DEP/DUA/1/14/06 (Normalised version)

Ann Monro

(1777)

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Ann Monro.

Another patient who as well as former, probably subjected to a disease which has been subject of remarks in former case.

Like last patient also have seen very little of her since first applied for our aid.

And from this circumstance in a case which in several respects doubtful can speak with less confidence.

Must however from slightest perusal appear that this patient subjected to many of same symptoms which occurred in case of Kath Hally.

Here also principle complaints cough & dyspnoea.

And these attended with expectoration at least somewhat augmented in quantity & more viscid than natural.

Presumption therefore that state of [illegible] principle cause both of cough & dyspnoea.

That is that affection catarrhal.

And when had already continued for space of thirteen years no doubt in considering it to be of chronic nature.

Here however evidently did not occur as a simple or uncomplicated affection.

Can hardly indeed consider vomiting as of itself indicating disease of stomach.

For well known that may be excited merely by irritation of fauces.

And that in this manner often [induced] by severe fits of coughing.

But then discharge which takes place either merely contents of stomach which have been employed as aliment.

Or there take place only, efforts to vomit without any discharge.

With present patient however are told vomiting accompanied with discharge of watery fluid.

And besides indication of affection of stomach which this affords have farther evidence of it in flatulence with which affected.

These then would lead to suspicion of debilitated state of alimentary canal.

But besides these symptoms another [giving] still greater difficulty.

That is profuse sweating to which subjected

This we are told has returned periodically every [morning] for space of between three & four years.

With regard to this sweating must own am not a little puzzled.

No reason to hope that can by any means be considered in light of critical evacuation.

And well known that colliquative sweats a frequent occurrence in diseases of worst tendency

Are particularly common especially affecting patients towards morning in cases of Phthisis

And this well known to be in its nature a disease highly insidious.

Will therefore have always additional reason for suspecting it where such sweatings the attendant of cough or other pectoral complaint.

And to all this may add that with this patient circulation greater than natural.

But notwithstanding these circumstances think that in this instance may venture to [promise] against supposition of phthisis.

Besides that many symptoms of Phthisis wanting, consider continuation of affection alone as an unsurmountable objection.

Colliquative sweats as well as diarrhoea generally an occurrence towards close of disease only.

With our patient however as already observed had continued for space of above three years.

And cough had subsisted for no less than thirteen

Can hardly however suppose that either vomica or tubercle would have continued so long without proving fatal.

Upon whole then would not here consider it as in any way symptom from cough.

And that cough may be easier where last is a circumstance which may suddenly happen without their having any [apparent] connection.

And must own that rather inclined to consider this in light of a distinct affection

That discharge by surface may suffer morbid increase cannot be [refused].

And when does so is observed to be product of loss of strength diminishment of appetite & similar affects.

Can see no reason then why should not as well as other [increased] discharge be considered as constituting an idiopathic affection.

And accordingly find that although not adopted as genus by all nosologists¹ yet [enters] some of best [systems].

Particularly those of Sauvages & Linnaeus.

Latter distinguished by title of [ suder] former of Ephidrosis term employed by Hippocrates

Under genus of Ephidrosis of Mr Sauvages many different species are comprehended.

And indeed may be supposed to arise from all variety of causes either increased force propelling blood to surface or diminishment [illegible]

For with certain [balance] sweating [must] occur.

From what particular cause took rise in present case totally at loss to conjecture.

May therefore I apprehend with greatest safety refer it to species which Mr Sauvages distinguished under title of Spont.

Informs us that had met with several instances in which took place to great degree for considerable length of time without any obvious cause

And although here other affections present yet none which could reasonably presume immediately connected with it.

Must however be allowed that [of] this are in many cases very inadequate judges.

And another peculiarity in case before us which [whatever] might be mode of operating was not improbable foundation of all complaints.

That is condition of menstrual discharge.

Patient but forty five years of age a period at which menses not usually [stymied]

With our patient however had not appeared for space of thirteen years.

That is had left her when little past thirty

And from that period dated commencement of principle complaints particularly cough & dyspnoea.

To be observed also that obstruction did not ensue without evident cause.

But how far was affect of [labouring] [illegible] of cold to which exposed during this, or of conjoined influence of both immaterial to determine.

May presume that whatever cause, [indeed] change of circulation affected lungs.

And that thus gave rise to catarrhal affection which has continued ever since.

Morbid discharge by sweating indeed of much more recent date.

Yet not impossible that may have operated as cause of this also.

But in what manner cannot pretend to say.

With this uncertainty respecting nature of the disease will not be expected that should be very decisive in opinion as to Prognosis.

Even in most alarming symptoms see nothing which can give reason to dread immediate danger.

And equally little reason in a [complex] & obstinate affection to look for speedy favourable termination.

Especially as while so much at loss respecting nature of disease must necessarily be so as to [practice] to be followed.

And therefore less grounds to hope for artificial termination of affection.

When began practice with this patient must own that by no means determined as to plan of cure to be followed.

And in this was intention to be chiefly directed by effects which should observe from medicine.

Here exhibited the vomit with intention as far could of unloading breast.

For if except coughing itself no means more immediate as promoting expectoration.

From this therefore hoped that might at least obtain temporary relief both to cough & breathing.

And was in expectation of some good effects as preventing return from use of Peruvian Bark.

For if consider great cause producing catarrh to be augmented secretion of mucus cure must unquestionably depend on restoration to natural state.

And if Peruvian Bark capable of [restoring] excessive discharge of mucus from other parts of system may unquestionably have same influence on secretion by lungs.

That does possess power however of [restoring] mucus discharge is I think incontestably proved by good effects in Gonorrhoea.

And on this ground have frequently suggested it in chronic catarrh although must own that hitherto have employed it but little.

Cannot be [refused] that although in some respects promises good effects in others a doubtful measure.

And utility as moderating secretion may be more than counterbalanced by bad effects as restraining excretion.

This then an objection to use in ordinary cases

But in instance before us an additional argument to employment.

That was profuse discharge by sweating [which] here occurred.

Although this temporary relief to cough yet to be considered as exhausting habit.

Looked upon it therefore as objective [claiming] attention in cure.

And as well as other excessive discharge considered it to be one which might be restored by use of tonic.

How far however Peruvian Bark had good effects either on this or other part of affection have not been able to learn.

To which future practice therefore might have directed us cannot pretend to say.

Ann Jeffrey.

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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.