DEP/DUA/1/20/03 (Transcript version)

Agnes Heggie

(1779)

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Agnes Heggie

For name of disease of this patient will I appreh in vain consult syst of modern nosolog.

Princip if not sole compt of patien is pain of breast.

Seat of this pain immed referd to sternum & parts below.

And although sore to touch yet at times suffers much more consid aggrav without any manif cause.

And While from very slight causes, walking in partic or any other quick motion aggrav to such degree that patient incap of contin it.

From severity has effect even of induce profuse sweat. over whole body.

In this state however seldom of long contin

When occurrs to such degree not surpriz that should occas affect of breathing

And that should not be entirely confind to breast itself.

Here however course which [pain] takes a circum deserv notice.

According to acct of patient strikes from shoulder into arm partic affect biceps muscle.

In this state however is seldom of long contin.

But if does not entirly cease at least soon returns again to situat more tolerable.

In state of compl. now describd very little or rather no resemb. to any of those gener. affections in nosol. syst. [compreh] [under] gener orders of Dolores Pectoris.

Nor indeed does it as far as I know resemble any of those gener. [describd] by greater part of practic writers.

To those however who have read histories lately given of that disease now known by title of Angin pectori must appear that in many of [most] essent partic there occurs strictly resembl.

That this disease equally comm in antient as in mod times a suppos at least highly probab.

Yet seems always to have been confounded with other affections

And to have passed under gener titl of pain of breast.

Of late however pointed out as separ & distinct genus of disease.

First probab. by Dr [Heberden] of Lond. in the transact of Col of Phy of that [plc]

In sever diff papers of that work has given distinct narrat. of sympt in cases of that affect.

And of late his observat confmd by those of other physic of great emm. who have also fav the [publ.] with hist of the affect.

Partic the late Dr Wall of Worcester & Dr Haygarth of Chester, Dr [Fother] Dr Perciv

On this subj also will now find some observat in introd to Theory & Pract of med written by late worthy & learnd Dr McBride of Dublin.

Nothing respect it indeed in first edit of his work.

But in that publishd in Ireland in 1777 a chapter on this subject.

And besides observat of other writers has there given not only result of his own exper. but also of Dr Smyth.

From comparison of all these histor. with pres. case will find that in inst before us have every charact mark of this affect.

Nature & seat of pain, manner of attack, degree to which occurr & place to which propag. all corresp exactly with descript given.

And although of opin that Angin pect may occurr, without pain extend to biceps musc. yet when this circum does take place is strong charact of dis.

The pres case then, can have little hesitat in consid as being an inst of that affect

And although all the succeeding [writer] following Dr [Heberden] have hitherto given it title of Angin Pecteris, yet with view to introd into nosol system may give it appellat of Pectoralgia or some simil compound.

While however give this name to the disease must be allowed that not altogether without pecul.

Of these indeed must judge almost solely from descript of others not from own exper.

For pres. but second inst of this [affec] which have met with in my own pract.

And first by no means distinct markd.

In pres. inst may be pointed out as in some meas. a singularity that here occurs with female.

For in almost all the other inst upon record has affected men only.

But still greatr singul in this case in freq. of attacks.

When first came under care subj to such returns twice [thrice] or even oftener in space of day.

Such freq of return has indeed occurrd in some other cases & as excited also by [slightest] cause partic motion.

But such appear only after contin of disease for many years.

With our patient however has subs for few months only.

Shews therfore an uncommon degree of severity

But farther to be observd that in this case there occurs also another circum rarely to be met with.

Pain viz to the touch on pressure.

Do not observe this circum pointed out in any hist of the affect.

Would seem to [argue] some local disease.

Which however if we except the case treated by Dr Haygarth as far as [dissec] have yet gone has not been discov.

On contrary in cases of some patients dying of the affect, partic in one treatd by Dr Haygarth of Chester opened with great [attent] by that accur anatom Mr J. Hunter as morbid condit whatever to be discov.

Hence then although such may occur in pres. case yet probab. not essent connected with the affect.

If however does exist even as concommit circum will still encrease the danger of the affect.

And from this joind to other [partic] cannot here give fav prognos.

In by much greater part of inst of this affect, unless where patient cut off by superv. disease has at length had fatal termin.

And that too often in very unexpected manner.

With pres patient this partic to be dreaded as has soon arrivd at very great height.

At same time cannot be repres as an affect which has [never] admitted of artif cure.

Must indeed acknowledge that am acquainted with no ration prin on which this to be attempted.

Nor have any of those authors who have written of it, as far as any know attempt to point out such.

But in Dr McBrides observat are informd that this disease has oftener than once been success. treated by Dr Smyth of Dub.

And history in partic given of one case treated by him in which by means of an antim & an issue a compl cure obtaind.

On this authority then was induced to have recourse to these pract in pres case

But in place of employing antim wine of Huxham directed patient to use of crude antim.

Which of all the diff modes of exhib it reckon the best were to be employd as an alterat.

As in this state unquest has influ as entering circul. syst while at same time less apt to occas. sickness at stom.

In Dr Smiths case, issues [illegible] [illegible] thighs.

But here thought it more advis to order applic of blister to the back from which drain afterwards to be supported by epispas ointmnt.

As thus while benef from disch. hoped also for good effects, from deriv from seat of affect.

Cure by this means if to judge by what has happened in other inst not to be expected for consid length of time.

Unless perhaps as disease has more suddenly than usual arisen to great height so may more suddenly cease.

And indeed allev of sympt app obtaind, already more consid than could have expected.

For both freq & severity of pains for space of two weeks past consid abated.

Hardly however to be expected that compl. may not again be consid aggr.

But should this even by case, shall still wish to persist in pres. course for some length of time.

And must own that if proves ineffect am much at loss what meas next to be tried.

Is however one of those affect in which should be inclind to hope for some good effects from use of those tonics operat as Antispas.

And should wish to give trial to Cupr. Ammon or Calx of Zinc.

Which I imag might at least be tried without inconven.