DEP/DUA/1/32/31 (Transcript version)

Grizel Douglass

(1783)

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Grizel Douglass.

Now for second time my patient for affect to which before subj.

And look upon affect as being in nature singul.

At same time is not so rare that have not oftener than once in former pract met with other [ones] of it.

And there too appear under form threat greater obstin than pres.

But although have met with sever inst of this disease yet must own am at loss what name to give it.

Nor among num gener. introd into nosol. & pract syst. by Sauv & other do I known to which can with prop be referrd.

With view to cure however this less matter than the ascert. nature of affect.

And on this subj if cannot arrive at cert. may at least form probab. conject.

Here disease entirely consists of enlargem of one leg

Can proceed only from one of two causes.

Must dep. either on solids or fluids. With respect to former would not poss. assert that even bone may not in some degree be affected.

And this conject [rend] probab. from exam of such legs by dissect of or after amput.

Here however, both from size, & from method in which extends above thigh knee viz to under part of thigh can have no doubt that if at all takes place but an inconsid part of bulk.

Must therefore suppose that prin depends either on fluids or softer solids.

Perhaps no inst where is not in some respect depend on former of these causes.

For hardly possib to conceive that such affect of solids can take place with out some effus of fluids.

But in inst formerly treated from fixd state, firm feel, obstin nature, & other circum have had reason to concl. that princip an enlargem of solids.

And probab. more of cellul [membr] than any other.

For certain that [nerv] [accrat] of this most ready means of enlargem than any other.

And as great reason to belive that immed dep on effus of coag. lymph can easily conceive how may be prod of diff accid.

But without entering into consid of these may here observe that look upon pres enlargem as depend to consid degree on this cause.

At same time to greater degree than in most inst I have met with, comb. with enlargem from water.

For although much more firm & hard feel than any swelling [from] anasarc. yet on strong press. leave very consid pitting

Farther proof also of water in conseq of some change from horiz posture.

For obs. that in the morning leg easier & swelling less than at night.

These circum then led to more fav prognos. than could give in most simil cases.

To this the rather encouraged from what formerly happened.

For when this patient with same ailment was before our patient under care at the dispens, affect from meas then empl. although not altog removed yet very much dimin.

Nothing in case when came last under care which could lead to entert less fav. hopes.

And must own still expect that may be able to obt. mitig of affect for this patient.

At same time little progress now made for space of month.

Reason therefore to fear that will be more obstin than formerly.

Yet in as far as cure to be artif accompl. must I think be cond. on same prin.

Here whether dep on solids or fluids, no doubt that only [chance] by which can prob. be removed is [Lymph] syst.

By these have unquest evid that even firm & hardest parts of body even earth of bones, may be taken up.

Before this can be affected howevr probab requist that should be [brough] even to fluid state.

Hence much more readily to be expected of matters prev. in this condit.

Is therfore I appreh. by encreas. action of absorb. from leg that [chiefl] to expect allev if not remov of this affect.

With this intent, as formerly have had recourse to a topic applic to leg itself.

An ointm viz formd of crude Sal Ammon united with axunge.

From mode in which this to be applied exp at least to reap benef of friction.

But expected also farther encrease of action from topic stim to extr. [vessel]

While from this however expt local augm of absorpt. was prop also to afford ready outlet for matters thus absorbd.

And for disch of watery fluids none more ready than urin [excrt].

As means of augm this therfore had recourse to dulcif spt of Nitre

Which as far as my own exper. goes, although not most powerful find to be one of easiest, most exp & [illegible] [illegible]

And where has effect in this way is also powerful means of encreas action of absorb. in gener.

For this the effect of every consid drain from syst.

As by this means demand on [abs] vessels is augmented.

Hoped therefore that from encreas of absorpt & augm of urine matter taken up from leg would by thrown off by kidneys.

And indeed formerly, from same med, of this there was highest presumpt from cop sedim depos by urine when encr. in quantity.

Repet however has not hitherto been prod of desired effect.

And as did not even [encrease] [quantity] of urine, have in conj. with Spt Nitri ordered infus of Junip.

Since diluent added to former meas quantity of urine indeed augm.

But without that appear of sedim indic disch of matter taken up by absorb.

And although now contin for sever weeks no change on leg.

In this situat begin to be [appreh] that at pres not adeq to affect.

If therfore no fav change by next report have thoughts of empl. other meas.

And partic elect. sparks drawn from effected limb as means of promot absorpt.

With same intent also, may use topic vap bath.

And internally have thoughts of employing infus of Digital.

In these however regul by circ