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Case

The Honourable Mrs. Duff of Blervie aged 36 years -
Embonpoint - of a lax fibre - an irritable system of nerves
& subject to Hysteric complaints - on tuesday the 15 September
went on a visit to a neighbouring Village on the sea side
& having passed some hours in a warm room where
she had been overheated - on her return home kept the
windows of the Carriage down with a view to enjoy the
see breeze - but before she reached Blervie began to
complain of chilliness - & having being thirsty drank
some cold water by the way - & in a few hours after
she got to her own house was attacked with coldness
shivering & flying pains - On Sunday at noon
I saw her & found she had passed a restless night
& on the intervening days had frequent attacks of
flying pains with coldness of the extremities at nights
& partial sweats extending for the most part only
over the breast & shoulders - When I first visited
her (ie on sunday) she complained of sharp pains
shooting along the course of the abdominal muscles
& thro the breasts & shoulders - Her Pulse was 120 -
pretty full & soft but easily compressed - her urine
high coloured - voided in small quantity - & with

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pain - On Saturday she had of her own accord taken
some Rhubarb - & on the sunday morning by persuasion
of a female friend had taken a dose of Salts which
operated several times - she had also applied bottles
filled with hot water to the soles of her feet & hot
bran to the region of the stomach - & to the belly

She informed Me that on Saturday night she
had an attack of the Globus Hystericus - from
which circumstance & from the state of her Pulse
& general habit I cautiously avoided letting
blood - & only recommended to keep out the sweat
which the hot applications had produced by
drinking plentifully of weak whitewine whey
at the same time renewing the application of the
hot water bottles to the soles & changing the bran for
bladders half filled with warm water - At bedtime
I gave a Draught containing Soot Tincture Castor.
Spirit of Hartshorn Thebaic Tincture, twenty five drops of each, in one ounce of Spirit of Peppermint Water - She had a slight remission of the pains in
the night but slept very little - the Sweat continued
general & propere - yet in the morning her Pulse {illeg} re¬
mained at above 118-20 - her urine was still high

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coloured & was made in small quantity & with difficulty
the pains however were now more confined to the ab¬
dominal muscles - In this state she continued with oc¬
casional remissions tho' there was not an absolute cessa¬
tion of the pain - for several days & her urine began
now to be rendered more freely - with less pain &
deposited a copious sediment - She was wrapped in
flannel & the disposition to sweating encouraged
by weak diluents while the former Draught
was repeated every other night - In a few days her
Pulse came down to 95- & she was able to sit in her
chair for half an hour every forenoon - & I then
ordered her a teaspoonfull of Vol. Elixir of Guajac
morning & evening to be taken in a little wine & water
repeating the former Draught occasionally

This course having been followed for a few days
the pains became less severe & less frequent & there
was some prospect of returning health when she
was again attacked with the pain which had now
moved into the region of kidneys - in the course
of the ureters & shooting down the thighs & the
urine was again voided in small quantity - with

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much pain - & of a high colour & turbid -

In this state Mrs. Duff was when Dr Brodie of London
first visited her on tuesday the 30th September - From the
Proteus like appearance of Mrs. Duff's Complaint which
seemed to have exhibited Hysteria - Rhumatism &
Gravel in succession Dr. Brodie agreed with me in
thinking the same general Indications were still
to be pursued - but in place of the Volatile Elixir
& former Draught which were now laid aside
were submitted at night - a Draught compound
of Gum Guaiacum Spirit of Hartshorn & a larger proprotion of Thebaic Tincture which sweated her profusely & procured
rather a greater remission of pain -- But the
difficulty & pain in the Chylopoietic organs increasing
this Draught was changed for one compound
made with Spermaceti Sweet Almond Oil Sweet Spirit of Nitre a few
drops Juniper Oil & Thebaic Tincture as formerly - from
which she seemed to enjoy more rest & a greater
remission of pain than at any time since her
first attack with a small increase of Urine &
less difficulty in rendering it - The day following
she had a Glyster with the addition of some tonica
Turpentine which she felt comfortable to her

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bowels - it procured one stool in the evening & she
passed the night without any draught tolerably
well - Every night since however she has been
obliged to use the Anodyne Draught to alleviate
her pain but I am sorry to acquaint You it
has not afforded the relief that could be
wished for - Some days past she has com¬
plained of headachs & Nausea & one night
she threw up the Draught - The Nausea &
headach Dr Brodie & I are disposed to attribute
in some measure to the Anodyne. On wednesday
night last the 8th instant she was attacked with
slight diarrhoea - violent gripes & tenesmus
for which in Dr Brodie's absence I ordered only
a large quantity of chicken broth & the repetition
of the Draught at night with a less proportion
than at first of the Guajac omitting the Sweet Spirit of Nitre which last ingredient had been dis¬
continued several days - Last night she had
her Draught & slept tolerably well but was
much oppressed with disturbed Dreams -

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The tenesmus continues tho' in a slighter degree &
this morning she has complained of violent gripes
& for the first time of flatulency in her stomach &
bowels - Her Pulse is at present 80 & rather languid
urine more copious & limpid - & the pains are
now less frequent & less violent & not as formerly
in the region of the kidneys & ureters but confined
chiefly to the abdomen -- On the whole tho the
pains have remitted of their violence they still
continue is some degree & I am sorry to add that
there is a visible loss of strength - dejection of
spirits - & no very sensible amendment in any
respect - Menses appeared about eight days be¬
fore her first attack - & the recurrence of that
period may be soon expected - Her constitution is
never particularly affected by that discharge
which is in general ↑is↑ copious & easy -- The above
is as fully as I am able to collect all the Circum¬
stances in Mrs. Duff Case in drawing up of which
as well as in the general treatment you will
readily perceive how much I owe to the skill

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& abilities of my friend Dr. Brodie who is ever
ready to guide the inexperience of a Young Prac¬
titioner to safe & efficacious remedies ---

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✍

Mrs Duff of Blevie
October 1783
V. XV. p. 294.