DEP/DUA/1/27/17 (Transcript version)

Isabel Sim

(1781-1782)

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Isabel Sim.

With regard to this case must own equally at loss both with regard as to nature & name of affect.

Consist of very numer assemb of diff sympt.

And hard to say whether can be consid as connected or not.

But besides this still farther diffic from pecul. of some appear.

And partic of two princip. cutan affect & disease of throat.

Must own that in formr pract have not met with any case in circum simil to pres.

Am very not without doubtful how far pres affect, ought or ought not to be consid as depend on cause to which attrib.

Supp them to be connected as caus & effect equally at loss to conceive how connex to be explained.

These doubts however did not deter me from taking case under care.

And that not merely as subj of pract but of lect. also.

To this led both from consid as example of singul & rare complic of affect.

And likewise from expect that during course of affect circum might occurr illust nature of affect.

Of this latter circum however now very little probab.

For patient has not attended us for some weeks past.

And highly prob. that from not speedily receiv benef. wishd for, has gone to seek assist somewhere else & that shall see no more of her.

In pres. state of uncert. therfore unnecess to say much either with [regard] to nature of affect, or plan of cure.

May only remark that when patient applied for our assist most obvious disease at least Cutan affect.

This app, under form of pustules which in as far as resemb to any I had before seen, appr. most nearly to Small Pox.

At same time neither when came under care, nor at any time during whole course, attended with febr. symp

And before we saw her, had cont. for space of sever. months.

Hence then could in no point of view, consider it as belonging to any of Exanthem of Nosol.

With regard to cutan affect, occurring as chron diseases, have already had occas to observe that except Psora & Tinea which pecul & distinct marked, consider all others as refer to gener [applat] of Herpes or Lepra.

And that in nature of these no very essent diff.

In so much that very freq [trans] from appear most exact corresp to defin of one, to what answ to that of other.

To be consid therefore rather as oppos extremes of same affect, than as diff.

In appear of these, it must be allowed, very consid variety.

But in case before us, nothing which could be consid as approach in app to either.

And for my own part can give it no other name than that of anom cutan affect.

With regard to cause, no circum to which could with any degree of confid be traced.

Had indeed we are told, succeeded soon after drying up of abscess on [shd]

And can be no doubt, that from obstruct of accust. disch, partic by [surf], cutan erupt of diff kinds, often prod.

But besides this, some circum in case, from which would inferr pecul affect of skin.

Partic from what happened with regard to blisters.

From these even on repeated applic, no effect whatever prod.

Would argue then, that here there existed some degree of paralysis if may so be calld, of cutan or extr. vessels

And if such an affect existed, not improb. that may have derived origin from excess loss of blood, which are told had suffered, by accid remov. of band on arm.

An accid to which all other former parts of compl. were attrib.

Of nearly same standing with cutan erupt, was affect of throat.

And this when she came under our care, if not equally obv. more distress to her.

Here also however affect very singul appear.

Cannot indeed consider as such common sympt which here occurred of cough, hoarseness & diffic of deglut.

Nor could it be thought uncommon that with these on inspect of fauces one of Tonsils should have been discov. swelld & inflamed.

But was I think very great singul. that should have cont. in this state for space of three months.

At least for that period are informd that sympt. above ment. had subsisd

And are also told that had not of late encreased in severity.

Hence then in as far as depend on local affect here obv. may concl. that had contin same.

Such an affect however not simil to any modif of cynach which I have seen.

And does not corresp. to any descrip I have met with in pract auth.

Here therefore likewise reduced to necess of looking upon it as an affect of that kind throat of anom nature

But while these prin sympt when patient came under care, to be observd that preceded by set of affect commonly totally unconnected with [either] one or other.

These partic consisted of variety of dyspep sympt.

And attended with severe pains of head & back shooting partic through region of uterus.

Though these of very diff nature yet here some reason to inferr [conn] from one having preceded other.

And from having much dimin at least on appear of other.

In case of compl last mentioned however, evid of connex with still anoth circum.

With want viz of Menst. flow.

This evinced both by want of menst disch & by period aggrav at time when should flow.

For obstruct of menst disch [howev] a very satisf. cause assignd.

Profuse haemmor viz already [ment] to which patient accid subj.

This however well known to be a circum in female oecon well known to prod most consid morbid affect.

Upon whole then only conject which to me seemd in any degree prob. was that to this cause all sympt to be referrd.

