DEP/DUA/1/21/07 (Normalised version)

Ann Hossack

(1779-1780)

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Ann Hossack.

A case with regard to which as introduced into register¹ many difficulties may be stated.

Have selected it not so much as subject of practice from which can hope to derive success as affording example of doubts & uncertainty which every day occur to [people] in practice of Physic.

Symptoms with which at present principally affected Dyspnoea & cough.

And these attended with expectoration of viscid white matter to considerable extent.

Such symptoms in common to catarrh & to Phthisis.

And naturally led to adopt one or other supposition according to other concomitant circumstances.

Here when history of case at least taken patient not affected with any symptoms indicating hectic fever.

Pulse not quickened a circumstance at least very commonly occurring in Phthisis.

Belly with constant tendency to bound state, the opposite of that condition occurring in Phthisis.

And while mucus accumulating in breast a sufficient cause for weight & oppression for dyspnoea & cough would seem that matter expectorated of no other kind.

Have not indeed had yet opportunity of trying it by those tests which reckon to afford criteria between matter & mucus.

But from quantity alone presumption of this.

For while to considerable extent, disease had not been preceded by any of those marks which could lead to supposition of vomica.

And matter spit up neither the disagreeable smell nor taste of purulent expectoration.

To these farther argument against Phthisis from state of Tongue.

Observed indeed to be moist.

But without that peculiar clean & red appearance which has uniformly in Phthisis from purulent expectoration.

Notwithstanding all these circumstances however reckon it by no means certain that Phthisis is not the disease.

To this latter opinion, of the two am even the most inclined.

More indeed from former knowledge of patient than from any of present symptoms

This woman some months ago, long under my care for a disease apparently very different from present.

Then affected with several very large indolent swellings of neck.

These was disposed to consider as being affection of Lymph glands & of scrofula nature

With view however to promoting circulation through them & thus obtaining resolution had recourse to Cicuta.

And I think with very remarkable success

For from time that began use tumour gradually began to diminish.

And during course which continued for three months got entirely rid of them

This indeed it is true conjoined with use of camphor oil externally rubbed on tumour.

Am far from thinking that this application entirely useless.

Yet to the Cicuta am still inclined to attribute greatest part of cure.

But to whichever owing, under these means patient had apparently complete recovery.

Are not however from thence positively to infer that disease eradicated from [constitution]

And from former occurrences, scrofula habit so far marked as to give suspicion in [future] [ailments]

Well known however how much has tendency to induce Phthisis as giving rise to tubercules in lungs.

This even so much the case that some inclined to consider all instances of Phthisis as arising from Scrofula.

And although in this consider them as wrong, yet no doubt in viewing it as a very frequent origin.

Particularly therefore to be suspected where former indications of scrofula.

When to these circumstances add insidious nature of Phthisis presumption by no means weak

And have seen so many instances where Phthisis thus made gradual approach that am very apprehensive present will afford another example.

Still however consider nature of disease at present as one of those doubtful points to be determined only by attendance to future progress.

But besides principle disease, other circumstances also in case with regard to which equally at loss to give decisive judgement.

And this particularly case with menstrual discharge

Has now seen nothing of it for 3 months.

Is however a married woman & in course of child bearing

Is therefore a very probable supposition, as she herself suspects that maybe affect of Pregnancy.

To be remarked however that taken by itself gives no certain indication of this.

And till more certain evidence of pregnancy from motion of child, must remain in doubt whether does not take place as a morbid symptom.

Here also to be observed in Phthisis frequently symptom

And when occur always indicate great danger.

Probably as indicate highly debilitated state of system.

But even allowing that this not symptom of Phthisis but of pregnancy, still does not follow that Phthisis does not exist.

For this by no means uncommon.

Is indeed true that during pregnancy other diseases more rare.

And observed that fewer women die in this state than at any equivalent period of life

Holds even with respect to Phthisis as well as other affections

But when pregnant women subjected to this disease, progress after delivery extremely rapid.

And such am apprehensive may be case with present patient.

Although do not consider pregnancy as giving succour against affection yet hope that during this period may not be cut off.

Yet can hardly flatter ourselves with hopes of recovery.

If however disease catarrh merely may look for more favourable termination.

And either during course of pregnancy or after it, reason to hope for recovery.

Here however to be observed that although disease merely catarrh, & although patient confines herself to house, much against speedy [cure]

While at same time from violence of cough every pregnant woman subjected to no [illegible] danger.

Even on this supposition therefore reason to apprehend danger & to dread a tedious affection.

And although where so many uncertainties cannot speak with confidence yet in no view of the disease can I consider it as slight, or free from hazard.

If uncertainty as to nature some doubt in prognosis, gives still greater with respect to treatment.

Here however whether Phthisis or Catarrh general plan of cure to be followed in great measure the same

When cure does happen in Phthisis is chiefly at least work of nature.

And utmost done by practitioner is to alleviate or obviate symptoms

Alleviation chiefly to be expected from diminishment of impetus of circulation at breast

And from counteracting influence of [illegible] causes exciting cough.

On these principles also may expect alleviation of catarrh.

And in situation of present patient perhaps nothing farther can with prudence be attempted

These therefore foundations of practice hitherto employed.

And unless from alteration in symptoms of disease, or from farther knowledge of nature, shall probably continue on same plan.

Began by putting this patient on use of two different medicines.

Cream of Tartar & Mucilage Mixture.

First hoped might be of some service from influence as refrigerant.

As thus from tendency to diminish general impetus of circulation hoped that might lessen momentum at breast.

But chiefly led to it as means of obviating costiveness.

Among other symptoms will observe generally bound state of belly.

From counteracting this therefore not only remove cause of irritation but give also determination from Thoracic to abdominal viscera.

Should not indeed have wished for any considerable discharge by belly with patient so much exhausted.

But this not to be expected from Cream of Tartar to extent of single dram.

Nor was such observed to be consequence of use - But from another circumstance led to intermit use.

Patient complained very much of being distressed with sense of cold.

Although therefore thought that derived benefit from Cream of Tartar yet as imagined might aggravate this symptom wished to see how would continue without it.

On this account has for these two weeks past been continued on mucilage mixture alone.

From this principle objective in view is to take off irritation as merely lubricating fauces.

Although held also that basis of it, the Gum Arabic acts as demulcent from [entire] system & being again collected at [excretion].

Under such gentle measures shall probably continue patient till present doubts in some measure removed

And if pregnancy ascertained will still the rather be inclined to persist.

Recommend to her at same time use of mild & nutritious diet & avoiding cold.

If not pregnant should wish here to give fair trial to Emetics frequently repeated

A remedy on different principles useful both in Catarrh & Phthisis

And indeed of late recommended also in cases of Scrofula, from whence if Phthisis exists in present case suppose it to originate.

Whether pregnant or not may have occasional recourse to blisters or anodyne.

As from both reason to expect temporary alleviation of cough

Thus at least may alleviate distress of patient

Without however any progress to radical cure

And if apprehensions well grounded, this I am afraid hardly to be looked for.

Still however during course of attendance here, shall by these already proposed or such other means as symptoms may [indicate] endeavour to relieve her complaint.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.