DEP/DUA/1/15/14 (Transcript version)

Margaret Anderson

(1777-1778)

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Margaret Anderson.

Of case of this patient have not been able to form any very decis. opin.

When came first under our care appear of sympt. somewhat diff. from what are at pres.

And whether of precis. same nature am much at loss to say.

At that time attacks of affect appar in form of parox.

And consist cheifly in palpit of heart.

With this attackd with great viol. three or even sometimes four times in course of day.

Palpitat unquest. consists in an inordin affect action of heart.

Is however a change from natur [stand] which may arise from diff. causes.

Most commonly howevr refer. to one of two

May depend either on an affect merely nervous in which way often a sympt with hyster girls.

Or may arise from an actual local affect. either influ. course of blood into heart or altering state of sensib.

Of this last kind exampl in inflam of heart itself, polyp of large vessels &e

Here then to determ or perhaps rather to conj. only from circum to which is to be ascribd.

And in giving name some quest. whether should be derivd from cause induc palpitat or from palpit itself.

Here to be observd that some circum favour suppos. of affect arising from inflammat of heart itself.

Besides palpit affect attended also with severe sense of pain.

And with very consid degree of heat.

These however well known to be const attend of inflammat.

And among sympt of carditis palpit univer rankd.

May farther be added that cause [unden] such as might be supposed to give rise to this affect.

Was we are told conseq. of having hurried herself much in walking.

From which presumpt. that both consid heated & suddenly perhaps [imposed] [cold].

Yet although some circum in fav of this suppos. liable to much strong obj.

Carditis very gener. attended with other sympt. than here occurr.

Were patient subj to that disease pain & heat would not as is here the case occurr only at times but be const.

Is also strongly markd by pecul. anxiety diffic respir. inequal of pulse & syncop.

But above all const accomp with very great degree of fever.

These sympt however which undoubt essent. to disease in our case totally [abs]

For although consid quickness of pulse yet without heat or febrile anxiety.

Hence whether from local affect or not have at least very little room for suspecting that derivd origin from this cause.

From sex of patient some presumpt afforded that might be merely a nerv. [affec]

And well known that palpit a freq. occurr. with hysteric patients.

To this suppos. however nothing giving counten in other sympt.

Cause inducing it not such as should have suspected to give rise to hyster.

Patient not formerly subj. to hyst. compl.

And greatly past period of life at which most freq. occurr.

Hence then disp to consider this suppos also as rather improbab.

Among other causes of palpit has been said to arise from gout.

And no doubt that well vouch’d inst at least where has altern with attacks of gout

To this suppos. some obj from sex of patient

Is with females a disease but rarely occur.

Yet suppos in some degr probab. from all sympt which have pointed out as indic inflam.

Still more from an [after] occurr. which took place soon after patient came under care

And which indeed happened nearly about same time when affect of patient most consid relievd.

That was partic pain in left foot attend with very consid swelling.

This well known to be common seat & appear of gout when most distinct marked.

And upon whole of three suppos I have mentiond disp. to consider this as most probab.

Must however at same time observe that as palpit an affect from gout, is also from rheumat.

Of this at least had once occas to observe a very stricking inst.

Disease indeed there much more threat than with our patient.

Case to which I allude was that of a Clin patient treated in R. Inf. about 14 years ago by late Dr M.

These sympt began with every [appar] of cardit.

But partic markd by great palpit.

After however of some contin, & when patient thought in greatest danger had very unexpect. conclus.

Many of larger joints became affected with the pain inflam. & swelling disting acute rheum.

And to common treatm of this dis. all the sympt soon yielded.

There could be no doubt On these grounds the learnd Prof. who then gave lect [show] no doubt in pronoun that affect to which patient subj. was of the R. kind.

In pres case however this by no means clear.

And although some inst of gout which may be readily disting from Rheum yet others where even greatest diffic.

And whether here suppose pain connected with palpit or not may be stated as quest. of some import from what cause arises.

Partic whether are to look upon it as of gouty or rheumat kind.

Pres. one of those doubtful inst where presumpt argts may be brought for both sides

And perhaps by farther progr of disease only that certain determ. can be formd.

Age of patient more period for gout than for Rheumat.

And part princip affectd viz foot more seat of Gout than of Rheum.

But on other hand to be observd that parts here affected which seldom seat of Gout

Ex. trunk of body.

Gout seldom observd to affect more than one part at time.

But with our patient has existed with consid sever. in sever. diff parts at once.

Farther presumpt of Rheum from sex.

And upon whole must own that most disp. to fav that suppos.

