DEP/DUA/1/35/28 (Transcript version)

Janet Duff

1784

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Janet Duff. July 9^th 1784.

Resp. disease to which this pat. subj am I own in sev resp. very doubtful.

And while diff conj. may be formd with regard to prin sympt. probab. that all do not arise from same source.

Thus some of them consid prob. with justice as conseq of Interm.

While others again existed long prior to her being subj to that affec.

This partic the case with resp to sympt most distress. to her when came under our care viz Pain of side.

Had been evid subj to it for space even of sev years.

While interm again had existed only few weeks before.

Hence pain of side both in nature & cause diff from other sympt.

And here with respect to nature much at loss to form any pos op.

From having been so long & so much fixd to a partic part, ground for susp. some local affect.

And [besides] more integ. diff viscera in which from situat may be supp. to be placed.

Thus circum of situat may be consid as fav idea of its being placed in kidney.

And well known that this [viscus] is from diff causes a very freq. source of obstin & excess. pain.

But where kidney to any degree diseased may reason. expect an affect of urine.

And this indeed an almost unav. [conseq.] of disease of that organ.

[Hence] then as disch here in natur state, strong presumpt against pain origin from that cause.

While seat by no means so strictly defind that may not have situat in other viscer.

And here cause to which pain origin attrib would lead to diff supp.

Patient herself, has to greater or less degree been sensib of this pain from time of a deliv about six year ago

And ascribes origin to injury which sust. on that occasion.

This well known to be a freq. cause of pain.

And although may prod it from affect of many diff parts, yet chiefly led to susp. either uterus or append.

And here situat such that not improb. may be in left ovar.

Which indeed rather to be susp. than uterus itself as has [never] [been] attended with affect of menstruat.

This therefore conject as to seat [which] disp to think the most prob.

While seat by no means so strictly defind, that may not have situat in other viscera

And the rather so when consider how often morbid affect in diff ways take place in these organ.

This howevr at utmost to be offerd as conject only.

And the rather so as no obvious [enlarg] of that viscus detected by [exter] exam.

Such a change howev in gener. the [attend] of fixd pain arising from that source.

And notwith presumpt of [viscus] may merely dep. on affection of [intg]

And that too rather in way merely of encr. sensib. than of any prop. local disease.

But whatever cause of pain, would app. that of late consid [emaciated]

And on any idea of it this may be supposed to occur as conseq of [interm]

But partic fav to idea of local affect in ovar.

For well known that nothing a more common conseq of interm than obstr. & schirros of viscer.

And many inst of affect of Ovar as well as others.

Where therefore diseasd state had prev. existed this may readily be supposed to be encr.

But whatever orign cause of pain of side or of encrease since other affect comm. this by no means only sympt. to which subj.

Of the others if not all at least greatest part dated only from attack of intermitt.

May therefore with greatr confid be assignd to that cause.

And espec as many of them well known to be conseq & [concom] of Inter

This may partic be observd with respect to weakness vertigo & headach.

Weakness a necess conseq. indeed of almost every disease.

But in an espec mannr of those of febrile kind.

And of all fevers none perhap prod so great degree of perman deb. as intermit.

Towards close of many fevers inded debilit to still more consid degree than intermit.

But there as far as my observ. goes recov. of strength takes place more rapidly.

And accord. interm more freq. than other fevers obs. to induce dropsic affect.

If however thus consider weakness as conseq of fever may view also in same light Headach to which subj.

For well known, that of all symp of interm, none more gen, few more distressing.

And while is an almost unif attend of parox. so also a very freq. conseq. of the disease.

In so much that none more liab. to freq. headachs from slight causes than those once subj to interm

Many who from this origin subj to headachs on every easterly wind.

Many with whom return in regul. & period mannr under same form, as interm itself.

And indeed, thus often consid as remaining interm, though all other sympt. removed.

Hence then by no [measure] singul, that should here [taken] place.

Nor one we even to wonder at occur to such extent as to render her [sometimes] incap of standing.

To headach, vertigo to which subj is I think entirely to be referrd.

For one well known to be very freq. concommit, & affect of other.

