DEP/DUA/1/34/36 (Transcript version)

Jean Johnstone

1784

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Jean Johnstone April. 17. 1784

Concerning disease of this patient am very much at loss.

Consists of consid diver of sympt prob. little connected with each other

Of these the first ment. is gener swelling of abdom.

When consider that this tense to the feel, & not only without colour but liab to sudden aggrav. partic at night, reason to presume that arise rather from wind than any other cause.

At same time no mention of borb. of eruct, or of flatus giving relief to counten this suppos.

But besides this anoth sympt still more distress to her prob. not connected with pres.

A pain viz a little to left side of scorbic cordis.

This in some degree const. but at short interv. suffers very consid aggrav.

No circum attending this pain [which] throws any light upon nature.

And must own that totally at a loss to form any prob. conj. with regard to it.

Nor indeed do I see any other partic in case with which can supp it to be connected.

Unless perhaps be somewhat of same nature, with those pulsat. obs. on right side of Trachea & left mamma.

Though these indeed of themselves at least without pain.

And besides this in their nature somewhat singul.

For neither of them synchron to the pulse.

While pulse 126 strokes [increm] the pulsat at side of Trachea when most distinct markd only 112.

But besides this both very irregul.

With regard however to these pulsat. may be remarked that had not attracted notice either of pat. or her mother.

Could not therefore learn of what durat. they were.

And what of still more import. whether const. [or] not.

Would be improp. therfore to offer any conj respect them till have opport. for father observat.

And of this now very little prosp. as patient who resides at some dist. in country is we are told unable to attend here.

Upon whole then must acknol. myself much at loss both with regard to name & nature of this affect

And hence cannot pretend to offer any conject with regard to termin.

Must however acknowl. that am by no means without [appreh] of danger.

And here would not be at all surprizd if an event suddenly fatal should occur.

And if found on exam by dissect that pain proceeded from an [aneurm] or some simil local affect.

At same time must obs. that no circum here taking place from which can on any prob. grounds alledg that an affect of that nature does occur.

And notwith early period of life would not be surp if should yet app. that all her sympt depend on an affect of hyster. kind.

For this well known to put on various app. & to imit diff disease

And partic in this way, often occurrs prior to app of menst. disch.

But this opin also can offer only on footing merely of vague conject.

And with view to pract here can do very little unless in way of obv. sympt.

Is therefore solely with that intent that pract. hitherto empl. have been directed.

With a view to state of appetite & other affect of stom. had here recourse had here recourse to the Infus Amar.

And to try what effect opium might have as allaying pain at scorbic cordis as well as in prev. recurr. had recourse to Pil Theb.

These taken to extent of gr i of opium in course of day.

From neither one nor other however, did it app. that any benef. was to be derivd.

For while she herself, in such situat that unable to attend us at next report were informed that all her sympt very much aggrav.

In this situat of disease & in state of uncert. as to nature, thought it more advis to make a trial of a diff med, than to persist in use of what had hitherto empl. with so little affect.

And on idea that affect as have suggested might be of hyster. kind had recourse to simple foetid pill.

While trial innocent on diff grounds prom some advant.

For besides some chance of [count] pain at scrobic cordis, if swelling of abdom from flatul. may have effect of dimin from prod disch of flatus.

But with regard to future empl. must be entirely regul by effects.

[If] [attended] with benef. may persist in use encreasing quant.

And at the same time endeav. by more accur. obs. of the disease to form more decided opin of nature

If however either no effect or aggrav of sympt. much at loss what meas shall next take.

May perhaps however make trial of Aether or some other of stimul antispasm.

But in this our conduct [must] be very much regul. by acct which receive of patient.