DEP/DUA/1/16/02 (Transcript version)

Ann Mason

(1777-1778)

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Ann Mason.

When this patient came under our care disease in some respects more doubtful than at pres.

From state of sympt with which is now affectd can have no hesit in pron. that is subj. to Phth. Pulmon.

And this indeed opin which would prob. have given had we been to trial of case immed after admiss

For even in history at first given had greater part at least of sympt indic Ph

Patient then affected with cough & fixd pain of breast.

And this cough attended with expect cont. mixt of blood.

To all these may add that had then to remarkab. degree emaciated & [red] app which const occurs during that affect.

Look viz disting by title of Facies Hippocratica.

From these circum at least strong presumpt.

Yet very far from amounting to cert.

And patient then subj. to some other compl. partic what respected menst flux by which case rend more doubtful.

Now howevr farther progr. of disease has put this matter beyond all doubt.

Have already had occas. to remark that from diff trials made on matter exp. by this patient strongest evid of its cont. purul. matter.

And accordingly progress of hect fever, with colliq diarrh. has reduced her, if still alive, to last extrem.

Whatever therfore may have been affect at earlier periods, no doubt with respect to concerning it at latter part.

With respect to origin & progress of this affect. here room for many [remarks]

But as in many partic simil to case of Janet McKenlie of which have already spoken shall now say but little with regard to it sever observat which might be offered are in great meas superseded.

Here also as in that case complc of Ammen. with Phthisis

This consider to be one of most powerful cause of obst.

[illegible] operat is affect of strict [induced] on bleeding vessels.

But strict occurrs on extrem of [vessel] at time when farther up dist. with blood.

Chance therefore at least that [illegible] may thus be induced.

And vessels thus filld with [thrombi] of coagul lymph by which ever afterw rend imperv.

Do not pretend to say that this always happens.

But when from this circum perman obstruct occurr am disp. to think that is thus to be expl.

And such conclude to have occurrd in pres. case.

Is evid howevr that will seldom take place in every vessel. Hence even with strongest evid of occurr no ground for pron. disease incurable

Here also Ammen consid as prior cause of affection.

And said to derive origin from imprud expos to cold during checking natur. flow.

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In pres. case see no circum which can lead us to entert any susp. respectn this acct.

And in all these partic then exhib example of affection formerly spoken of

Here however connect with menst disch. seems to be still more immed. than in case of McKenlie

And to have constit at least at earlier periods greatr part of morbid affect to which was subj.

Here from date of obt menstr. no room to suspect that was conseq of Phth.

And for long time after first obst evid that did not proceed from either state of inan or want of due [impet] in circul.

Partial accum in uterus seems for sev. months to have gone on in usual [mannr].

At least cannot help thinking that of this suff. evid in period return of pain of [loins], with sense of weight & [tension] about region of uterus.

And indeed this may readily be concluded if in reality arose from cause before suggested.

This diff. Physiol according to theories held of cause of menst. would expl on diff prin.

On opin elsewhere deliv would refer it accumul. of blood in uterine vessels.

While at same time would ascribe period relief after few days cont to blood being again expelld from thence.

This expuls. am disp. to refer to action excited from uterus itself.

When superveens after blood accum in uterus one of two things must follow as conseq.

Either disch of blood into cavit of uterus or return into syst.

In pres. inst resist in formr way seems to have been greatest.

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And here from return into syst would expl. sever. of sympt.

To this I appreh are to referr period looseness to which was subj.

And disposed to look upon it as being in some meas a vicar evac.

At same time have not before met with any simil. cause.

Although daily exper. must afford numb. inst of othr haemorr. occurring during obt menses.

And these I appreh. to be expl. on basis mentioned.

Occur sometimes under form of Epistax. sometimes of Haemoptys.

But of all others most freq. of [Haematoe]

Is in few cases only that [haemorrhag] ensues from othr part of alim canal.

Yet on same ground as occurrs from vessels of stom. may also from those of Intes.

And cause thus in some cases prod bloody disch. in others may give rise to mere [serous] evac.

Such indeed not in reality an occur so freq. as might thus inferr from prin.

Yet when does take place may I appr be better expl. on theory of menst alluded to than on any othr hitherto prop.

This then idea of nature of affect to which patient subj. for sever months before came undr our care.

