DEP/DUA/1/18/02 (Transcript version)

Elizabeth Mill

(1778-1779)

---

First Pat. Eliz Mill a female in 23^d year of age.

With regard to affect to which this patien subj. must own that am not without very consid diffic.

Have however selected this case as subj of lect. as probab. affording an examp. of affect. where have never before had occas. to treat.

I say prob only for here conject which am to offer is by no means without diffic

Affect to which I allude that disease to which Dr [Heberd]. has given title of Angina Pect.

And to which he has been first to call attent of medic pract.

That this disease not of modern date may I think be fairly presumed.

Yet till describd by Dr [Heberden] prob conf. with other affect or passed under gener title of pain of breast.

Of late however by him pointed out as separate & distinct genus of disease

+ whose syst. if not the most accur. at least the most [complet]

And since his descript many cases commun to public by oldest & most emmin pract which had long since fallen under their care.

Partic by late Dr Wall of Worcester Dr Smith & Dr McBride of Dublin Dr Haygarth of Chest. & sever others.

How far all of them have with prop. followed Dr Heberd. title of Ang. Pect. is I think matter of doubt.

Perhaps with view to future introd into nosol. syst. might be better disting by title of Pectoralgia or some simil comp.

In pres. nosol. syst. partic even those of Sauv. & Sagar + no genus, descrip of which, nearly appro to that of Angina pect. except the Cardiogmus.

Of Cardiogmus accord to these nosol. essent constit is pain referrd to region of heart.

This pain howevr then attended with palpitat of heart affect of pulse deliquium [anima] & like.

These sympt suffic. serve to disting it from Angina Pect of Dr [Heberden].

And evid point it out as being a very diff. genus.

Of Angina Pector or Pectoralgia many descript now to be found in diff. works.

But most accur those of London Med Transact.

Partic first artic of third vol. where have a case of this disease drawn up by patient himself from own feelings, & commun to Dr Heberd.

May in gener. observe that this affect consists in tempor. acute pain of breast return at no regul. periods.

This pain while it lasts so severe as necess to cause suspens of action.

Patients for example when walking obliged to stop.

And to support themselves by any obj that near them.

Pain thus occurring cheifly seated in Thorax.

In sever cases howevr has been observd to extend to neighb parts.

And partic freq. affects with great severit. the biceps musc. sometimes of one, sometimes of both arms.

In othr cases has begun in biceps & from thence propag to breast.

At commen of disease attacks of pain but of short durat. & at consid intervals from each other.

In process of time howevr become more freq, & more severe.

Till at last in greater numb of cases patient falls sudden a victim to affect.

These then charact of the disease, which has been calld by Dr Heberd. Angina Pector. & which I would disting by term of Pector.

To descript here given can be at no loss to see strong simil. in case before us

Our patients princip compl. also a violent pain comm at stern & extend to back.

Is not indeed said to extend so low as biceps muscle.

But are told that to a consid degree affects shoulders.

And this in many of most distinctly marked cases of Angin. Pect. utmost extent to which has gone.

That severity of pain in our case very great cannot be matter of doubt.

For goes even to such length as to excite profuse sweat.

Here then have at least what hitherto consid as great charact of Angina pectoris

But on this ground cannot I imagine give pos. judgement.

For in pres. form of disease, some circ, which create doubts with respect to this affect.

And some which may be thought to give counten to other suppos.

Cannot indeed rank eithr extens of pain to biceps muscl. of arm or origine from thence, among pathogn of disease without which cannot be said to occurr.

Yet at least a freq. sympt.

And here wanting to corrob. suppos.

Other inst. of Angina Pector. observed solely in Men.

Our patient a Female

But from some other partic still greater difficulty.

Pain in case before us does like angin pect. return in fits.

In all hist of that affect which I have seen patient repres. as perfectly easy [unless] while during fit.

But our patient although at some times much more severe pain than at others, never entirely free.

From this then reason for presum exist of some local cause.

While on contrary in cases of Angin pect. exam by most accur. anatom [partic] Mr J. Hunter no local affect whatever discover.

Patient before us at early period of life viz twenty third year.

Angina pect. howevr in all cases that I have read has occurd only in advan age.

