DEP/DUA/1/21/23 (Normalised version)

Kitty Smith

(1779-1780)

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This inclined to ascribe more to season during which this prevails than to any other circumstance.

But whatever might be cause cases which have of late occurred to me more severe than formerly.

Kitty Smith.

One of many patients lately treated at the Dispensary for Pertussis

For this disease, as have already observed in case of James Scott has of late prevailing epidemic, in very general manner.

Have already remarked, that upon whole consider present epidemic to be more mild than former one.

And present case not without hazard.

Occurred with patient at early period of life.

A circumstance in such cases always unfavourable.

For in order to withstand concussion from fits, strength to considerable extent is necessary.

And at early period of life fits of coughing not unfrequently give rise to fatal convulsions.

Hence while with some other diseases of infants even desirable that should be affected at early period of life, with this of consequence that should be late occurrence.

But besides early period of life several other circumstances also unfavourable.

Disease here without any spontaneous vomiting.

A circumstance occurring indeed in severe as well as in slight cases.

Yet when occurring always tends to mitigate disease.

Serves both to shorten severity of fits & to render occurrence less frequent.

Is a symptom usually taking place only after disease of some continuation.

And comparatively speaking very few written in which becomes frequent which have not a favourable termination.

Here however notwithstanding continuation of disease for space of two months had not been observed to occur

And while absence rather unfavourable as otherwise, not less so that after such continuation, in no degree observed to decline

True indeed that affections often of much longer duration where yet very favourable conclusion.

And in place of few months will continue even for year together

Yet long continuation without diminished severity must always be distressing to tender frame.

But if these symptoms unfavourable still greater grounds for alarm in occurrence of febrile symptoms.

For besides quickness of pulse fever here indicated, by heat of skin, bound belly & thirst.

These symptoms are told had commenced only about fortnight before came under our care.

But during that time, till admission on our list had gradually increased.

Well known that in this manner many children particularly in infant state cut off in Pertussis.

And fever perhaps even more dangerous at late periods than before disease formed.

Upon whole therefore was inclined to consider this as being bad case

And reckoned fatal termination more probable than recovery.

In this respect however apprehensions now happily at an end.

For both febrile symptoms & chin cough so much mitigated than now fair prospect of favourable conclusion.

Would not pretend to say that this entirely to be attributed to measures here prosecuted.

At same time cannot help thinking that these had at least considerable share.

Here however am not disposed to attribute this to any one particular remedy but to measures directed to urgent symptoms as this occurred.

This however will more fully appear from remarks on particular practices to which had here recourse.

Will observe that short time before treatment of this case commenced patient had taken a vomit.

And that from this vomit had derived some relief.

Attention therefore to [prevent] naturally indicates here repetition of medicine.

But besides former benefit led to it also from another circumstance.

When patient came under our care breathing will observe remarked to be laboured.

And although may arise from different causes yet here some reason to presume was affect of mucus

For after paroxysm of coughing disease here attended with considerable discharge of this matter.

From evidence therefore of increased secretion presumption that accumulation in breast might be cause of dyspnoea

While emetics then tendency to [relieve] it as producing discharge hoped also that by frequent artificial vomiting disposition to natural might be induced.

Hence then from repetition looked for advantage in different ways.

As means of exciting vomiting here had recourse to emetic tartar.

Must own that in general am disposed rather to give preference to Ipecacuanha.

Especially as means of certainly producing effect, and of exciting full vomiting without danger of doing too much.

With infants in particular however often [choose] rather to employ Tartar

Both as in small doses operates more gently & as from want of taste or smell more easily introduced.

Besides this more influence as tending to operate on intestinal canal & move belly.

And hence, in cases like present where constipation occurs an additional cause of [preference].

With present patient were not disappointed in effects at which here aimed.

For while emetic properly operated considerable mitigation obtained of all symptoms

Not only was affection of breathing removed & all febrile symptoms abated but frequency of cough also diminished

And what to be reckoned perhaps not worse symptom than any of these, appetite before much impeded now considerably mended.

