DEP/DUA/1/41/12 (Transcript version)

Betty Micheson

1787

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Betty Micheson. Febr 25. 87.

Of this patient also have seen but little since last spoke of case

And to what before obs. now not much to be added.

From obvious swelling conj with scarcity of urine could have no doubt in consid affect as prin. anasar.

And although of short standing had evid gone to consid height.

This manif app from extent.

For not only consid in infer. extrem but also in abdom.

And indeed in some degree over whole body.

But still more from cough & [dyspnn].

For in these evid of effus in cell memb of lungs.

Of affect of system also evid in state of stom

For with intense thirst not only impaird app. but also freq. vomit.

Same also indic by state of pulse

For quick & small.

A condit though not uncom in anas. yet in gener only in adv [par] of disease.

While these however common sympt of consid disease others somewhat uncomm.

As such may partic mention tense state of swelling.

Gave you will obs consid resis to pressure.

And did not easily bear impr of finger.

From this might perhaps at first sight seem prob that depend on some other cause than water.

For want of pitting on press a mark of [illegible] & [illegible] or large collect of fat.

And must always be case, either where fluid can not be expelld from cells or immed regains situat.

This however not in gener at least case with water.

Hence comm readily yields to press & retains mark for some time.

But this it may be obs. not necess conseq.

For water itself if not altogeth at least nearly an incomp. fluid.

And therefore more ready to give tense swelling than even air.

Must always do so where not ready passage, from distended cells into empty one.

Or where state of cellul memb is such as to give resist to disten of cells.

Hence chiefly occur where disease but of recent date

Where has taken place as imm conseq rather of some accid than of gener condit of syst.

And where happens with those possess consid vigour.

To this cause then want of ready passage from one cell to anoth would here ascribe tension of swelling as well as not easily [bearing] impress of [fingere].

To simil cause also perhaps to referr anoth pecul severe pain in abdom.

Though not improb. that these in part at least connect with [cause] inducing Anasar.

For here inclind to adopt opin of patient, that conseq of want of menstr.

This disch had you will obs. ceased to app at usual period.

And patient had now arrived at that stage of life when comm leaves females.

This however known to be on sever acct with them very [ticklish] period.

And among other conseq from want of accust evac one not least comm affect of anas. kind.

In this view then case of our patient might be consid as a com occurr.

While at same time never without consid danger.

For if attempt cure by restor of disch often most excess. haem.

Any by these affect ultim very much encr.

From this circum then [former] expressed great doubt as to prognos.

And as now unacq with state of case can offer no farther conject resp it.

In treatm here consid it as first obj to evac water.

For from this had reason to expect most immed relief of urgent sympt.

And without this no means of radic cure could on any princip be prosec with pros. of adv.

Was with this intent that had here recourse to Crem of Tart.

An artic in such cases partic advant as comb. both purgat & diuret powers.

And here the rather indic from scarcity of urine.

For though purgat most immed disch. yet more perman & less debilit evac from diuret.

Espe in cases where natural disch. deficient.

From these consid then seemd in every point of view propr.

And indeed know no one from which in such inst, so much benf may in gener. be obt.

Here however imag that addit benef from some combin.

And with view of encr. purgat power added small prop of Jallap.

For by itself requires consid dose to opr as brisk cathar.

And Jallap before empl by itself with adv.

But while this empl as [adjun] added Zingib as corrig.

Cream of Tart very apt to [exer] great coldness at stom.

Where therefore as with our patien tenden to vomit some arom requir.

As such [illegible] [illegible] Cinnam or Cassia [most] grateful.

But Ginger while cheaper no less active.

This combin taken to extent of Tea spoonful four times a day.

At first no consid effect as purg.

But after few days, prob from accum in intest brisk cathar.

While from begining effect of encreasing urine.

Undr these evac soon fav. change in affect.

Dyspnoea much relievd, swelling greatly fallen.

And therfore directed contin in hopes of compl. removal.

But since that have seen nothing farthr of pat.

And not improb that dessertn the conseq of recov.

But at same time after what already said of [ticklish] situat of patients at this period of life dare hardly offer any conject.