DEP/DUA/1/41/18 (Transcript version)

Agnes Turner

1787

---

Agnes Turner March 10^th. 1787.

Formerly express great doubt resp. case of this pat.

These not remov. by any thing that have since seen.

In place of being dimin upon whole rather encr.

For while disease equally anom as before has now very much changd app.

And now evid that former conject were ill grounded.

Formerly remarkd that was [illegible] no decided evid of Dropsy.

But some indicat of it in swelling of abdom & legs.

Espec. as conj with state of urine

And with sense of coldness in [illegible]

Besides these indeed many othr sympt.

Prickling sensat. tremb. of hands &e.

But with complic of various kinds dropsic affect not uncomm.

And conject that affect might termin in formal inst of that disease.

Now however app of dropsy [have] altog disapp.

And that too without any remed. which could have been supp. to give remov. if tend to disease had existed.

Hence concl. that for this susp. little foundat.

App. also that not [more] for anoth partic.

Susp. viz of pregnancy

With regard to this our pat herself express uncert. & [inclind] to [contr] before

Was a married woman not past period of bearing childr.

And had seen nothing of menst disch of three months.

Besides which affected with freq vom. a very comm app in pregn.

Could not indeed consider pregn as by any means cause of sympt.

For to many of these had been subj even for space of two years.

But imag. that pregn state might have consid influ in modif comp.

And the rather to be susp. as she consid all compl. as aggrav after a former pregn.

When deliv of delic child dying in few days.

At any rate whether pregnan in any degree connected with comp or not if was pres. would necess [res] in use of med.

And want of menst with vomiting at least suff grounds for some supp.

This however was soon satisf. also without foundat.

For after under our care for some time menst disch returned.

And that too without any med empl. for restorat.

And without any mark which could be consid as indic abort.

Hence then no foundat for former suppos.

At pres. app. consid diff, from what [was] when came undr care.

As far at least as can learn from report of others.

For of late patient has been in such state as to be unab. to attend us.

This has in great meas arisen from condit of legs & feet

What at first app. under form of partic prickling & coldness in these now conv. into acute pain

And that too little or nothing mitig by any remed we have empl.

Of nature of these pain at loss what judgm to form.

From situat & circum of pat might naturally concl. them of Rheum kind.

But began at least under an uncomm form.

And derived no relief from [these] pract, giving in gener at least some mitig of sympt in Rheum

While reason to susp. that somehow connected with affect of alim canal.

For freq. subj to freq returns of vomiting.

But besides this were informed of inord actions still more alarm.

Were informed told as app from report of 17^th of Febr, that patient subj to convuls. fits cont for almost space of a day.

These accord to acct given us put on somewhat of app of Epilep access.

But have had no such accur. descript as to enab. us to form any prop. judgm of them.

Serve however at least to shew an anom app in course of affect.

And indeed of this throughout whole case abund evid.

Hence after treatm for two [month] as much if not more at loss than ever to form prob. conject.

Have sometimes been inclind to conj. that pains here rather of gouty than rheum kind.

In this case indeed many object to suppos of gout.

Such for examp. as age sex & [status] in life.

For while case with females & lab poor, seld occurs till after 34th y.

But to all these some except.

And such a singul except may occur in pres inst

Yet must confess that to this conj chiefly led from anom [nature]

And of all diseases with which acquainted perhaps no one putting on more singul or uncom app. than gout.

In so much that [some] & [these] too pract of first emmin give name of gout to every disease with regard to which at a loss.

Partic where there occurr viol pain & affect of alim canal.

And in such cases as app from conclus conject often right

For what at first app render very anomal form, afterw turns out to be regul gout.

This therefore a conject which may at least be hazarded with respect to pres. case.

But at same time uncert. such that cannot make it foundat even of prognosis.

And must own that with regard to probab. termin of case totally at loss.

May only obs. that obstin with which has resisted pract already emp. give no reason to hope for speedy cure.

If such occurrs more effect of natur than med.

For hitherto pract empl. chiefly directed with view of obv sympt.

And at pres at least see no other foundat. on which can afterw. proceed with greater prob of advan.

When came first under care had recourse to dilut vitriol acid, diffus in mucil mixt.

In this had in view both drop affect which then susp, & likewise state of stom.

Imag. that might be benef to former from operat [as] diuret & allaying thirst.

