DEP/DUA/1/26/09 (Transcript version)

Mary Monro

(1780)

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Mary Monro.

Case suffic charact by obv. sympt.

Here evid distort & mall-conf. of bones.

And although patient yet at early period not only in long bones, limbs & forearms, but also in many others.

Partic remark both in growth & posit of ribs, stern & clavic.

And in conseq of this distors of chest, are without doubt to exp affc of breas [illegible]

While other bones thus diseased head also not unaffected.

Evid Manifestly of size uncom. large.

In these circum evid charact of disease very common in this country viz Rachitis.

An affect by some indeed supp pecul to Brit & indeed has even been contended that in some meas pecul to mod. times.

Assert however which can hardly suppose strictly true.

An assert. however which cannot suppose strictly true.

For although not describd as partic dis yet well known that distort. freq. no rare occur. in ancient times.

And if some lived to manhood many others may pres. died in early life

Hence for my own part put little credit in acct of Glisson & others who consid it as of late date, & ment part part of Engl. counties viz of [Sommer] & Dorsetshire as place where first comm.

But whatever progr of affect suff demonst. from number of [diffor] [figures] [among] adults that now commn affect with those recov.

And well known to every med pract that many fall victims to it during infancy.

Hence then an affect which in mod times must be allowed to merit attent.

And must farther observe that for my own part at least acquainted with no certain or exped mode of cure.

Where recov is effected in general much more in grad manner & by operat of syst. itself than by med aid.

Is also during progr of the disease a very diffic matter to fortell what will be event

And in case now before us with regard to Progn. am very doubtful.

Some circum rather fav others very much the contrary.

In judging of termin besides progr & duration of affect & sympt with which attended, conject also in some degree to be formd from causes induc it, from condit of habit attackd, & from period of life at which occurrs.

Of all inst of the affect those the worst where disease heredit.

Or where though affect does not exist in parents, yet those in diseased & debilit state when have child.

A very unfav circum also where arises from any fault in [illegible]

In all these cases interwov. as it were with origin constit.

And accord in gener. commen. most early, progr most rapid, & sympt soon at greatest height.

Upon whole very few inst where lifeve to manhood.

In these diff respects case before us not so unfav. as some others.

As far as can learn no heredit taint, no morbid dispos in parents to which can be attrib.

Same parents other child entirely free from every sympt or app of it.

And these also reared by same nurse, their own mother.

Hence then may concl. that here arises from some accid cause.

And probab. from some circum to action of which child no longer exposed.

May also remark that as far as can learn this cause no [preced] disease giving matter affect of constit

For accord to acct given us before commen of pres affect, enjoyed good health.

But if these partic favour others very much contrary.

Is much against patient that affect has taken place at very early period of life.

And although yet but of short cont for space viz of six months, yet progr has been very rapid.

Affect of bones already gener & to consid degree.

And in thirst with which patient affected, state of heat. pulse, &e have indicat of hectic fever by which in general fatal termin induced.

Upon whole therefore opin of case notwith circum first ment. unfav.

Will by no means be surp to find that notwith best endeav patient cutt off by affect.

And if should not fall victim to disease yet recov of prop shape, after destr already taken place more than expect

Of general plan of treatm in this disease pract by no means agreed.

A circum necess arising from diver. of sentim as to nature of affect.

Although disease cheifly app. under form of affect of bones yet by many this consid as depend on condit of [illegible].

And in many cases at least sympt prev to any remark affect of bones indic a dropsic state.

Concl. that from this watery cond morbid affect of bones origin.

And that therefore prospect of removal, by evac.

But this plan though applic in cert. cases by no means gen. so.

And even in these to which best suited, when pushd to great extent never fails to be prod of much evil.

Prop. of having recourse to evac in any degree much regulated by circum & cause of affection.

In case before us, in neither of these any partic which can led to use of evac.

Only sympt. which can [true] be susp of dropsic kind is swelling of abdom.

This however with such [illegible] much more freq from wind in alim canal, than from water in cavit of abdom.

Indeed this cause of swelling [seldom] absent even where swelling from water obv.

That in pres case totally dep on wind, in no degree on water may inferr from want of fluctuat & [absence] of other drop sympt.

If in sympt nothing induce to [illegible] as little in cause.

Here indeed cannot say from what affect origin.

