular or uncommon appearance than gout.

In so much that [some] & [these] too practitioners of first eminence give name of gout to every disease with regard to which at a loss.

Particularly where there occurs violent pain & affection of alimentary canal.

And in such cases as appears from conclusion conjecture often right

For what at first apparently rendering very anomalous form, afterwards turns out to be regular gout.

This therefore a conjecture which may at least be hazarded with respect to present case.

But at same time uncertainty such that cannot make it foundation even of prognosis.

And must own that with regard to probable termination of case totally at loss.

May only observe that obstinacy with which has resisted practices already employed give no reason to hope for speedy cure.

If such occurs more effect of nature than medicine.

For hitherto practices employed chiefly directed with view of obviating symptoms.

And at present at least see no other foundation on which can afterwards proceed with greater probability of advantage.

When came first under care had recourse to diluted vitriolic acid, diffused in mucilaginous mixture.

In this had in view both dropsical affection which then suspected, & likewise state of stomach.

Imagined that might be beneficial to former from operating [as] diuretic & allaying thirst.

For both these effects have not unfrequently observed from it.

But expected still more powerful effect on latter.

Particularly as allaying vomiting.

An effect which have often I think observed to result from employment.

Accordingly soon after began use had at least for some time [complete] remission from vomiting.

And although no remarkable increase of urine, was no longer affected with ardor.

While at same time less of dropsical appearance.

And no return of swelling of limb even on erect posture through day.

But after this remission for about ten days had again return of vomiting.

And at this period menstrual discharge appeared.

While at same time, in place of coldness & prickling of limbs had severe pain in these.

In this situation nothing to led us to continuation of former medicine.

And astringent which might in some degree interfere with regular menstrual discharge even [constrained].

Omitting this therefore thought it necessary only to do something with view of obviating pains.

Was with this intention that [directed] friction with Unguent Terebinth cum Opium

Consisting of proportion of Oil Terebinth & Opium [rubbed] up with Hogs lard.

This present on idea that pains of Rheumatic kind.

As in such instances have often seen very great relief from use.

But in place of being attended with this effect during employment pains aggravated.

Changed it therefore for Anodyne Balsam.

And at same time directed internal use of opium.

But under these affection also still continued to increase.

And vomiting again [returned] with greater severity.

By this led to substitute for Opium the use of Hyoscyamus another very powerful sedative.

And not unfrequently giving relief where Opium fails or disagrees.

In conjunction with Hyoscyamus directed also use of Guaiacum

An article in some forms at least recommended both in Rheumatism & Gout.

Particularly as given under that of volatile Tincture or Elixir.

But to this form in many instances strong objections occur from Menstruum Volatile Alkaline.

And am inclined to think that all advantages from guaiacum [itself] best had by giving it in [substance]

Particularly as combining with Cream Tartar [illegible]

For by this convinced that its solution in alimentary canal very considerably aided.

Accordingly under this form here employed.

But from these medicines no more alleviation than from former.

And that too although dose of Hyoscyamus augmented.

While employed these, this patient subjected to convulsive fits [mentioned].

And may perhaps be considered as matter of doubt whether was not consequence of augmented dose of Hyoscyamus.

Certain that belongs to tribe of Narcotic poisons.

And that affections of convulsive kind no infrequent consequence resulting from these

While at same time from peculiarity of constitution much more readily induced with some than others

From these circumstances then at least a possible supposition that may have originated from this

But at same time consider it I own as improbable.

For took pills only to extent of grains X at bed time.

That is two of extract of Hyoscyamus.

In former instances however have given much greater quantity without any such effect.

Besides Hyoscyamus taken at bed time

Fits did not occur till course of succeeding day.

And by that time may reasonably conclude that its effect entirely over.

Hence though Hyoscyamus possesses cause yet that here induced fits not probable

At same time even on this footing thought continuation improper.

And as pains still severe thought of returning to use of Opium

Now however directed it in conjunction with Calomel.

An article from which could not indeed expect any immediate alleviation of pain.

For has not effect at diminishing [illegible]

But in some obstinate painful diseases often great influence in radical cure

Particularly in cases of Chronic Rheumatism

In so much that some disposed to put greater confidence in it than in any other medicine whatever.

Thus then imagine might here be useful.

And farther expected advantage as opening belly.

Or at least as counteracting tendency in Opium to produce constipation

In this however disappointed.

Had not indeed during course of succeeding week any [convincing] alteration

But while pains nothing alleviated by use of pills, was affected both with costiveness & very great drowsiness.

Consequences often resulting from Opium

By these therefore [determined] again to make trial of Hyoscyamus as substitute for opium.

And appears at least that had not same effect as binding belly.

But at same time pains still nothing abated.

And in conjunction with these affected also with return of vomiting.

While at same time drowsiness still continued.

Or at least, though restless in night slept much during day.

Notwithstanding these circumstances however still wished to give farther trial

And accordingly directed continuation.

But at same time with view to vomiting had recourse also to repetition of vitriolic acid.

What however will be effect of these practices, after being so frequently disappointed can hardly now venture to conject.

And must own equally at loss to say to what others may afterwards have recourse.

A necessary consequence of ignorance with respect to disease.

And if any truth in conjecture respecting gout perhaps most advantageous plan to do little or nothing

But to trust even alleviation of pain to patience & flannel.

Two perhaps of most useful practices in that affection, notwithstanding all said & written respect to cure.

Not improbable however that may here try a practice, which some think they have of late used with success in instances of anomalous gout.

Vitriol aether viz taken in camphorated emulsion.

But in this and indeed in future treatments in general must be very much directed by [circumstances] in which shall find our patient