DEP/DUA/1/37/14 (Transcript version)

Elizabeth McDonald

1785

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Eliz. McDonald. 19 Febr. 85

In history of this patients case many sympt. enum.

And these too what may be consid as indic diff. affect.

Consisted however chiefly of severe pains.

And was I own at first at some loss whether should consider these as being of Rheum or Nerv. kind.

Parts affected were what Rheum often attacks.

But were much more of transit nature than should have exp. from pains of that kind.

For expect that of left side none of them fixd for any length of time

But propag. in transit manner from head to points of fingers.

While on other occas extend again to infer. extrem.

Besides pains anoth remark symp in case was coldness & shiv with which often affected

These however reason to believe were not of febrile kind.

For never followed by heat or sweat.

Hence then seemd most prob. that these also of Nerv. kind.

And upon whole viewd affect as being an inst of hyster.

Not indeed app. under form of regul hyster fits but of hyst. symp.

These well known often app. under form of pains & those too of most excruc. kind.

In so much that a partic severe pain in the head the Clav. hyster as has been denom. consider even by Dr Sydenham as great pathogn of the disease.

But besides such pains hyster sympt put on also a variety of other app

And of this nature was inclind to consider, all the sympt mentiond in hist of case.

With this idea of disease was not disposed to give an unfav. progn.

For well known that hyster much more a troublesome than danger diseas

Under any form however is often very obstin.

And notwith relief which patien has now obt. may prob. find it so in pres inst.

For sympt. even after entirely disapp. very apt again to recur.

This espec. the case, during when app under form prop. hyster fits.

For during interv patient may be consid as in state of perfect health.

And without any excit cause affect again returns with great severity

That therefore unexpected recurr of sympt. may take place in pres. inst. is at least highly prob.

But whatever may afterwards be case, have for the pres at least obt. a very consid remiss.

And this I own am in some degree disp. to attrib to pract here employd.

Began treatm. of this case by direct for patient the Pil Foetid cum Aloe.

A formul which as have already oftener than once had occas to remark consist of equal parts of Assaf. Al & Soap.

To these had chief. recourse with view to that pecul affect which Assaf. has on nerv. syst.

And in conseq of which in diff. form often highly useful in affect of Ner. kind.

And that too both as allaying inordin motions, & counteract affects of uncommon sensib.

Hence often used with greatest advant under form of Tinct. Foetid. Tinct Fulig &e in prop. hyster fits.

Still more in hyster sympt consist in affect of alim canal.

And also not unfreq as obv. pains.

Hoped therefore that should here obt this conseq from use.

From bound state of belly, was induced to empl assaf. here, rather as comb. with aloes, than by itself.

And imag. that ten gr of [mas], cont little more than three of aloes, would have no more influ than gently to move belly.

For upon whole, might be consid as but small dose.

And indeed where belly not bound, has in gener. little more than effect of gently loosening it.

Here therfore where belly repres as very bound, no reason to susp. that would have done too [illegible]

But had affect of giving in general too stools in the day.

This however I consid as being more than to be wishd for.

As although wishd to remove irrit from alim canal, yet was equally anx to shun evac from syst.

For from this, had reason to appreh encr. of irritab, with augm of pain, & all other sympt.

Ordered therefore that should afterwards be taken only to half quant, from which imagind, that should obt. affect at least of obv. costiv.

During former use of pills some sympt allev.

But still much affected both with pains & watchfulness.

While therefore gave only morning dose of foetid pills had recourse to Opium at bed time.

An article which both as allayin pain & proc. sleep unquest one of most powerful we possess.

Opium here given under form of Pil. Theb. to extent of gr X cont. 1 of Op.

This with an adult not habit to use am inclind to consider as full dose.

And in my opin, has often even better affect, than when at first empl to consid extent.

Here however cannot say that reapt from it all the advant expected.

Pains indeed in diff parts of body seemd to be somewhat allev.

But those of head still cont severe

And nights as restless as before.

While although quantity of foetid pills reduced, belly still loose.

An event which consid former bound state should hardly have expected.

And espec. during use of pil Theb. which very great tend to bind

Here therfore imagind, that beter to omit Pil Foetid altogh

And while cont. the opiate with view to procure sleep directed also a blister as a remed for headach.

From this hoped that might obt benef. both as giving deriv from head, and as counteract nerv. sensat.

In these expect however were disapp.

Prob. in part from blister not oper so well as could have been wishd.

For are told that prod of but little disch.

Rather however than try repet, resolvd on having recourse to anoth med.

And while gave up also the Pil. Theb. directed the use of the extract of Hyosciam of Henbane.

Effects of this artic as sedatve & narcot known to most [illegible] [illegible] of M. M.

But for a very long period very little empl.

And may justly consider it as again introd into pract by Dr Stork of Vienn.

Of all subst. with which am acq. consider Hyosciam as app. most nearly in affects to Opium.

Do not indeed by any means consider it as equally powerf. either in allaying pain or induc sleep.

Both in both has very consid effect.

And seems to give what may consider as diff sedat impr on Nerv.

For of sedat as well as stim can be no doubt that impress [in] very various.

Is from this circum that would expl. its having much less influ in prod vertigo & confus of head.

While probab from some saline [illegible] in place of binding belly like opium tend rather to open it.

From this then expected that while allayed pain & proc sleep, might also have affect of keeping belly suff. open

While however empl. these pills intern directed anod linim extern.

From which reason to expect benef. both from affect of friction & of anod influ of opium.

In these partic, intent not altog. answered.

For at succeed report, pains in [should] to which frict prin app, still cont.

But headach very much relievd

An affect which was I own disp to attrib. to the the Hyosciam.

While at same time also, was inclind to consider it as having prod better nights.

For in place of former restless state now slept well.

An event which could not you will obs. accompl even by opium.

Here however cannot perhaps be altog attrib to effect of Hyosciam as a soporif.

For probab. that not a little the conseq of remov. of pain, partic of that in head, by which kept [watchful]

But whether immed effect or only second conseq of Hyosciam yet think it probab. that to be attrib to this med.

And while attended with these conseq. had not affect of binding belly.

At least for week after use begun, contin rather loose than otherwise.

But at succeeding report, found that oppos state of disch had taken place

And as now little affected with pains wishd to try how would do without it.

Have therefore given direct for being intermitted.

And have merely advised, the contin of Anod Linim with occas [use] of aloet pill to obv. costiv.

If under this contin easy have thoughts of direct Peruv Bark, with a view of prev. return.

And at any rate may have recourse to it as a remedy promis advant in this affect.

Partic, as conj with Valer.

But in case of severe return of pain shall prob. first try again the effect of the Hyosciam.