DEP/DUA/1/14/04 (Transcript version)

Grizel Craig

(1777)

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Grizel Craig.

This patient has already oftener than once subject of Lect. with me in other courses

Was first my patient about twelve month ago in R. Infirmary.

And but short time since several had opport. of hearing me make sever. remarks on case in as treated in Colleg. Casuale during winter.

On these diff. occas compl. not precisely the same.

In one case consid her as patient princip for dropsy in other for Ammenorrhea.

And on both occas had at least tempor. removal of compl.

Evid however that by no means a radic cure.

For when came at pres. under our care had as it were conjunct of both.

From which led to conclude that opin before entertaind that affect viz unconnected was a mistaken one.

And although at diff. times have appeared separ. yet now disp. to reffer both to same cause.

And not improbab. that a morbid cond. of the uterus may give rise to the drop affection

For here to be observd that though dropsic affection in form of anasarca yet with some pecul.

Anasar. swellings indeed more freq in infer extrem than any where else.

But after subsist for any length of time seldom so completely confind to any one part as are in case before us.

For except by appar. fulness of counten. have had no indicat of swelling on any other part.

Urine not affected to any remarkab. degr

And unless when accid catarrh repeat easy

Would argue therefore rather some local cause acting on infer extrem. than general hydrop. diathesis.

And when consider that most [matteral] funct. of uterus, menst. disch, evid affected may lead to suspic of disease of that visc.

And when known that schirros. in other viscer. prod of dropsy may unquest arise also from uterus.

But besides what already mentiond anoth pecul. may here be taken notice of

That is state of pulse.

Here for a dropsic affect. uncommon [question]

Which when happens in dropsy is usuall conseq of irrit afforded to syst. by disease of some viscus.

From all circum taken togeth then some reason for presum. that a local affect of uterus to be consid as cause of both dis.

But in what that affect consists a matter of diff. to determine

Nor can we pretend to conject with any great degree of probab.

Whatever course may be with regard to exist of two affect. already mentiond there can I appreh. be no doubt.

But with regard to third besides these some room even for suspecting third [affect.]

In weakness of legs & diffic of walking have appear. as if tenden. to paralysis.

For hardly to be imagind that should have had these affect to so great degree from all swelling that here occurd.

Unless debilit augmented by an affection of medium through which all motions [passed] viz Nerv. fluid.

Must howevr be allowed that in impedd motion here occurring no certain proof of paralysis.

And no evid of affect. of other great function depending on nerves viz sensibility.

Loss of motion indeed may completely take place without loss of sense.

But more freq. are connected.

And at utmost can assert that if paral. does here occurr is to slight degr. only.

Even on this suppos. however must still look upon disease to be a complic affect

And after manner in which have already faild, no room for expect. speedy or effect cure

Must own that entertain very great doubts how far that will ever be affected.

And on whole disp. to think that all our endeav. shall in end prove abort.

By this howevr would not be understood to mean that think there is little [prospec] of our being of service to this patient.

Should origin cause of affection remain measures may yet be taken giving releif.

From measures already taken have obtaind at least tempor. removal of swellings & consid augment of strength of limbs.

And have little doubt that either by plan at pres. prosec or by others [meas] also may at least for some time be [restr.]

But whether in any of these ways [relief] will be perman is a matter of much [great] doubt

And if conject respecting local affect of uterus be well founded can hardly expect that will be the case.

At same time where dropsy in diff forms conseq. of worst local affect. former may be removed while later contin.

From this then would inferr that tempr removal of dropsy neither proof that does not proceed from cause suggested, nor evid of cure of affection.

Yet appreh. that this as well as restora of menses are objects more immed to be aimd at.

For are not only great sources of immed distress but are farther the affections when as already observd can cheifly expect to [illegible]

While at same time removal of even chance of removal of origin cause to be expected only from long cont. course.

And must own that with patient so long subj. to disease should have even some doubts as to prop. of attempt.

Of the two partic already mentiond consid dropsy to be most urgent.

And here great object was reabsorpt. & disch of water already effused in cellul memb. of infer. extrem.

Action of absorbents augmentd by many diff measures

Few however more affect. than those producing evac from the system by [serous] outletts

As from these therefore conjunct of two affects requisite thought such practice the most advis. in pres. case.

Of all evacuants employd in dropsy prefer. perhaps to be given to Purgat or Diur

First most immed & certain

Second the least debilitating.

When this patient formerly under care with a dropsic affect employd as purgat the Elect.

And operation then product. at least of tempor. cure.

Would naturally therfore seem to indicate repet of employment.

But as patient debilit by longer cont of disease thought at first of trying more gentle meas.

And was with intent of obtaining [affect] both of gentle purgat & diuret. that had here recourse to Cream of Tartar.

Which that might be prod of [illegible] in stomach from refrig. quality, united with small prop of Cinnam.

In affect of this prescript were not [disappointed]

For from use, urine consid augmented & freq. loose stools induced.

Conseq. was that swellings very soon disappeard.

And med as tending in some degree to induce unnecess. debilit was omitted.

Since that howevr on threatnings of return have again had recourse to use

But employd it to less extent.

On total disappear of swelling shall again [intermit] us

But while cont to produce some good affect shall not probab. think of changing med.

Or That is of having recourse at least to any other evac with view of disch. [effused] water.

But from this can expect little as tending to removal of Ammenorrhea.

And although not immed sensib of inconv. from this yet restorat an obj of attention.

For hard to say how far obstr. alone may not even be cause of drop. affect

And suppos. this not to be case yet restorat of due disch. by menses may be means of prev. return of dropsy.

For restorat of menses when this patient last under our care had empl. electric.

And then disp. to attrib to it reapp. of this flux after obst. for very consid time.

Was naturally led therfore to have again recourse to same remed.

That electri in some cases a very powerful mean of restor. menses can admit of no dispute.

Pract. howevr diff. much respecting [mod] in which operates.

Into this subj. howevr cannot here prop to enter

May only in gener. remark that hold action of uterus to be a condit necess to menst disch.

And imagine that electricit operates either as immed restor. action or dispos. to action.

In same manner as where paralyt affect often [restores] capab. of action in other parts of body.

Can hardly venture to say that electr in case before us has yet been prod of desired affect.

Yet since patient put upon use of it has at least had shew of menst disch

And not without hopes that at next period may be more abundant.

Am therfore encouraged to persist in use

And this the rather from suppos [that] tendency to paralyt. affect in limbs themselves.

If howevr in the end this mode of restoring menses found ineffect. many other measures with same view may be tried.

With this intent may employ Rubia Tinctor. Tinct. [Melampod] &e.

But if as suspect local affect of uterus has in reality taken place, [altho] may prod tempor. restorat yet will never again be able to obt regul or prop. disch.