Suppos entert by parents that affect arose from worms, have no doubt in consid as totally imagin

Worms in this country in partic assignd as cause of num diseases which have no share in induc.

To this indeed numer & anomal sympt which unquest do prod gives some counten.

And according seldom appear [which] with vulgar are not assignd as cause of all other sympt at same time pres.

In rachitis cases however few appear more common.

But with every one best. [reflex] on subj, this consid only as conseq. of that state of alim canal attend disease, being most fav to gener

While however consid app of worms as happen only on this prin & while no probab ground as to of conj. as to cause are yet certain that has not arisen from [obtstructed] disch to which body habit.

The cause of all that take place the most indic evacuat.

While against those tender age of patient & debilit condit strong obj.

But whatever true patholog of affect if some cases in which evac useful still more num inst in which benef from tonics.

Can hardly indeed be supposed tha dimin of tone of syst. is immed [cure] of softness or any othr affect of bones.

Yet can easily conceive that encrease of tone may be means of remov morbid state in which affec of bones depends.

But whatever princip of operat cert that from tonics often very great benef.

With this view many diff artic in use.

And partic to be recomm. used in those cases where syst very much weakned.

Of all the tonics used in Rachit. none perhaps from which greater benef in gener derivd than cold bathin

And especially when conj with frict.

To this therefore not improbab. that may yet have recourse with pres patien

But while so great quickn of pulse & other febrile affect. some obj. to it.

On this acct determind first to make trial of another tonic.

Well known that this qualit. poss by many artic of min tribe.

And by few to greatr degree than prepar of Iron.

This metal whether in active form by acquir saline state, or by being disslvd in water or any other [menst.] or by being exhib in form of calx univ allowed to exert tonic powers.

Is with view then of obt. these that here resolvd to try it with pres pat.

And of various forms of chalyb had here recourse to Sal Martis or as is term by Ednr Coll. the Sal chaly.

In this prepar. the Iron brought to saline state by Vitriol acid.

And with infants where obj to taste of med as well as to large form one of best modes of exhib.

From ready solut of in stomach are more sure of effects than when exhib under form of Limatura or Rubigo [form]

While at same time from exhib in small doses can obt. tonic without stimul. powers

But for avoiding latter caution in admin necess.

And dose small at first to be grad augm. till see to what extent can be taken without inconven.

Here at first exhib only to extent of two grains.

United with crabs eyes more with intent of giving form & covering taste than with any other view.

Since that dose of Sal Mart. [illegible] without any inconven.

And is intent if circum permit still farther to encr dose, & order more freq repet

On this course mean to contin patient unless interruptd by some partic occur till has had full & fair trial.

Yet although shall should not be found attend with success after what already said of nature of case shall not be disp to consid it as proof of ineffic of med.

On other hand recov may take place during use, in which has in reality no merit.

Yet if circum admit of contin will afford us opport. of marking effects.

Not improb. however that from superv effect. may be obliged to desert from employment.

And if that the case pract [must] be directed to circum then occurring

But if without such occur disap in effects may think of having resor to other tonics have thought of [trial] of another pract with this patient.

Use viz of oil prep from liver of skate fish.

Of this pract for my own part have no exper.

And deterrd from empl. it at first in this inst from consid case as very precar one.

For to be obs. that although an extern applic effects by no means [sligh]

At least this repres given of it by those with whom chiefly empl.

On subj of use will find short paper in late number of medic comm

Said that from topic applic excites tempor fever.

Or at least encreased heat of syst with quickness of pulse.

And is opin. of most observ of those who have had opport of witnessing use that by this fever disease cured.

Evid therefore that if have effect [alled] cautious admin requis.

And upon whole though wish to try it yet look on pres as no very fav. inst.

Hence then the having recourse to this trial must in good meas depn on circum of case at time.

And not improbab. that in pref. to it may direct cold bathing [illegible] in which I own have no less confid.

If tend to curvat, & other pres sym could be overcome, might next be obj to restore to bones their prop. fig.

And for this purpose many [mechan] contriv have been prop.

But may with confid repres. whole if not as pernic at least as danger.

For where not defect in contriv yet often so in applic.

Hence then unless by partic modes of exert. nothing in ways ever to be thought of.

And from danger tenden of pres case very doubtful wheth [direction] even in this way ever requis.