DEP/DUA/1/11/02 (Transcript version)

Mary Rankin

(1776-1777)

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Mary Ranken.

Disease not altogether without ambig.

Many sympt indeed evid indicating dropsic affect.

And from swelling of abdomen, diffic of breathing, thirst & scarcit of urine might conclude her to be affect with ascites

Probab. is that this really the case.

But here a very essent. circum wanting.

No evid fluctuat.

Almost const observab where depends on water

Or where even dep on othr fluid matters as blood pus or like.

Would naturally lead to inquire how far reason to suspect swelling from any other cause

Especially as no appear of effused water at any other part of system.

For although pure ascites may exist by itself yet is for most part conjoind with other drop affections.

Here two othr suppos respecting cause of swelling naturally pres. themselves.

Sometimes happens that such swellings from solid matter. as in Physconia.

But to this suppos two insurm objec

First gradual & uniform encrease from progress of disease

In physcon. very gener. begins at partic part

And from thence extended to othr parts of abdom

But in pres. instance though encrease gradual yet more unif.

And no partic local hardness ever discov.

Besides this in Physcon. swelling never liable to sudden changes.

With our patient howver consid less at some times than others.

Hence for this suppos. little foundat.

Another suppos that may depend on [Air]

From this also well known that a disease induced the tympanites

But of this affection also most character sympt. absent.

Partic neither gives sound nor [crackling] of air

Nor is any relief afforded by disch of wind.

Upon whole then still most probab that depends on water.

And want of fluctuat may arise from diff circum

Such for example as water being containd in hydatides.

For of dropsic affection thirst & scarcity of urine give strong presumpt.

Yet would be by no means surprizd to find it turn out of complic nature

Neither entirely depending on water nor encrease of solid but partly from both.

With this uncertainty cannot suppose that will be much disposd to fav. prog.

Youth of patient somewhat indeed in favour

And still more so that has receivd temporary relief from encrease of quantity of urine.

But these circum excepted most other against patient

While thus uncertain of nature of disease reason to dread some local affect.

And from pain of belly can prognosticat nothing favourable.

From contin of disease also may conclud it of [subborn] nature.

Although but 8 years old has been observab. no less than 5.

And probab. of even much earlier date

For may consider as sympt of it thirst with which affectd from time of nursing

Besides has already resisted power of sever med.

If therfore admits of speedy & fortun. termin will I own be more than expect.

May seem strange that neither in history nor prognos have taken notice of a circumst partic mentiond in case viz the worms.

These however do not suspect to have any connex with pres. disease.

Although now a less freq. affection than formerly yet still no very rare occurr.

And often without much inconven [altho] at times indeed productive of most threatning & most anom sympt.

With our patient cheifly appeard during a fever.

A time when often observd to be disch.

And would seem that from morbid affec situat becomes uneasy to them.

Is however from thence improp to conclu that fever worms the cause of the worms fever.

And in pres. instance would consider them as merely accid.

Has indeed even of late discharged one

And not impossib. that may still be others in bowels.

Would even admitt that may either be cause of some sympt or may aggrav. them.

Yet do not consider them as any danger part of affection

And hence unless from future occurren. will not perhaps claim attent in cure.

With regard to gener. plan from what said will conclude that sentim not very determ

Have however begun treatment on what reckon most probab. suppos.

That viz of Dropsic affection.

And here mean first to attempt disch. of water by natural outlets.

Of these cheif are by stool & urine.

From first most immed & sudden disch

From last evac with least debility to patient.

Hence can be persisted in with more regul & for longer time.

This therefore cheif object in pres. attemp

Yet wish also in some degree to conjoin other

With these intent have put patient on use of two diff. med. viz

Cream of Tartar & Squills.

The first while purgative at same time powerfully diuretic.

Last intended solely with latter [view].

If from these can obtain copious disch. with dimin of swellings & at same time with without debility may go far to recov. of patient.

At same time in dropsic affections consider evac of water as least import. part of cure.

And in numberless cases find it much more diffic mattr to prev. return.

May be necess. therefore in order to [secure] good affect to have recourse to Bark & other tonics.

But can by no means promise that shall ever be able to come this length in cure.

And may soon even be satisf. that pres. plan is not to be persisted in.

Evac may be greatr than patient able to bear.

Or may take place without dimin of swelling

In either case will be prejudicial & would be improp. to persist in it.

What measures may then be disp to adopt own that cannot at pres. even conject.

Shall prob. however try some med more immed. tending to encrease tone of aliment. canal.

Such for exampl. as what calld Carmin & stomach.

Yet must at same time observe that future plan of practice in great meas. regulated by situat in which shall find patient when pres. trials concluded.

With contin of pres. course however mean to conjoin friction to abdom.

And to induce to contin for suffic length of time shall probab. order it to be done either with some oil or some soft powder.

But without expecting from these any other affect than that will lead to [perser] in friction.