DEP/DUA/1/18/04 (Transcript version)

Elizabeth Anderson

(1778-1779)

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Third Patient Eliz. Anderson.

Evid affected with complic of disease

And at least some room for doubt how far diff parts any connex with each other.

Most obvious part of disease tumour of consid size immed on Stern at its upper part.

Externally no change in colour or appear of integum.

While at same time so hard to feel, & so much fixd in situat, that cannot consid it as having any tenden to suppur.

From this however patient affected with const & viol pain.

And partic on any circum giving motion of parts, espec of bones ex. [illegible]

This tumour we are informd not a spont occurr. but affect of partic [acc]

A stroke viz on part where now appear

From all these circum then taken tog. must endeav to determ nature of this swelling tumour.

Well known that from severe strokes to any part of syst encreased action of vessels induced.

And that from this inflammat with all its conseq. pain effus, tumour &e

Nature & tenden of inflam however much varied accord to nature of part in which situated

And from this circum in partic, conseq. whether in resolut, suppurat, schirrus, or like, very much affected.

For these, with sever other partic [altho] not so commonly occurring, to be ranked among sequel of inflam.

And although sever conseq. which may occurr to many diff parts, yet some pecul to certain parts.

From this circum then inquiry into nature of part affected of some conseq.

And here from progr. as well as appear. cannot suppose it a cut. affect.

From fixd situat & hardness can neither believe it to be affect of gland nor of cellul membrane.

Nor indeed can we easily suppose it to depend on [enlargemt] of any softer solids

Among all genera of tumours in best nosol. syst, partic that of Mr Sauv. from appear, as well as prop. other circum can be referd only to one of two Exostosis or Condyloma

Of these genera latter no place in syst of Dr Cull unquest. an impr. on that of Mr Sauv

While to his defin of exostosis affect before us very exactly corresp.

Tumor durus ossi insidens.

According to this defin will observe that every exostos not be viewd as affect of bone itself.

And in pres. case as in many other inst, am inclind to think that rather an affect of periost.

From sentim however with regard to use of periost, & format of bone, hold that from this source a real bonny tumour may be formd.

And is cheifly from state of this part that varieties in exostos. prod.

Although indeed must also be admitted, that much affected by cause.

And from this source in syst of Mr Sauv. sever diff. species of exost. as Scrophulosa Scorbut. Syphilit &e

Of any such cause in pres. case no suspic.

While at same time from severity of pain, does not corresp with exostos benigna of Sauv.

And of all his species most exact resemb. to what calls exostos supria.

Am inclind then to give this name to first part of affect to which patient subj.

And to view it, in its nature as depend on a diseased state of the periost. [induced] from injury given by the blow.

But although this most obvious perhaps hardly to be may be some doubt whether lookd upon as most consid part of affect.

For besides this subj to freq attacks of vertigo & tinnitus aurium.

And these we are told to such deg as freq. to deprive her of vision

In these can hardly be consid as having charact of any affect.

For occurr as sympt of many diff diseases very little connect. with each other.

Both vertigo & [illegible] indeed, [receivd] as genera into syst. of Mr Sauv.

In this however appreh that has multip gener with improp.

And that even where these sympt do not occurr with others, must still have regard to cause.

In acct given by our patient [nothin] partic to direct us with respect to this

From labor. respirat however was led to imagine that might arise from distens of alim canal by flat.

Both because from occur of this breathing often affected from lungs being pressd upwards.

And because well known to be a circum from which vertigo often arises

In this suppos, somewhat [confused] by other partic.

Especially by other sensat which flat. excites

That this part of affect in no degr consequence of other evid from being of much earlier date.

And probab. even that aggrav. lately taking place rather conseq of from some accid circum than in any meas arising from superveening affect.

This leads us in prognosis to speak of each separ.

And indeed accord to opin given one may admitt of total remov. or consid allev. while other either nothing dimin or encr. in viol.

Of the two affect to which our patient subj. am most alarmd with respect to tumour on sternum.

See no reason indeed for imagining that bad conseq will soon arise from it.

Yet on other hand from hard & fixd nature cannot hope for speedy removal.

And diffic to say in what way may yet termin.

Have however at least some chance that may be able to artif means to obtain resolut of it.

In that case by progress to recov as grad as encrease has been, may at length be compl removd

If however in this disapp. which by no means improb. may possib degen into state of insensib.

And tumour may contin for whole remainder of life without either pain or any other inconven. than arises merly from bulk.

Have however some reason for appreh. still worse termin

From contin & severity of pain consid [us] as still exposed to danger of termin in suppurat.

