DEP/DUA/1/17/02 (Transcript version)

Mary Gallet

(1778)

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First case in list that of Mary Gallat.

This patient selected not so much as giving rise to remarks useful in after pract as affording an examp. of an affect somewhat [singu]

And is indeed a case with regard to which must own have very great diffic.

At same time this diffic arises solely from nature of affect itself.

For in history introd into regist. drawn up by Gent who last [offic] as Med assist at the Disp, have very full & accur acct of all her compl.

And that disease no misrepres. but dep. really on even local cause can admit of no doubt, even from most superf. exam.

Most obvious part of compl. swelling of abdomen.

This even extern of such magnit that cannot fail to strike every observer.

This enlargement extends through whole abdom.

And in no degree attended with that fluctuat which if not univ at least very gener the attend of accomp. swelling dep on water that in fluctuat.

Besides this patient affected with at least few of the othr sympt which remarkd considered as common attend of dropsy.

Is indeed remarked that after erect post through the day her legs obser. to be swelld towards evening.

And that while this subsides during nigh hands not unfreq. affected in simil mannr during in morning.

These transit swellings so much connectd with post. in all probab. effect of depos of water in cellul. memb.

This however by no means an uncommon occurr. where dropsy in other cavit entirely [wanting]

And in numb. inst takes rise as mere effect of debilit.

That from this circum may arise in case before us can hardly be doubted, from what said, & indeed obvious, as to debilit condit of patient.

Must own therefore that am much more disp to adopt suppos. of patient herself.

That swelling vizr to consid degree at least is effect of wind.

Of this evid in some measure from [feel].

Still more from flatul with which patient affected.

And lastly from change in point of size to which swelling subj without any other disch. but that of wind.

From these diff circum then rather more ground for presum, that swelling in part affect of wind rathr than of water.

Yet must be admitted that far from [illegible] to certainty.

And that even swelling of legs not only dropsic sympt.

Compl. also of some affect at least in disch of urine.

Rather however diffic in passing it than scarcity

Shall not however be surprized to find that from after circum [there] shall appear greatr room for doubt.

But whether suppose gener. distens of abdom from wind or from water, must necess entert diff suppos. as to greatr part of it.

For there With this patient there is manif. to be discov. also a hard local swelling in great meas fixd occup great part of abdom but princip right side.

In this pecul. of patients disease [consis]

And from this whatever it is are prob. to acct for all other sympt.

From firm hard feel & from manif inequal from firm hard feel, & from manif inequal. can be no doubt that [natur] to be ascribd to air nor water.

At least as lodged in cavit of abdom.

And here threee diff suppos. may

Are necess. led therefore to form some other suppos respecting it.

And here three diff suppos. may be entert.

May either dep. on diseased state of some of those viscer. natural to syst.

On growth of some tumour totally praeternat.

Or may depend on the retent of a foetus.

And this last suppos. which patient herself disp. to adopt.

Respect. circum of this case have [conver] with many pract. in this city.

And some of them have carried to exam her.

The conject which they entert are diff. [may] I however own that I have however met with no one, who eithr has or has not exam. her, who is disp to give credit to suppos of patient.

And must observe that here my own opin is very doubtful.

Yet of three mentiond cannot help thinking that greatest number of circum in fav of suppos. that depends on [foetus].

Is indeed true that inst have often occurrd of large praeternat tum in the abdom. occup if not exactly at least nearly same place as that in pres case.

And in other inst. viscer. themselves have been morbidly encreased.

This partic observ. with respect to ovar.

Sometimes enlarged to very great size from schirrous swelling.

Sometimes from dropsic affect.

And not unfreq. both conjoind.

That is while central part degen as it were into a [sac] coats of this [sac] at same time acquire pecul. firm & hard consist

And of all opin with which have been fav. from others respecting pres. case this the most gener

Is supposed that local tumour here either effect of mere schirros or of schirros cont water.

And is at least somewhat in fav of this suppos. that is at least more common than either an inst. of an [extract] foetus, or [retin] of foet in uter

But still farthr ground for pres. from anoth circum which has occurrd since last rep.

That is an invol. disch of a clear watery fluid from vagin.

And accord to her suspic at least not from bladder but from uterus.

