DEP/DUA/1/35/20 (Transcript version)

May Ross

1784

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May Ross. June 25. 1784

With regard to disease of this patient must own am very much at loss.

And partic do not know what name with greatest prop to be affixd to it.

But little doubt in asserting that disease of a complic nature.

Sympt in case of the most remark. is consid swelling of legs

And with this many circum connected which would lead to opin of its being a hydrop. affect.

Partic encr. towards evening & dimin from horizont post. during the night.

The thirst with which connected.

The scanty disch & high colour of the [urine]

All these unquest to be consid as indic of a drop affect.

Here however one circum giving difficult.

The want viz of pitting on pressure.

This if not a constant at least a very gener attendant of anasac. swellings.

And would at least argue some singular.

In anasarc pitting a conseq not only of nature of fluid effus, but also of situat.

A thin watery fluid viz in cellul memb

Here then reason to suspect either diff of fluid or diff in situat.

And when consider condit of superfic [vessels] of leg, some reason to suspect that this may be case.

These you will obs. describd as in remark varicose state.

Reason therfore to belive that though swelling may in part be affect of effus, yet in great meas effect of accum of blood in vessels.

Thus then would app. that even this most obv part of compl in its nature singular.

But not more so with regard to nature than cause.

By patient indeed herself attrib to obstr. menstr.

A cause which although not freq. yet as well as other obst. disch. has sometimes given rise to dropsy.

And partic under form of Anasar.

Here however will obs. that affect of legs of much longer standing than want of menst. disch.

At least although no consid swelling, yet num varicose veins in legs of much earlier date.

And great reason to believe that to these, swelling at least in part to be ascribd.

To what accid however varicose state of veins to be referrd cannot readily discov.

But while diff morbid condit to which may be referrd, none more probab. than loss of due tone in vessels.

To some accid therfore inducing this, would referr that state.

And to condit of vessels thus induced, think that swelling in part at least to be attrib.

But whether Amenor. any share in giving rise to it or not, from acct given us app. that patient subj also to that affect.

And here likewise in all probab. want of menstr. arises not merely as sympt. of other affect.

For while now absent for space of three months interrupt of course followed as conseq of a partic accid.

Expos viz to cold during period of natural flow.

This an accid by which well known that obstr. often induced.

And which probab. operates in checking this as well as other haemorrh, by sudden constrict which gives to rupt. vessels.

By this means not only stopt in first inst, but gives rise also to [chang] of determ & addit resist.

And in this manner, obstruct contin till natural course of blood & condit of vessels be restored.

But whether in this manner that cold operates or not, can be no doubt that from imprud expos. to action, during flow of menses, is freq. cause of Amennorhoea.

And to this little hesitat in attrib it in pres. case.

To ammenorrhoea many of the sympt. may be referd.

And whether any share in induc swelling of legs or not at least presumpt. that gives rise to [illegible] debilit, avers to action & like, to which this pat. subj.

For while these very common conseq of this affect, to be observd that here took rise only after menst. flux was obstr.

And therefore probab. with prop. referrd to that cause.

This then neither least consid nor least distress part of affect.

Thus app. that patient lab. under complic of affect.

And some of these probab. but little connected with each other.

Hence termin may be [various]

But at same time from complic conject with respect to any of them much more uncert.

Of all affect what consider as most import. & what at same time probab. best chance of remov. is Ammenorrh.

This at least has not hitherto subsisted for such length of time as to give susp of obstin or dang disease.

And often even by operat of syst itself spont. removed in cases appar less fav.

To be however observd that even where seemingly slightest will sometimes foil every attempt.

Hence then even with respect to this cannot speak with great confid.

If however menst. flux restord gives at least better chance of remov of other affect.

For though varicose state of [vessels] of legs long prior to this, yet little doubt that from that cause want of regul circul. through syst of womb much augm.

Hence then restor of menses may at least tend to dimin.

While by prop. means for [bracing] & encr. tone of vessels may be still farther dimin.

But after of so long standing [canno] reasonab. expect compl. remov.

And while this the case may also concl. that now at least will not be entirely free from swelling.

At same time this part of disease perhaps to cert extent at least more readily remov. than any other.

In as far as depends on effused watery fluids & is really of drop. kind may be comb. by encr. action of absorb., & augm serous discharge.

As far as depen on accumul in prop vessels may be remov. by renew & support. prop circulat.

And after once removed from whatever cause arises, return best prev, by strength tone of parts partic of the vessels.

Is chiefly with these intent that pract hitherto empl have been directed.

Began you will obs. by directing for patient use of brisk cathart.

Comp. powder viz of Jallap.

From this could expect little effect indeed as restor menst. disch

But yet in some inst cathart stimul to rectum some influ in this way

Would not therefore have been surprized had app of menst been conseq of repeated use.

But here prin given with view of evac water & thus promot absorpt from legs.

And well known that as [hydrag] cathart few more safe or more powerf.

While however wishd to prom absorpt & disch of water by cathars had in view also same intent by diuresis.

And was on this acct. that had recourse to mixt with Spt of Nitre.

An artic which in many cases have found to oper. both with safety & care as a diuret.

In operation however in this respect in pres inst expect. not answered.

For was not sensib of its having any affect as encr. quant of urine.

When however in pres inst withou obvious operat, could not expect that would have any influ in comb. diseas

As little benef. app derived from the purgat.

With regard to these indeed were not disapp of obvious operat.

For from both doses brisk & free catharsis.

But this little affect in [counterac] any sympt.

Thought indeed that swelling of legs somewhat dimin.

But still, as might indeed have been reasonab. [expectd], varicose veins in these contin as before.

And pains in diff parts of body nothing abated.

Contin of this course then, from which state of debilit could not fail to be induced, hardly to be advised at least without some interrupt.

In place therefore of immed repeating cathart. resolved to contin in use of [diuret].

But as what formerly empl. had not succeeded thought it advis to have recourse to anoth.

And for dulcif spt of Nitre had recourse to Nitre in subst.

This empl. under form of watery solut.

With view of covering taste added a proport of mucilage.

And as a means of correcting immed action on stomach directed a small quantity of Vinegar.

From this med, expect some influ as augm quant of urine.

And this probab. good effect on state of legs.

But at same time even from complete removal of these swelling of these, will have by no means cure of disease.

And this removal, after has now subsisted for so great length of time hardly to be expected.

Especially while ammen. contin.

To forward therefore removal of affect of legs, as well as of other sympt. meas to be taken with regard to this affect restorat of menst. disch.

And for accompl. this end see no remedy that promises more success than Electricity.

That indeed not fitted to every case of Ammn. will readily allow.

But power of comb. many causes of obstr. now confirmed by numer. trials & observat.

And here the rather led to use as imagining that might be serviceab in other respects.

Partic some advant I think to be looked for from electric sparks [drawn] from legs.

For by this means both absorpt may be promoted, & tone of vessels augm.

Thus in diff respects [suited] to pres compl.

Is therefore intent with contin of Nitrous mixt, to put pat on Electric course.

And if during this, menses restored may I think look for advant from it as mitig, if not remov, sever of most urgent sympt.

But if electric fails future pract must be directed by situat in which shall then find patient.