And appreh that circum now mentiond no inconsid infl. as inducing affect of breast.

Not long before she became our patient an occurr took place which may be supposed to deserve some attent.

That is bloody expectorat.

Haemoptys. have already remarked is not unfreq. conseq. of obt. menses.

Yet as attending Phthisis may arise also from othr causes.

And partic seldom fails to take place to some degree on rupture of vomicae.

To this indeed [only] cause of pres. haemorh. some obj from quantity to which repres. as having here occurred.

But in this respect great variety [from] diff size of vessels which may be accid rup

And still stronger obj. to suppos of its being Haemopt. symptom of Amm. from period at which occurrd.

Did not take place at that time when should cheifly have expected such haemorrhage.

When consider then occur at late period of disease & its being succeeded by purul expect. am disp. to consider it as being effect of rupture of vomicae.

And in such diseased state of [the] lungs suppose essent part of affect now to consist.

From this view of disease will naturally conclude that hopes of recov. must be very faint.

And indeed think it more than prob. that a fatal termin has already taken place.

Is but in very rare inst where after Phthis distinctly marked recov. ever takes place

Yet perhaps may add that no cause so desperate as to preclude all chance.

And hold chance to be even [better] when purul. matter has free disch. than when confined.

Or where in place of Vomica merely a tubercle yielding bloody sanies.

May also remark that in pron. fatal progn have sometimes found myself disappointed.

And have freq occas to see on street of Ednr. more than one patient who I was disp. to think would long before this time have fallen victim of Phthisis.

In one of these cases howevr am now disp. to think inclined to believe that mistook obstin catarrh for incip. Phthis.

And in anoth some doubt whether purul. mattr disch to great extent realy came from lungs.

If did was at least mild & bland [Res.]

For probab. that hectic fever more conseq. of pecul. separ. from ulcerated parts than of prop. pus.

But from these circum would only inferr that do not look upon recov. in pres. inst as impossib.

Yet own is an event which if does take place will be much contrary to expectat.

And in affect. which any meas. which we can employ will have very little claim to ment.

Am even very doubtful how far can take meas. that will have any consid affect in allev.

And for some time prescrip rather from intent of not seeming to desert patient than from any hopes of benef.

When patient indeed came first under care did not view cause in same [despr] light as at pres.

And had recourse to some measures with view to radic cure.

Then consid affect as very much supp by want of menst. disch.

And hoped that if restorat took place disease might have favour. turn.

Patient however in such condit. that durst not venture to employ any med rough in operat.

Had I consid system as capab. of bearing it should here have entert [some] hopes from use of electric.

But to this as well as many other [illegible] [emmen.] from affect of lungs & debilit sys obj. occurred.

By this therfore induced as in case of McKenlie to make trial of the Rubia.

A med of effic of which can say nothing from own exper.

Yet from [penatr] influ on system consider it as at least deserv. trial.

And for forming proper opin repeated trial in diff circum requis.

Here from tendency which evid appeard of dispos to haemorrhage case in some respects favourable.

But on othr hand was not a little against med that patient much affectd with looseness.

By this led to conj. Rubia with an astring.

From which at least hoped that influ of the Rubia as tending to augment loosen might be counteracted.

In prefer. to other here used as an astring the Terra Japon.

A subst with great improp. obt. name of earth.

For in as far as cont. earth is merly an impurity.

From accurate investig now discov. to be an extract from a species of Mimos. or [illegible] plant.

For best acct of this subst may refer you to papr in Lond. Med observ. by Mr Kerr a Surgeon in Bengal.

Has given accur. descript. & beautif. fig. of veget from which obt.

As well as partic acct of method of prepar. it.

From this learn that earthy appear. which has is totally derivd from method of prepar it.

For after express. from veget is dried in earthen kilns dug for that purpose

Consider then authors of [Pharm.] [illegible] as having made very prop alterat in nam by subst. term Succus. Japon. for Terra Japon.

And in Succus Japon [deparatus] a prepar. intended merely to free it from earth have introd a very useful improv.

In purif state look upon it to be one of most useful veget astring which we yet possess.

And partic as employd in cases of Diah

But especially when such an affect the conseq. of irrit or relaxed state of intest.

In such cases reckon it even prefer. to that now fash. remed the G. Kino.

