DEP/DUA/1/13/09 (Transcript version)

May Taylor

(1777)

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May Taylor.

With regard to case of this patient must acknowledge myself much at loss.

Was under care last summer in Royal infirmary for nearly same compl. to which at pres. subjected.

Then after trial of various med found princip. part of affect. to be obstin fixd.

And in other respects disease subjectd to changes by which plan of cure laid down was interrupted.

By these means when finished attendance at hospit. remitted her to ordin phys. in a situat even worse than when came under care.

And at distance of ten months has again become patient with affect [near] in same state as formerly.

Must still observe that of nature of patients disease can by no mean form any decis opin.

At same time see no partic which can now lead me to alter sentim before delivered.

Now as formerly most obvious part of affection is swelling in diff. [place] of system.

That takes place to no inconsid degree in face may be distinctly seen on first view of patient.

But still more remarkab in hands [which] enlarged to very great degree

And this enlargement extended a consid way up arms.

That this enlargemnt must be conseq of some depos. abund evid from consid changes which sudden take place.

After long contin which has already had can conceive it only conseq. of depos of one of three matters

Water Air or Fat.

To all three some object occurr.

To suppos. of water may be obj. that swellings do not as is very generally the case retain mark of pressure.

To suppos of air that less elastic & without any crackling noise.

To fat that occurrs in more local mann than that could be supposed to do.

That to feel much more tense than that subst.

And that while health of patient in other respects would not lead us to believe augm of this [part.] undergoes more sudden changes than could be consid to happen from fat.

After all then reckon suppos of water of the three the most probab.

And would acct for its not retaining marks on press. from pecul. state of cellul. memb.

Especially when this state conjoind with high degree of distens.

For here to be remarked that when by any means swellings much dimin impress are retained.

Which consider as strong corrob. proof of opin formerly deliv that swellings of anasarc. kind.

True indeed not now accomp with scarcity of urine

A circum which when patient last under care reckond strong proof of effus of water

Still however attended with diff. of breathing.

A sympt. with regard to which formerly much at loss.

Now very little more satisf. than was before.

Then threw out these diff suppos on which imagind might be acct. for.

Is often affect of serous watery effus in cellul. memb. of lungs.

And that this might have prod it in pres case reckond at least not impossib.

To this however some object that anasarcous affect here not general.

And was I own more disp to reffer it to another cause.

Depos of water viz in cavity of [breath] or affect known by title of Hydrothor.

Could not indeed be refused that of this affect several diagnostic wanting.

Yet from considering, insid nature of hydrothor., indistinct narrat. of patien & sudden affect of breathing on horiz. posture, was most inclind to adopt this opin.

Now however am I own disp to reckon it the least probab.

For had such an affect taken place would ere this time have been more distinctly marked.

On contrary patient now free from sympt. giving greatest room for suspicion.

Now therefore in as far as affection of breathing depends on water am disp to consider it as proceeding merely from an anasarc. affect.

But must at same time observe that now more than before disp. to give credit to third suppos. which before sugg

That vizr both anasarc affect, & affect of breathing may proceed from same cause.

And may be affect of morbid state of blood vessels about heart retarding circulat.

And cannot help thinking that suppos of a diseased affect of ven cav. sup. sup giving obstr. to course of blood would acct. for all sympt.

For look upon affect of menstruat occas. stomach compl. &e as merely conseq. of diseasd habit thus induced.

With this view of disease will not be imagind that entertaining any sanguine hopes of cure.

And if any truth in this conject utmost that can expect to do will be merely to palliate sympt.

May even be doubtful how far shall be able to obt. this end.

And need not surprize us should patient be even suddenly cut off by an affect which at pres. seems to threaten no danger.

If however be merely anasarcous from cause most generally [induces] such affections, may be able consid to palliate or even to cure this patien

And indeed on this suppos. must I appreh. proceed in treatment

For whatever cause of effus of water, is by disch. this alone that can expect either to relieve patient or to pave way for prev. of future affect.

Meas. hitherto prosec. then cheifly meant with one of two views.

Either to promote absorption or to evac serosity.

Was with first of these intent that had here recourse to electricity.

And with last employd purgatives & issues.

But besides this have also occas employd remed for obviating partic symp

Such for example as Infus Japonic for vomiting with which affected.

Under these med. diff sympt at least somewhat mitig.

Vomiting has left her, menst. flux has returnd, & swellings consid dimin.

While therefore appear thus far favour. shall not probab. think of altering plan of cure.

And as cheif affect in disch. water seems to have been obt. from issues without pushing other meas. is intent to persist in these.

Or at least only to conjoin gentle means of promot absorpt.

For till complete disch. obtaind should reckon any meas. for strengthen tone very improper.

If however shall get entirely rid of swelling is intent to put her for some time on use of Peruv. Bark.

Yet must esteem it very uncertain whether patient will ever be in condit for this.

And in a case so doubtful as pres can speak with very little confid of future plans of cure.