DEP/DUA/1/11/23 (Normalised version)

Susan Thomson

(1776-1777)

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Susan Thomson.

In this patient have in some measure seen succession of affections.

When first came under care was affected with a disease very distinctly marked.

Had evident swelling & inflammation of fauces & tonsils.

This attended with some degree of difficulty both in swallowing & in respiration.

While at same time patient affected with manifestly febrile symptoms.

No doubt therefore that laboured under inflamed sore throat.

Or to use language of Nosologists¹ Cynanche tonsillaris.

When came under our care had been but of short duration.

And in usual period had mild & favourable termination

Perhaps in some measure from remedies employed

But probably still more from progression of disease

Patient however still continues under our care

And that too not without complaint.

While at same time do not entirely seem to be such as might naturally have expected

Or at least what parents dreaded.

This patient several months ago had been affected with various symptoms from worms

Particularly pain of bowels.

And at that time freed of complaint in consequence of having voided several.

Now again became affected in some measure with same symptoms as before.

A natural supposition therefore that might indicate same affection.

And well known that those affected with worms often liable to recurrence after seemingly complete cure

Had little hesitation in concluding therefore that after sore throat removed cure of symptoms from worms would be only object of attention.

In this judgement however am now inclined to believe that was too precipitous.

For pains of belly excepted no other symptoms of worms have yet appeared.

And patient has not been observed to discharge any.

Inflammation of throat however has been succeeded by a catarrhal affection.

And that too of considerable obstinacy.

Besides attended with some other circumstances serving at least to give alarm.

Had not indeed such quickness of pulse as to give any strong indication of hectic fever

But observed to have remarkable disposition to partial sweats.

Particularly on head.

A circumstance well known to be frequently an attendant of Phthisic affections.

Yet although may give some alarm without other concurring circumstances can by no means be considered as positive or even strong evidence

Upon whole then consider her as at present patient for an affection purely catarrhal

And in this view would hope in no long time for favourable termination.

If however phthisic tendency here greater than at present inclined to imagine will soon undeceive us.

At any rate no reason to apprehend immediate danger.

And if phthisis, may consider of that kind, which product of catarrh.

Whether therefore adopt one or other supposition will very little affect practice at present period of disease.

For here in both one & other affections must endeavour to remove inflammatory tendency by antiphlogistic plan

To mitigate frequency of cough by demulcent.

And to diminish impetus at lungs by determination to other parts.

On these principles have had recourse to practices already used

With view of determination to other parts have employed cathartics, emetics & blister.

As demulcent have used oily & mucilaginous mixture

Hitherto however have not been attended with desired affects.

From this led to give trial to different plan

And on suspicion that both cough & sweating may be effects of peculiar laxity with irritability have ordered trial of Peruvian bark.

By effects resulting from it will naturally be regulated in future management.

If alleviating cough & sweating will be led to persist.

If has contrary effect will probably have immediate recourse to former plan.

Or to conjunction of demulcent with gentle opiates.

If has no influence whatever on complaint may lead to suspicion of affection being supported by other causes.

And should probably think of giving trial to some anthelmintic medicine.

For besides producing many very anomalous symptoms, cough an affection by no means unfrequent from worms.

Would fain hope however that many trials will not here be necessary.

And that complaint may soon be happily terminated.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.