DEP/DUA/1/14/01 (Normalised version)

Katherine Halley

(1777)

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Kath Halley.

Affection to which this patient is subjected one very frequently occurring.

And in case before us while distinctly marked is at same time without any complications

When came under our care most distressing part of complaint consisted in difficult respiration.

This at same time attended with frequent & troublesome cough.

And by that cough expectorated tough viscid white coloured matter in considerable quantity

From this last appeared that state of secretion by lungs different from natural condition.

And in this I apprehend sufficient cause for affording explanation of all other symptoms.

Must look upon cough to be affect of that irritation which accumulated mucus [occasions]

While at same time consider difficulty of respiration to proceed from air vesicles of lungs & even shall ramification of trachea being filled with matter prevent access of atmospheric air.

Supposition therefore augmented secretion of mucus thus far concerned in producing all other symptoms naturally led to considering case to be catarrh

And when attend to duration of disease as having now in some degree subsisted for near space of six years must necessarily consider it as a chronic affection.

This would even do were condition of functions indicating affection of system in general, different from what here cure

But with present patient, heat & appetite two of principle circumstances from which can judge of presence or absence of fever in natural state.

Pulse indeed somewhat affected.

90 pulsations in minute more than natural look for with a woman of 50.

This however naturally to be expected where respiration so much impeded.

For difficulty of performing this function leads to frequency of action.

And indeed to be remarked that where breathing affected in this manner for number of years for most part leads to irregularity of pulse.

For such irregularity on dissection a sufficient cause in general found.

Appears that difficult respiration induces even diseased state in large blood [vessels].

These often affected with distensions aneurisms or like.

And sometimes found to contain large & firm polyps [connecting].

Although however with present patient has not proceeded this length yet may [reasonably] consider affection of breathing to be cause of quickened circulation.

And notwithstanding state of pulse therefore view disease of patent as totally of chronic nature

In instance before us from age of patient might bestow upon it common term of catarrhus senilis.

This appellation however consider as less proper since affection will often even occur with young people.

While therefore little difficulty as to nature of this patients disease would distinguish it by term of chronic catarrh.

An affection frequently occurring in this country probably in some measure from coldness, but still more from vicissitudes of weather

And although not entirely confined to aged yet principally occurring with these.

Probably from state of circulation on surface being with them less free.

And from want of those exertions by which can be properly supported.

From nature of this affection in general must appear that by no means without danger

This must necessarily be case where a function so essential to life immediately affected.

Yet in cough though in some measure distressing to patient have as it were natural tendency to cure.

And although no influence as preventing return of cause affecting breathing yet gives immediate removal.

Hence may in general observe that an affection much more tedious than dangerous.

Such it had proved in present instance even before came under our care.

And after having subsisted for space of six years could not look for easy or immediate removal.

At same time no circumstance from which thought any reason to apprehend danger.

When fatal termination is for most part consequence of constitution being broken by excessive fits of coughing.

To such however present patient could not be considered as subjected.

And hitherto as have already observed disease had but little affected general health of system.

Might indeed be imagined that in cause of affection before us somewhat peculiar.

And this a circumstance in every instance to be taken into account in giving prognosis.

Very universally this disease derives first origin from imprudent exposure to cold.

And afterwards in general supported by inclemency of weather.

In instance before us, affection as is commonly observed to be much aggravated during winter months

But ascribed to a cause seldom under that affection.

Want vizr of menstrual discharge.

At least dated by patient from time menses left her.

Which however not sooner than the usual period

At same time observed that although affection then commenced had been much aggravated two years ago.

And that then patient exposed to much anxiety & distress of mind.

Both these circumstances patient herself imagined had share in inducing affection.

And will not pretend to affirm that for these no foundation.

At same time reckon it more probable that was principally if not entirely in case before us, affect of common cause

viz Influence of cold.

Look upon these therefore as nothing unfavourable in prognosis.

And from condition of patient in every respect joined to season of year, thought that grounds for hoping complaint might at least be alleviated under our care.

These expectations I apprehend not altogether disappointed.

For since became our patient both breathing & cough considerably relieved.

And hope that from continuation of medicine but still more from warm or at least mild temperature affection may be still farther mitigated.

This however not sufficient to secure against fresh attack on return of winter.

And should we even [wish] dismiss patient cured reckon it by no means improbable that cold weather will bring back complaint.

And perhaps with those who can afford it is of all others the most effective practice to direct their spending winter in a warm climate.

Know few diseases in which change of climate of more material service.

But with one in rank of our patient such a recommendation inadmissible.

And attempts to cure must entirely turn on such regimen & medicines as can here be put in practice.

In this disease great objective in cure is to restore secretion to natural state.

And this unquestionably to be considered as most effective means of preventing accumulation.

Restoration of secretion to natural state must turn on two particulars.

Condition of secreting vessels.

And condition of supply of fluid at these for secretion.

These ends would lead to use of various medicines.

Particularly means of allaying inordinate action & of producing determination from breast.

And on these general principles various practices in common use.

Though such however most effective means of cure yet not always most ready method of obtaining relief.

For this purpose mucus already accumulated must be discharged.

And before can expect to restore natural state of secretion must endeavour that be evacuated as accumulated.

Is with view of obtaining this end that only medicine which have here employed has been used.

That is the Squill pill.

Have little doubt that stimulus of this vegetable after entering circulation capable [of] acting as collected at secretion of mucus, as well as of urine.

In this way indeed may be supposed rather to have bad affects as otherwise in augmenting secretion.

But this more than compensated by augmenting stimulation to excretion.

And have little doubt that in instance before us has thus prevented [accumulation] in lungs when would otherwise have taken place

And to this together with warmer weather would ascribe all relief which patient has had.

If continues in same easy state [should] not probably think of altering plan.

If grows worse may have recourse to emetics or issue.

But am hopeful that in place of these practices may soon venture to dismiss her.