Thus [then] app that many symp. which may with consid probab. at least, be traced to intrm.

But some, & these too what have succeeded only to that disease, with regard to which greatr room for doubt.

This partic the case with regard to catarrhal sympt to which subj.

Is affected we are told, every morning with sever coughing.

And this attended with great sickness, & heaviness, or sense of weight in chest.

Seldom however with any expector.

This sympt may or may not arise from interm.

And diffic to determ which [symp] the most probab.

That coughs very freq. both attend & conseq of interm, will not be denied.

Connect. with that disease, in many inst distinctly proved from being attend of parox only.

And by no means a rare occur. to obs. them remaining after othr symp

Here then date of this symp. period returns every morning, & its not being accomp with expect. all in fav. of connex. with interm

But on other hand to be obs, that if cough sometimes from this [cause], much more freq. from others.

And at least equal reason for suppos. that may be merely accid catarrh.

Espec. as with that disease [after] of any standing cough in gener. most freq. in morning.

Thus then app. that with regard to diff parts of affect. much room for doubt.

But whatever view take of it, affords example of complic, prob of obst. [disea]

At same time prognosis both with regard to danger & obstin, must depend much on partic cause of sympt.

And on supos of [truth] of diff conject, must be led to very diff op. as to event.

Thus if pain of side an affect merely of integ may be soon removd

If again, arises from any fixd affect of viscera as ovar. utmost that can expect is mitig

And probab. notwith utmost efforts though tempor relief, will yet in end encr. in viol.

Nay from augm of affect, [althou] at pres nothing alarm need not even be surprizd at fatal conclus.

This however the part of pres. patients affect, giving most ground for alarm.

All sympt. which are mere conseq of interm, may in no long time, even without interpos of art, be removed even by operat of syst. itself.

While again reason to hope, that this remov, may be not a little forwarded by the remed which known to be so success empl. in combat intermitt.

By these means if cough a conseq of intermitt may be overcom as well as others.

If from any other cause may yeild in same mannr as simil [cata].

And nothing in pres. app. at least which can lead us to dread that either partic obstin or danger.

As prognosis so practice also varied by complic nature of affect & uncert. with regard to it.

And if any truth in conject offered, diff parts of affect, must be combat. in diff ways.

And indeed attempts to cure [hitherto] employd, rather directed to partic parts, than on gener. plan.

When came under our care, most urgent sympt, was pain of side

Of this from whatever cause might proceed, had some chance of obt. mitig, by external applic of Anod Balsam.

Of this artic need hardly obs. that activ prin depends on opium which cont.

For although besides [ard]. Spt, the menst. used, Camph & essent oils also enter compos. yet these by thems. form a very diff. med.

Opium the power of which as a sedat or in other words as allaying pain, or in other words as sedative, has long been known, prod of this effect wherever applied.

And partic seems to be encr. in proport. to sensib of part on which acts, as app. from effect as acting on stomach.

But has more espe. influ on pain from partic parts, when acting on nerves on surface nearest to [these]

And thus also avoid inconven. from action on alim canal as binding belly or like.

By this then & partic by degree of costiv already subs. led to applic externally, in pres. case.

While however employd this med extern, had at same time recour to anoth internally.

Use viz of comps powder of Crem of Tart consist of equal parts of that artic, & flower of Sulph.

This expectd, would have effect at least, of obv. costiv.

And thus imag, that headach might be allev.

But lookd for still more advant from it as counteract cough.

For in affect of catarrhal kind, very gener. prod, of consid benef.

After contin on these med for some time, pain of side became much easier.

An affect which could have little doubt in attrib to applic of Anod [Lim]

After this mitig obt. thought it improp to persist in use at least without intrmiss.

As should thus be depr. of benef. from it as afterwards prod mitig. if afterw. necess.

But as cough still contin persist in use of Cream of Tart.

If howevr allev of that sympt [also] obt is next intent to have recourse to Peruv Bark, with a view to [weakness] vertigo & headach.

And if pain of side contin, or return shall probab. have recourse to Cicuta.

In these partic howevr must be very much directed by circum, [hereaf] occuring, which may either tend to conf pres conj, or lead to other suppos.