On suppos of Hydrom or Drop of uterus itself such an occur might be supposed to take place.

Yet even suppos. that certainly from uterus diff conject might be given as to [cause]

And with retent of foetus & placent. room also for susp. that separ of waters might in some degree cont.

But perhaps still a more probab supp than either that this fluid not from uter but from bladdr.

And to this, the affect in the disch of urine, to which has long been subj. gives some counten.

Hence then we have neither in super freq. of this affect to other possib causes, nor in late appear what can by any means be consid as giving strong evid.

While at same time such suppos. [liab] at least to some obj.

In most inst of such affections, increase of size of tum. by no means so rapid as in pres. inst

For to be observd that here arrived at pres. extent in less than space of nine months.

And since that has never suffered any farther augment.

May at least then be consid as remark singular that should have stopt at this period

In by much greatr numb of inst cont to encrease even till death of patient.

Especially where at commen progress observd to be so rapid.

With rapid encrease also, eithr of tum entirely praeternat, or of morbid affect occurring in othr viscer. health usually much more affected than has hithert been case with our patient.

And indeed rarely consid degree of hectic fever has not sooner occurrd.

To these circum may farthr be added that schirros of ovar. or praeternat tumour of othr parts seldom with any affect of menst disch.

Flow for most part cont. nearly in usual [mann]

In pres. inst however very remark. affect.

And that too even in oppos. ways.

At commen menst. disch obstructed.

In after course has become much more freq. than natural.

And when occurring of much longer contin.

In all these partic then if are to suppos tumour the affect of Drop. or Schirros. of ovarium. [Hydromat] or like will yet not be refused that at least pecul. occurr.

And from this naturally led to inquire how far argts occur eithr for or against suppos. [entert] by patient herself.

That to suppos, of irregul tumour dep. on foetus retaind, either in uterus or in cavit of abdom., there are diffic cannot be refused.

Yet must own that do not look upon any of them as unsurmountable.

Cheif obj to this suppos. occurr from three sources.

1 From cases of retent of a foetus being very uncomn

3. From lightness of uterus as felt at os tincae when exam by the Vagin.

And 2^dly from length of time for which has subsist. without purul. state or [disch] of any part of foetus.

To these objections circum occur may be [urgd] in [answ] by which are at least invalid.

Although must indeed by allowd that retent of dead foetus uncommon, yet can by no means be repres. as what has never occurred.

Besides many others cases on [record], two inst lately publishd in Med Com. & third commun for publicat.

And these too on most unquest [author]

One by Dr Bell of Dubl. othr by Dr Perciv of Manchest.

In first case foetus extracted by artif op. & patient afterwards recov.

In second patient died after having disch by stool greatest part of foetus retaind in abdom for space of twenty two years.

In these then not only answer to obj. from case being unusual but also to what drawn from length of time without putres. state.

What has happened to others may also have occurred with our patient.

And would even be no unsurm object if even for much greater length of time no [putre] sympt. should app.

But perhaps of all three object mentiond that which yet rem to be spoken off the strong.

That viz which drawn from lightness of uterus

This patient, among other Gent in profess of midwif & surger. has been exam by my very ingen & intellig friend Mr Hamilton.

And from touching the Os uteris he is convin that at pres it does not cont a foet.

Should be very far from pres. on any [abs] reasonings of my own to contrad. the author. of a Gent. so much convers. in pract of this branch of healing art.

And cannot but admit that gives great diffic to the suppos

Yet must own do not consider it as giving certain refutat.

And on sever diff. grounds an answr may I appreh. be afforded to this obj.

In first place is possib that foetus may never have been in uteru.

Agreed among all authors that concept take place not merely in uter itself.

And in praeternat cases besides occurring in ovar & fallop. tubes agreed also on all hands that may occurr there take place what have been calld abdom concept.

To such a suppos in pres. inst indeed is some obj. that there seldom arrive at any great size.

Yet where or how limits fixd we can not pretend to say.

But besides this may have arisen to natur bulk in uter & afterwards made its way from thence

Of two cases of reten of foetus to which have already allud in one that viz by Dr Bell foetus during whole period for which retained supposed to cont in uter.