For both these effects have not unfreq obs. from it.

But expected still more powerful effect on latter.

Partic as allaying vomiting.

An effect which have often I think obs. to result from empl.

Accord soon after began use had at least for some time [compl] remiss from vomiting.

And although no remark encr. of urine, was no longer affected with ardor.

While at same time less of drop app.

And no return of swelling of limb even on erect post through day.

But after this remiss for about ten days had again return of vomit.

And at this period menst disch app.

While at same time, in place of coldness & prickling of limbs had severe pain in these.

In this situat nothing to led us to contin of former med.

And astring which might in some degree interfere with regul menst disch even [contraind].

Omitting this therfore thought it necess only to do something with view of obv. pains.

Was with this intent that [direc] friction with Ungt. Tereb. cum Opi

Consist of prop of Ol. Tereb. & Opium [rubd] up with Hogs lard.

This pres. on idea that pains of Rheum kind.

As in such inst have often seen very great relief from use.

But in place of being attended with this effect during empl. pains aggrav.

Changed it therfore for Anod Bals.

And at same time directed inter use of opium.

But under these affect also still contin to encr.

And vomiting again [returned] with greater sever.

By this led to substit for Op. the use of Hyosciam another very powerful sedat.

And not unfreq giving relief where Op fails or disagr.

In conj. with Hyosciam directed also use of Guaiac

An artic in some forms at least recomm both in Rheum & Gout.

Partic as given under that of volat. Tinct or [Elix].

But to this form in many inst strong obj. occurr. from Menst. Vol. Alk.

And am inclind to think that all adv from guaiac [itself] best had by giving it in [subst]

Partic as comb. with Crem Tart. [illegible]

For by this am inclind to think convinced that its solut in alim canal very consid aided.

Accord under this form here empl.

But from these med no more allev. than from formr.

And that too although dose of Hyosciam augm.

While empl. these, this pat. subj to convuls fits [ment].

And may perhaps be consid as matter of doubt whether was not conseq of augm dose of Hyos.

Certain that belongs to tribe of Narcot poisons.

And that affect of convuls kind no unfreq conseq result from these

While at same time from pecul. of constit. much more readily induced with some than other

From these circum then at least a possib suppos. that may have origin from this

But at same time consider it I own as improb.

For took pills only to extent of grX at bed time.

That is two of extract of Hyosciam.

In former inst however have given much greatr quant without any such effect.

Besides Hyosciam taken at bed time

Fits did not occurr till course of succeeding day.

And by that time may reason concl. that its effect entirely over.

Hence though Hyosciam poss cause yet that here induced fits not probab

At same time even on this footing thought contin improp.

And as pains still severe thought of return to use of Opium

Now however directed it in conj with Calomel.

An artic from which could not indeed expect any immed allev of pain.

For has not effect at dimin [illegible]

But in some obstin painful disease often great influ in radic cure

Partic in cases of Chron Rheum

In so much that some disp to put greater confid in it than in any other med whatever.

Thus then imag might here be useful.

And farther expectd adv. as opening belly.

Or at least as counteract tenden in Opium to prod constip

In this howev disapp.

Had not indeed during course of succeeding week any conv. alt

But while pains nothing allev by use of pills, was affected both with costiv & very great drows.

Conseq. often result from Opium

By these therfore [determ] again to make trial of Hyosciam as substit for opium.

And app. at least that had not same effect as binding belly.

But at same time pains still nothing abated.

And in conj with these affected also with return of vomiting.

While at same time drows. still contin.

Or at least, though restless in night slept much during day.

Notwith these circum howev still wishd to give farther trial

And accord directed contin.

But at same time with view to vomiting had recourse also to repet of vitriol acid.

What however will be effect of these pract, after being so freq disapp. can hardly now venture to conject.

And must own equally at loss to say to what others may afterw have recourse.

A necess. conseq of ignor. with respect to disease.

And if any truth in conject respect gout perhaps most adv plan to do little or nothing

But to trust even allev of pain to patience & flannell.

Two perhaps of most useful pract in that affect, notwith all said & written respect to cure.

Not improb. howevr that may here try a pract, which some think they have of late used with success in inst of anomal gout.

Vitriol aether viz taken in camphor. emuls.

But in this and indeed in future treatm in gener. must be very much directed by [cirm] in which shall find our patient