And when this happens, which at least not very rare occurr in such cases often prod of caries in bone itself.

From this however there never fails to arise obstin & painful ulcerat. sometimes even death itself.

Yet if such to be conseq of pres. tumour will not probab happen soon.

And entert hopes that may be able to dismiss patient in second situat mentiond.

That is with allev if not removal of pain although tumour should still continue.

On suppos that other parts affect. that is Vertigo, Tinnit aurium &e the conseq of flatul. imagine that less to be dreaded than from affect of breast

And inclind to hope that by prop means tending to expuls of flatul. return of attacks may be prev.

Still however even on this suppos. reason to fear that may be liab to renewal from slight irregul.

And if conject as to origine a mistake one may find it, much more diffic to combat, or allev than expect.

May even be forerunner of some of most distressing affect of Nerv. kind.

Such for example as Epilepsy.

If this the case may yet turn out to be most matter part of disease.

But from length of time, for which has cont in pres. form, as well as from opin of cause, inclind to hope more fav.

And expect that shall be able if not to remove at least to relieve this part of affection.

Practice here requis for diff parts of complaint very little correspondence

On suppos. that Vertigo &e conseq of flatul attempts to counteract must be directed with view to too diff obj.

The preven of general or [extricat] of air in the alim canal.

Or expuls after is extricated.

Is in latter of these ways than can here look for most immed relief.

While formr most affect means of radic cure.

Rather however to be brought about by regulat of diet & by general conduct of life than by med strictly so calld.

And was cheifly with intent of operating on latter principle that had here recourse, to Pil Gummos

These pills composd of equal parts composed of equal parts of [Gabban]. Myrrh & Assafetid.

From all these artic but espec. last derives stimul & antispas. power.

And to this some addit made by [illegible] succin artic by which mass formd.

Since began this med whatever may be princip. on which has operated, patient has at least obt. consid relief.

And if affect contin so far allev shall not soon think of having recourse to other meas.

May even desist. from pres. meas. [conf] attent entirely to affect of breast.

But if in place of this shall again be aggrav. or put on diff form hard to say to what meas. may think it necess. to have recourse.

Have thoughts howevr of trying some of min tonics with view to remov of an irritab. state.

And with this intent should be disp to put greater confid in Cup. Ammon under form of Pil. Caerul than any other.

But to this meas. am hopeful will not be necess for us to have recourse.

If however should have thus little diffic with one part of disease no ground for expecting that other will yeild in no short space of time.

Or that even if brought to termin, that termin will be so fav.

Here however should at least be first aim, in cure to obt. if can resol of the tumour.

And if this not to be affectd to alter condit of sensib. in such a manner as to mitig pain.

Am in hopes, that both these intent may in some meas be answered, by that mode of cure which have prescr. for this patient use, viz of Electric.

Of prin on which this mode of cure Electricit as [used] for med purpos operates do not at pres. prop. to speak.

May perhaps hereafter have some more fav opport. of stating to you my sentim on this subj.

Will howevr find some view of them in the Vol of Medical cases which I pub. last summ.

Partic in observat on a case of Dysp. treated with success by means of electric at this place.

On princip there laid down hold that may be no less useful as counteract morb sensib than as restor sensib when lost.

And in as far as is a means of renewing circulat in obst. vessels look upon it as a remedy which may be powful in remov. of tumours.

At least while vessels there cont [in] such a state as to admit of possib of renew of circulat.

In neither way however have affects been yet determ by suffic exper.

And this an addit reason for trial in inst. before us.

Unless therefore from some unforeseen occurrence shall be unwilling to adopt any other pract. till this has had full trial.

For such trial howevr since use first directed weather has been partic unfav.

And that both for attend of patient and for obt effects of electric machine in manner that would wish.

Hitherto therfore very little has been done in this way.

Is however intent, besides drawing spark from part, the only way in which have hitherto employd it, to direct also shock in such manner that will pass through it the tumour

And if patient submits to cure with prop persev. am in hopes that may be prod of good effect.

If in this howevr disapp. may have recourse to topic applic either of stim or sedat. kind.

Partic frict with unct subst., comb with camphor or mercury, with view to resolut of tumour.

Or applic of Hemlock or Saturn prepar, with view to mitig of pain.

And if notwith these both size & pain encreased, Cicuta or Mercury may be used internally.

But after failure of electric must own should not be disp to put much confid in any of these.

And after that has had prop trial shall be satisf if can dismiss patient even with allev of pain.