Taking it for granted then that compl of pres. patient origin from Rheum affect still some diff. as to name to be given.

And partic whether should consider it as partic species of Rheum or of Palp.

As have already observd genus of palpit adopted by most [physiol] Nosol.

And under it Mr Sauv. the most [celeb] of them has compreh. sever species.

Among other one disting. by title of palpitat arthrit.

On same footing may I appreh estab. anoth by denom of Palpit. Rheumat.

And this name might perhaps have been disp. to attrib to affect had sympt with which came under care been more perm.

Still however would I appreh. have been naming disease, rather from app. than nature.

For although cheifly markd by this sympt. yet [genus] of affect to be consid as of Rheum kind.

And although means may be occas empl. for obviating [sympt] of palpit. yet radic cure to be aimd at by remov. of Rheum.

Without therefore being more minute in name would consid it even in most anom state as Rheum in partic form.

May however here occurr as obj. that sympt not such as enter definit of Rheumat. in nosol. system.

Partic however Practiti. however have long disting between two diff states of this disease vizr. acute & chronic.

And these probab. not more diff from each other in sympt. than in nature

May be quest. how far should not be disting by diff. names.

But circum of one being so freq. [sequel] of other has led to best. upon them the same term.

And indeed often intermed states [partake] in some meas. of sympt of both.

This seems to have happened in inst before us.

In obv. inflam or swelling together with quickness of pulse had sympt of acute.

Yet gener. absence of febrile affect & pains commonly without external appear. led to think that inclind most to latter.

With this view of nature of affect do not I own view consid it as threatning great dang.

Rheumat even when most viol is more a painful than danger. disease.

And in acute state perhaps few affect more under command of med.

When however degener. to chronic often a very ted disease.

And even after seeming cure patients from vicisit of weather subj. to return even for life.

Partic the case with old people

From all circum then can hardly look there for exped cure.

And indeed even opin that free from danger rested on no very cert. foundat.

Rheumat although not highly danger as affect. joints, may yet be attend with greatest danger as affect vital organs.

Besides have already hinted some circum giving presumpt, that disease may be [Gout]

And if this the case well know that attack of diff organs attended with great dang

Should then return of affect prove even suddenly fatal will not be altog [unex]

Yet disposed to hope that for pres at least sever. over.

And that even in no long time patien may be in condit to be dismissd.

But hardly expect that during whole course of winter will be entirely free from pain.

In treatment of this case have proceedd pretty unif. on plan on which first beg.

First prescript intended with view of obv. an urgent sympt.

Second as means of radic cure.

When patient came under care had not formd any very decis. opin respect. nature of fits of palpit.

But from whatever cause, whether merely nervous or from more fixd local affect imagin. that might at least be counteracted by means allaying inordin motion.

And was with that intent that had recourse to aether.

From even commen of use had appar good effect.

For by being taken prev. to parox. these mitig in viol. shortened in durat & rend less freq.

During use however a circum occurd remov ambig as to course

Or perhaps should rather say giving ground for more probab. conject.

That was severe pain on left foot attended with swelling.

As from this led to conclude that palpit either from Rheumat or Gout pract. directed accordingly.

And here accomod to disease as in [interm] state betwen acute & chronic.

Or to use diff. language between [infla] & atonic condit.

For consid first as depend on state of inflam induced in partic parts of syst.

Last as arising from pecul. irrit condit depending on atonia.

First then to be combat by evac [partic] blood letting & sweating.

Last by means most affect. [tracing] Peruv. Bark cold bathing or like.

But for intermed cases consid. those remd as best suited which possess some degree of stimul & evac powers in conj.

Was on these grounds that here determind to use of Guaiacum.

A remedy active part of which consists in resinous gum.

And which in whatever form exhib, long deserved ranked among stim diaph.

Of all formul. howevr perhaps most powerful that of volat elix.

And in a Vol of cases of Rheum & Gout lately pub. by Dr Dawson of London is extolld as a most effect remd both again rheum & gout.

Dr Daw. not cannot be consid as introd of this med.

But was at least first who gave it freely to great extent.

And encreased dose from not many drops to extent even of ounce at time.

Since his public have employd it in both affect for which recommend. it.

In gout think have given it with advn

In Rheumat. have found it prod of most manif good effects.

With pres. patient has not had that obvious operat which expectd.

Yet think that has been here attendd with advant

And hope by contin to overcome affect

At pres. therfore no immed thought of altering plan.

And should this fail must own at loss to say what plan should next [illegible]

But in all probab. change will only be requis from alterat of affect.

And in that case future pract determ by circum then occurring.