With this favourable change in appearance from emetic matters now in such train that chance of recovery much increased.

Although however inclined to attribute this to vomiting did not reckon it advisable to persist without longer intermittence

And circumstances formerly inducing to employment if not entirely removed now less urgent.

In this situation then resolved to intermit use at least for week.

And during that time to try patient with Cicuta

Use of Cicuta in medicine altogether but of late date.

Formerly ranked among most virulent of the vegetable poisons.

Even with this characteristic however still in frequent use as externally applied.

Dr Stork of Vienna probably first who ventured to recommend internal use.

On his account of efficacy however in scirrhous & cancerous cases, foreign to present purposes, to make any remarks.

May however remark that first introduced & recommended in Hooping cough by Dr Butter of Derby.

Not long after publication of his essay on Kink cough as he calls it had very frequent trial at this place.

And may safely venture to say that most of those who had recourse to it by no means prejudiced in favour of remedy.

For to be observed that whatever might be in Dr Butters practice his reasoning upon subject was what few could adopt.

While at same time publication in many respects an empirical appearance.

As instance of this may mention his representing it as certain & infallible remedy in every case & in very small dose.

But still more his asserting that would not be answerable for effects & would not be surprised at failing if extract prepared by any other person than his own apothecary.

Under those prejudices then not to be expected that practitioners would be disposed to draw more favourable termination than merited.

And from experience of every one who made trial was I believe found that his expectation of efficacy greatly exaggerated.

At same time as generally allowed that had some effects.

And although by no means gives speedy conclusion of disease which Dr Butter contended yet had manifest effect of diminishing frequency of fits.

This many disposed to attribute to perhaps with justice to its effects as a narcotic.

And that narcotic powers considerable cannot be denied.

Has accordingly led to use of other narcotics in this affection.

And now much more frequently than formerly recourse had to opium.

If however cicuta merely operates as sedative here must still be allowed that a peculiar one.

And here as in stimulants, perhaps no two give same impression.

Sedative impression from Cicuta seems to me to have peculiar influence as counteracting inordinate action which takes place in pertussis.

And such I think reason to presume was consequence of employment in present instance.

For although complaint somewhat alleviated before commencement yet after use began gradually to decline.

And while no inconvenience from mixture fits of coughing less frequent than before.

But during use was attacked with some distressing symptoms of which no appearance to [commencement] of affection.

In place of bound state of belly became subjected to severe looseness.

And that too attended with considerable discharge of blood.

These symptoms could in no degree attribute either to the medicine or the disease

And was inclined to consider it as a complication totally accidental.

Probably however connected with discharge of some worms of ascarides kind which at same time took place

But whether looseness brought off ascarides, or presence of ascarides induced bloody stools matter of greater doubt

In this situation thought it most advisable to take measures with view to both.

And while as means of restraining looseness had recourse to Laudanum directed injection of Lime water with view to [illegible]

From situation of ascarides principally about rectum few articles taken by mouth much influence.

And among various articles used in way of injection have found none more efficacious or more safe than Lime water.

Here also hoped that from absorbency & astringent power might have some influence on looseness.

How far operated in latter way perhaps a question.

But in former did not seem to have any influence

Or at least as consequence of use dead ascarides not observed to be discharged.

This however might perhaps have proceeded from none remaining in rectum.

For after use no longer affected with any symptoms indicating presence.

And whether from this practice from Laudanum employed, or from looseness operating as cure for itself, was freed both from bloody stools & from frequency of discharge.

In this situation have omitted injection but continued the mixture with Cicuta.

And am hopeful that as disease continues to decline no farther measures will be necessary.

Although fits of coughing should in some measure remain that will not even be requisite for patient to continue attendance.

Is indeed true that without occurrence of new disease fits of Pertussis after being for some time abated will again return with greater violence.

But if this even should be case have still I think in this instance seen good effects both of Emetics & Cicuta