And that to use words of emmin author whole affect to which patient subj. to be enum. to use words of emmin author among multa, gravia, algue incredib [fue] sympt. quae ex [hac] [foute] [fluvint] suppression mentruorum [ovumtone].

With this idea of disease it may be imag. that notwith number, & anom app of sympt prognos should not be unfav.

For if this the case, reason to hope that on restorat of menst flux all sympt should cease.

This patient however at period of life when syst. still subj to many diff. revolut.

In so much that no reason to despair of restorat, even by its own operat. indep of artif means.

At same time when consid that sympt have already subsisted even with encreas viol for space of some years no reason to expect that such natur recov. should occurr during few week. of attend here.

And must own that from artif mean of cure had equally little prospect.

For here consid ammen. as being conseq of excess loss of blood to which patient subj.

And therefore as being symptom of gener state of syst, rather than of partic condit of uterus.

At same time from long want of distens vessels of uterus apt to become imperv.

Hence though due condit of syst rest, does not follow that restorat of menst flux will be conseq.

At same time with this intent had in view the trial of diff pract

And many means of cure also which might have been used with view to other compl. indep of menst disch.

Even first trial which intended to make however interrupt if not disap by want of attend on part of pat.

Began by directed use of Peruv Bark.

In this had in view the restor that condit to syst. of which had been depr. by excess haemorrh.

Partic the restor of due vigour to superf. & extrem vessels.

[This] however not to be expected from weak formula or short cont.

Directed empl. therefore in subst.

And to such an extent only that notwith tend to stom compl. thought it might have been retaind.

On this remedy then, if no circum should occur as obj to use, meant to cont her for some time.

But besides this at same time also directed anoth remed.

Applic viz of blister between the shoulders.

This chiefly intended with view to affect of throat.

And hoped that by deriv from [these] might have some influ both in dimin inflam & swelling.

But besides this thought it in some meas natur indic by another circum

Was observd that erupt first began on ulcerat on shoulder drying up.

Wishd therfore to see whether [dimin] might not take place from simil disch.

And on this acct ordered that blistered part should be kept open by episp ointment.

Thus expected renewal of effect of former suppurat.

Expect. however in this partic totally disapp.

For blister never rose.

Hence then not to be expected that should have any influ. even on affect of throat or breast.

Still less on ulcerat. eruption

On this however would app. that no better effect from Peruv. Bark.

For although during first week taken without any inconven. yet erupt encr. yet erupt. & pustules became more numer. than before.

This however imag. in no degree to be attrib. to med employd.

And as imag. that blister had faild in operat merely from some accid circum ordered both contin of Bark & repet of Epispast.

From this second trial of blister however no more effect than from first.

While at same time, blisters from same mass had full effect [illegible] [illegible]

Now therfore led to concl. that depend on state of extreme vessels.

And that from this pract nothing to be expected.

Still however thought of persist in use of Bark.

But now an obj occurrd to use which had not before taken place.

By last doses vomiting had been excited.

Was merely with view of restraining this, & that Bark might sit more easily on stom, that ord. for patient mixt of Confect Japon with Mint Water.

But whether this has had desired effect have not been able to learn.

For since prescribd have seen nothing of patient in this place.

And from time that has since elapsed, now more than prob, that will see no more of her.

Hence then in great meas unnecess to say any thing of other trials which had in view.

May only here remark that after trial of bark, if had proved unsuccess. had next in view the empl. of Electric.

Would indeed by no means repres as a cert. remed in every inst of Ammen.

Although even this contend for by some.

Yet without suppos it so extens useful, am convin that many cases of Ammenorh in which prod of most consid effects.

And upon whole know no means of restor menst disch equally powerf.

But besides this

For this purpose most effect when slight shocks given through region of uterus.

But besides this was intent also in pres case to have recourse to simple elect. or [illegible].

For no doubt that very powerful influence as encreas action of whole [vacul.] syst.

And on no part more consid than on extreme vessels of surface.

This manif by influ as augm perspirat.

Here then where reason for believ in some meas paralyt. state of [these] might seem to be partic indic.

If therefore patient returns to attend, without farther empl. of Bark to which seems to have great obj mean to have recourse to this pract.

Rather however by way of trial than with confid much hopes of success.

For must acknowl. that belief in theoret prin. laid down is not so strong as to make me expect it with great confid.

And as set out must concl with observ that conject as to nature of disease not so far supp either by reason or former exper as to give even high degree of probab.