In Ang. pect. pain has been espec. remarked to occurr in afternoon.

With our patient occurr equally at every time of the day.

>+

In cases of Angina pectoris occurring to most emmin pract. no other sympt whatever besides affect of breast.

But in case of our patient sever other affect also.

And these such as indicate disease of very diff. nature.

Is freq. troubled with nausea, sickness & vomiting.

And at times much uneasiness from distens of stom. by wind.

In these indicat of an affect. which am inclind to consider as one of most common to which people of all ranks subj.

What formerly viz passd under gener title of stom compl. the [Ventric] [Act] [illegible]

But what now with greatr prop. [receivd] by modern nosol. among distinctly markd gener. of disease under title of Dyspep.

Whatever be nature of that part of affect first ment. that this patient subj. to Dyspep. sympt. can I appreh be matter of no doubt.

And may even be question how far pain of breast may not have origine from this source.

Well known that flatul in alim canal by inducing distens giving [spasm] often cause of very viol pain.

And although the most freq. seated in stomach yet may at times have place in oesoph as well as often have in intest. tube.

To this supppos. some counten given in cause to which the affect is referrd.

Are told that all compl. had origin in conseq of drinking quantit of cold small beer when very hot.

Influ of cold on human syst. both as removing & induc disease unquest very great.

And although at pres. cold applied in diff forms justly ranked among most fash. remed. yet perhaps diff to say to what diff affect may not at times give origine

This support argt in support of suppos. that pain may dep on local affect.

But to this again freq. return with so great severity occurr as strong obj.

Is partic observd to operate as cause of disease as cause of disease when body pre heated which according to acct given was case with our patien.

In this situat have known it induce many diff. affect of gener. syst.

Even violent nerv disorder of convul [kin]

Of all other parts howevr has chance of acting most immed on stomach.

From this therefore some farther counten to suppos. that in pres. case whole compl. may origin from stom.

Yet to this suppos. great diffic unquest. occurs from const of pain in breast.

>+

And upon the whole, of three suppos. which have thrown out viz Angina Pect. Local affect in some of Thoracic viscer. & Dyspep, am still most inclined to first.

And whatev reason may afterwards have fr adopt. diff opin at [presnt] at least disp. to look upon it as compl. [case]

And consider it as case of Angin [Pec] or Pectoral. united with Dyspep. to no very high degree

After these suppos. respecting name of disease or rather diseas. to which pat subj next come to offer conject as to Prog.

And here may observe that some parts of compl. with regard to which under little appreh.

In dyspep. affect see nothing very threatning.

Stom ailments although very distress. often exist to much greater degree & for much greater length of time than has yet happ. to our pat. without prov. fatal.

Besides is one of those compl. which [alth] may not readily admit of radic cure

Can at least in most cases be kept moderate.

And ground I think to hope that in case before us by aid of prop med this may be effected.

If therefore, as among other suppos have thrown out, disease entirely a stom ailment whole affect may in no long time be in great meas, if not entirely removed.

If this however the case, must own, shall be agreeable disappointed.

And if on contrary foundat for suppos of Angina pectoris may look for unexp & fatal terminat.

For if examine most of hist. of this affect will find that patients seemingly in perfect health, suddenly cut off within space of few min from very [serve] fit.

And if except pract. tried in Dublin by that very emmin pract. Dr. Sm. & since more fully conf. by justly celeb. Dr [McB] no method of treatmnt, hitherto found of any avail.

Even on suppos of Angin Pector. however from following treat which they have pointed out some chance of success.

Yet at same time from freq. fatal termin ground for appreh. the worst.

And if in place of what strictly to be calld Angina Pectoris disease depends on any local affect of Thorac viscera prosp. of success not more fav.

Patient indeed, may in that case hold out for greater length of time.

And may even at last be cut off by some superveen affect.

Upon whole however with regard to this case am in hopes that shall be able to mitig stomach compl.

But apprehensive that affect of breast will in end prove fatal to her.

This however am hopeful may not happen during period for which cont undr our care.

And although may sometimes be aggrav. sometimes dimin. yet that upon whole in reality will be little altered under care.