And at length extractd from thence by opera

But in that of Dr Perciv where circum in many respects simil to what occurred with our patient foetus not only forced [thro] uter. but at length through rectum also.

May naturally then suppose that after foet had made its way from uter. [feel] at os uter. came as if never [contin] it.

And lastly from feel in natural cases cannot inferr what may happen in partic morbid states.

If foetus here retaind unquest. that posit much altr from natural.

Hence then while distens at other parts cervix uteri may in great meas. have [retn] natural posit.

From these diff reasons then can by no means consid as unsurm obj. to this suppos or as affording cert. evid that is groundless.

Next then to inquire what circum may be urged in support of the opin.

Of these first which naturally occurs is origin & progr. of the affect.

Accord to acct of patient pres. compl. [begn] during pregnan.

When in state of perfect health she [becam] affected with usual sympt of pregn condit.

That is, some degree of nausea & sickness of stomach, but partic obst of menst disch.

These symptoms at prop time followed by still farther evid of pregn, motion of child

And matters we are told in every respec went on in natur cond. till seventh month.

Then however an appear. which to a Wom in this situat could not fail to be highly alarm took place.

A prof. Haem. viz from utrus.

And this not for short space only but for period even of eight days togeth.

This haemorrh was at same time ascribd to an obvi cause.

Accord to her own acct followd as immed conseq of a draught of milk ale & sulph.

In none of these artic however, such active powers, that taken to moder extent any thing to be appreh. from them

And must own that in this partic [should] be inclined to think that pat. deceived mistake

Especially as then subj exposed to a cause still more powerful.

Had for space of many months sever weeks before been sub. to very great fatigue in conseq of sickness of her husband.

And immed before commen of morbid had been subj to under influence of great greif in conseq. of his death

Was during this distress that drank draught she ment. exhib to her.

And in preceding circum have I think a much more powerful cause of dis.

But whether to be referrd to one or other of these obv. causes is from this period that consid affect as having begun.

And ever since has been subj. to freq. returns of bloody disch from vagin. & if not to great extent at least of very consid dur duration

To these all other pres. sympt have superveend.

From time of Haem. however marks indi life & vig of child dimin.

And By ninth month from extraord. [waste] & want of mot. had reason to conc. that was dead.

And in place of natur deliv has ever since remaind with no very remark changes in pres. situat.

If, on this acct of patient entire reliance could be put, nature of affect could not ad. of doubt.

Yet must be allowed that although patient no intent to deceive us may [have] been deceived herself.

Obvious enlarge of abdom. want of menses & even sense of mot. are occur which may take place without pregn.

And from concur of all these circum women sometimes suppose themselves preg. when in real. subj. to drop.

Mistak for motion of child effect of flat in intest or like.

Must howevr be observd that such mist prin during earliest period of preg.

And hold cheif with respect to motion at commen.

For by seventh month motion of child so pecul. that nothing in any dangr of being [confound] with it.

And Such mist also cheifly happen with those who never any child before.

And who on that acct less acquainted with nature of motion.

Pres patient however by no means in this situat.

For before commen of pres affect had been moth of many child.

To period then to which pregn. said to be advanced this may be added as [farth] argt.

May subj as third that here no intent to deceive us.

That patient in reality subj. to disease could admit of no doubt.

And indeed rather surpriz as otherwise that not affected with sympt more distress.

But may observe that of same compl. had happened to many othr females would probab. have heard much more of it.

For, as far at least, as can judge, seems to be natur dispos. to avoid compl. as much as possib.

Yet while evid disease exist situat at [leas] such as affords no obj. to suppos. & even in some meas. fav it.

Have a circum still farther in fav of supp. in manif [ineq.] of tumour.

Such indeed may occurr in othr cases.

Yet in schirros of ovar. in [meteor]. or [praetr] tumours such inequal. as here discov. less freq. to be met with.

While in case of foetus must necess & unavoid happen.

This then at least a circum more in fav of suppos of foetus than any other.

To [argt] drawn from exist. situat & inequal of tum. may add anoth from moveable nature.

Can not indeed alledge that have here evid of tum being loose in abdom without any attach.

But this affect. prev. by size.

While at same time is manif so far loose that can be pushd form one side to other by extern force.