First introd to notice of Europ. pract by Dr Fothr. in London Med observat. under title of G. Rub. Astring [Gambic].

Two remed in some respects [suited] to simil affect of the alim canal.

And hold G. Kino to be of the two the most powerf. astring.

But although has name of Gum is so much of resin subst. as to be very completely dissolved in Spt.

And in any state in which can be exhib is more irrit & acrid than succus Japon.

Which on contrary is to consid degree of mucil nature & readily solub. in pure water

From this circum then while no inconsid astring power acts as it were as demul. & serves to lubricate [abrad] intest.

Was from these consid then that gave it prefer. in pres. inst.

How far in pres. case here counteracted loosnss which otherwise would have occurrd cannot pretend to say.

Did not howevr render stools less freq than had before been.

But on othr hand [free augm] no encrease of loosenss from use of Rub.

And after had for some time cont this med. appear seemd rathr fav as otherwise

Had not indeed least shew of bloody disch by vagina.

But was again affected with sense of pain & weight about region of pubis [indi] accumul of blood in uterine vessels.

This indeed no more than had often before experienced without use of any remed.

Yet as followed so soon after use of med some reason for pres. that may in part at least have arisen from that cause

While at same time whatever may have been cause had reason to hope that while such accumul. existed menst disch. would be more easily restored.

By this then led to entert some hopes, &, notwith looseness, to push use of med.

With conf. therfore ordered that dose should be more freq. repeated.

While still farther to counteract loosnss ordered addit use of succus japon in diff. form.

From what already said of impur. dep. on earth & of ready solut in water, must appear that simple infus one of most elegant forms.

In sedim falling to bottom, [difference] quickly takes place.

While parts on which activ depends remain fully susp. in watery menst.

In this state where intest highly irritab. effic may be much augm by conj. it with a sedat.

A combin of succus japon with opim. long basis of very celeb. formula of [illegible] Pharmac. vizr Diasordum.

A med deriving name from an article on which effic in no degr. depends.

And accord while now denom in Ednr Pharm under title of El. Japon the [Scord] is entirely rejected.

Consist solely of astring & aromat conjoin with opiate.

In this state may either be given in subst or diff. through watery menst.

And no doubt that in many cases is a most useful & grateful med.

Not howevr in every case that conj. with such aromat as Cinnam & Nutmeg [advan]

Not always that wish for stronger astring than Succus Japon [suff] cap of giving.

And freq. that would wish to give opiate in either larger or smallr propr than these directed.

Is from these diff consid than that view Infus Japon as possess advant over mixt of Confect Japon.

In simple infus has mod degree of astring in propor of ℥p to ℥IV of Water

And this strength at which suppose it to be made if contr. not specif.

Here then while directed infus without aromat encreased very consid prop. of opium

Ordered simple infus as conjoin with equal quantit of Syr. Diacod.

This directed to take to extent of ℥i every night at bed time.

And with state of her expect hardly thought that could venture on use of opiate to greatr extent at once.

Even in this way howevr with [use] of the succus japon combind with Rub. looseness still contind severe.

While at same time powders set less easily on stom than formerly.

Occas. not only some degree of [sickness] but even vomiting.

To all this, to be added, that prospect of restor of [menses] entirely vanished.

For by time of second report, feelings which seemd to indic approach entirely gone.

In this situat then could have no hesit in discont. Rubia.

For while now little hopes of future benef from it reason to suspect that supported pres. uneasiness.

And patient reduced to so low a condit as to be very improp. subj. for precar. [med]

Confind her therfore to use of infus Japon alone but ordering more freq repet

Under this, loosness rathr mitig as [other]

But without any mattr relief of affect.

For with encrease of purul. expect had aggrav of hectic sympt & much dysp.

In this situat was doubtful as to the prop of the anod.

For with debilit state accumul. in breast may have prod suffoc

By this therfore led to omitt it also.

And was merely with view of nat seeming to give up patient that [used] mucil. mixt.

With same intent also when thus disagreed with stomach substit for G. Arab the Balsam Syrup.

And if finds any reluct to this may vary it for some simil [innoc] prescript.

Yet without hopes of deriving least benef. from them.

And reckon it highly probab. that if [scene] be not already closed, patient will very little longer stand in need of assist.