But how far this conject. which may indeed be consid as in great meas. random one well founded hereafter better able to judge.

And after these remarks on prognos. come next to give acct. of intended plan of cure.

On view given of case two affect here occurr as claiming attent in treatment.

Those viz of breast & of stomach.

With respect to first all knowledge of disease which have yet acquird not suffic to conduct to any ration. plan of cure.

Differ. hypoth indeed offered with regard to it.

And that not less in what respects seat than nature of affect.

Thus while Dr McBride suppos it disease of heart Dr Haygarth contends that depends on affect of mediast.

To both dissect after death give some countenance.

Yet in still greatr number of cases no morbid appear. whatever.

Probab. therefore that neithr unif affected.

And perhaps may even be sometimes entirely seated in other organs.

At least where no morbid appear nothing to ascertain the contrary.

Want of any determ local affect has led very gener. to suppos. that disease of and indeed to this spasmod kind.

And indeed, to this, manner in which fit commen & ceases serves equally to give counten.

Yet as far as pract goes med of Antisp, or nerv kind, do not seem to be successf.

Only pract. with whom I am acquainted whose pract has had success in this affec Dr Smyth of Dub.

Acct of his method of treat. will find will find in edit of Dr McBr. introd to Theor & Pract of med pub. at Dublin last year.

He two consider immed cause of pain & sense of strangul. as being affects of spasm.

But suppos. this spasm induced by pecul [acrim] of fluids.

Hence led to conclude that [rational] cure to be aimd at by alterat & evac

With this view in one case at least has tried issues & antimon with success.

And whether look upon theory as well founded or not must still consid [same] pract as deserv. future trial

Is then on this author. & on suppos. of angina pectoris that have already presc. for patient an antim med.

Here indeed must observe that have not employd same antimon as used by Dr Smith.

He used antim wine of Dr Huxh. [while] I have had recourse to Antim in crude [stat]

Can be no doubt that formr much more active than lattr.

Yet long disp to think that if [wish] for alterat affects most conven had from antim in form here prescr.

Very rarely that not suffc of acid in stom to render it active.

While at same time rendered [active] in so grad manner that rarely subjec to looseness, vomit, or even nausea [which] other prepar. very apt to occas.

These then reasons for giving trial in first place to this med.

And if find it prod of any remark affect on pain shall give it to greater extent & persist in use without addit of any other med.

If however does not soon prod manif change for better, shall have recourse to issue

And must own am inclind to suppose that on this more than antim good conseq in Dr Smyth’s case depended.

If these remedies of no affect at a loss to think what shall next have recourse to with view to this part of affect.

Upon suppos. at least that no such change in appear. as to lead to alter opin as with regard to name of disease

For in angin pect as have already observ consid us as having no suff. knowl. of diseas to lead to rational cure.

May only observe that on suppos of [being] affect of spasm kind dep on pecul sensib. inclind to think that trial may be made with safety & even advant of Electricity.

If from observing future progr of disease shall discov to be of diff nature from what at pres. suspect may be led to other pract.

But with regard to these cannot at pres. pretend to make any conject.

Thus far then have spoken of [intent] in pract. with regard to prin part of compl.

Have remarked however that besides this patient also affected with stom ailm.

And for this may be supposed that should also have recourse to med.

Here however must own that should be sorry to interrupt or disturb plan of cure operat of remed for other affect.

Unless therefore for obviating urgent sympt shall avoid doing any thing with this intent.

If however either acidity flatul or constip give great uneas. will necess be led to employ means for tempor. relief.

And is with view to first of these that have already had recourse to G. Pills

Into compos of these sever active artic of Gummy kind enter.

But artic on which put princip [reli] in pres. case the Assafoetid.

This consid to be a very powerful antispas. of stimul. kind.

And from such powers freq prod of good affects as obviating flatul.

This especialy to be expected when conj with anoth med of same kind as in these pills with Ol. Succin.

Hope therefore that from these patien may derive benef.

But if this compl. tolerably easy [shl] think even of omitting these.

Principaly that may be able to determ with greatr certainty how far remed already mentioned have influ on first part of affection.

But may concl. with observing [that] in case where so much in dark must speak either of pres or future plans of cure with great uncertainty.