And that with much greater case than should susp imagine on any other suppos.

Lastly in support of suppos of foetus may urge simil in circum to other cases

Partic to that mentiond by Dr Perciv.

Upon In some of these also for long time equal grounds for doubt & uncert. as with pres

At last however nature estab. beyond doubt eithr by disect. after death or by disch during life of patient.

Upon whole then cannot help thinkin that of all suppos suggest this the most probab.

Must however concl. as began notes expressing diff.

And when find so many others of diff opin cannot be surprized if that which disp to adopt should be found to be erron.

Yet whatever affect if not uncomm. in nature is at least so in appear.

With this uncert. as to nature can say nothing with conf. resp. prognos.

Yet on any of suppos. given have no foundat. for giving fav. opin of termin.

On suppos of tumour being of schirr. [natur] are acquaintd with no remed from which any expect of remov. after pres. size.

While at sam time very rarely if ever that such affect suffer natural [resol]

On suppos of foetus equally little ground for hope.

Without removal no possib of recov.

And if remov attempted by artif means, or should happen natur., not without utmost danger

While howevr thus faint hopes of recov. would not however be understood to mean that patient will be suddenly cut off.

May even although sympt at greater height than at pres. cont. subj to compl for space even of many years.

And may farthr remark that of late sympt. hardly in any degree aggrav

Yet must be observd that often affectd with great oppos at [praecord].

And That During night often awakd in sudden fright

Of late these have [prevailed] to such length as to threat deliq. during day.

And should not I own by much susp. if during fainting fit scene unexp. closed

Yet reckon it more probab. that may not soon fall a victim to affect.

And even before this happens circum may occurr by which no longer left under any diffic as to nature of disease.

While this the case then something meas must be taken

Have thus then at some length given opinion or rather conj. as to nature of the patients disease & probab termin.

Next follows that should speak of [treat]

Here however will be necess to say but very little.

From what already observd must be evid that can entert no sang. hopes either from artif or natural cure.

In as far as natural cure may occurr must be nothing entirely affect of time.

And attent of pract. solely bestowd in attempts to obviate sympt.

Occurr then as quest. how far artif cure in this case to be attempted.

And this the rathr to be mentiond from what told in case as to prop of remov cause of disease by incis.

This, as taken from acct given by patient is said to have been joint opin of two very emmin Prof. & able pract. Dr M & [Young].

In this however patient unquest mist.

For have taken opport of speaking to both these Gent on this subj.

Neithr of them can now recollect the circum of this case.

But at same time are very clear that never recommended such an operat to any woman in that situat.

That compl. of pres. patient are not feignd any one may be fully satisf. who takes trouble of exam.

And that did make applic to Dr [Youn] & Dr M is at least highly probab.

But at same time is not less so that may have misunderstood what they had said as to treatm of affection.

Cannot then consid prop. of operat [tum] as warranted by their opin.

With regard to pres. inst may only observe that if absol. certaint as to cause supposed still doubt as to advis

Certain that patient in very great dang of being cutt of by operat itself.

Perhaps even more to be dreaded from operat than disease.

And although in case ment by Dr B comp. recov. obt. by operat yet, this if not entirely a solit case is at utmost very rare.

These howevr, as integ first burst of themselves, operat might be consid as [merely] aiding nature

And from disch of bones from opening prov to use of knife nature of affect put beyond all disp.

In pres inst howevr besides danger of operat. unsurm object to it from doubtful nature of disease

And if affect in realit diff. from what supposed, would certainly termin in death of patient, & hurt reputat of operator.

Of plans of radic cure on other suppos. as to nature of affect say nothing after opin already given of nature of disease reckon it unnecess. to say any thing.

And indeed on these also affect might be consid as equally desperate.

Utmost therfore here to be aimd at is the obviating sympt.

And of these the cheif to be comb are, the constip, flatul. haemorr. & tendency to deliq.

Has been merely with view of [counterac] such sympt that med hitherto directed have been employd.

Of the partic however at pres. forbear to make any remarks.

And may concl. with observing that selected pres. case rather with view of exhib a singul affect & that might have opport of watching prog. perhaps of investig nature, than from expectat of being of any essent. service.