DEP/DUA/1/24/02 (Normalised version)

William Robinson

(1780-1781)

---

William Robinson.

When case of this patient at first introduced into register¹ at some loss with regard to disease.

From method of attack so suddenly during night.

From singular difficulty of breathing.

And from peculiar noise with which attended some grounds for suspecting, a disease often suddenly fatal in this country viz. Croup.

An affection respecting nature of which many disputes.

For while some consider it as spasmodic & refer to head of Asthma, others as strenuously contend, that of inflammatory kind, & refer to genus of Cynanche.

But whatever may be difficulty as to nature, none with regard to diagnosis of affection.

Such distinguished from other affections by peculiar croaking sound in inspiration.

Of this however practitioner must always judge, rather from having himself heard it, than from any description.

When patient brought to us [although] peculiar hoarseness still remained, yet nothing which could be called croup.

And indeed no more than frequently observed in many catarrhal affections

From trusting to description alone then could not here speak with certainty.

And indeed from event, is now more than probable, that even from beginning no attack of Croup.

Cannot it is true positively assert that such is the case.

Croup may have existed [though] Chin cough has since succeeded.

For now no doubt that this the disease to which patient at present subjected.

Well known that chin cough often begins in forms very different from what called regular state.

And though not distinctly marked at beginning yet even then some presumption of it from the disease then prevailing among neighbouring children.

At present no doubt with regard to disease

Distinctly marked both by appearance of fits of coughing – by kink or back draught - & by succeeding [vomiting]

Must hold chin cough therefore to be only affection to which observations either on Prognosis or Practice to be applied.

With regard to termination cannot at present speak with great certainty

Several circumstances in the case rather unfavourable as otherwise

Patient from beginning affected with considerable degree of fever.

And although disease newly formed, that fever rather increased than diminished.

Fever however, next at least to inflammatory affection of breast, reckon most dangerous appearance.

And not unfrequently a fatal conclusion.

Besides this age of patient unfavourable

In case of some other epidemic contagions, is of consequence that patient should be affected at early period.

But with this disease on contrary is a material circumstance that before attack, patient should have constant vigour.

And much more fatal in early infancy, than at any other period.

With our patient therefore still in second year, more to be apprehended than if farther advanced.

But if these circumstances unfavourable, others again of contrary nature.

Now disease is what is called distinctly formed.

And after this, at least danger of inflammatory affection of breast less, than before it

Besides this another particular still more in favour of our patient.

That is ready termination of fits in vomiting

When this occurs, has in general effect of putting period to fit, without distressing patient.

And of all symptoms in chin cough, is in general reckoned one of most favourable.

In so much that after this vomiting once begins, with many, danger of chin cough is thought to be passed.

Although far from being of this opinion, yet look upon it as a favourable circumstance.

And would fain hope that with proper management disease may be overcome.

For this purpose however will not probably be in our power to employ remedy, with that regularity which could be wished.

For patient confined to home at commencement of disease, & has within these few days been removed to country at some distance from Edinburgh.

Such removal a practice from which am inclined to think more good affects may be derived than from any thing we can do.

Here however benefits by no means to be attributed to freer & purer air, but to change of air & situation.

And may again be benefited by removal from country to town.

Advantage in both cases manifestly from immediate influence in diminishing frequency of fits.

On this therefore whatever may be principle on which operates am disposed to place some confidence in present instance.

At same time advantages derived from it may be increased from conjunction with other measures.

And these may be directed as occasion requires either with view to obviating particular symptoms, or to radical removal of disease.

Was with first of these intentions that directed measures, when began treatment of this case.

Then indeed was not certain of the affection.

But whatever the disease, could be no doubt that symptoms aggravated by bound state of belly.

As means of obviating this therefore had recourse to gentle laxative.

As such employed Tincture of Jalap combined with simple syrup.

Use of this mixture as purgative for children, was first taught by one of those gentlemen who inoculated at this place in conjunction with Mr Sutton

And have found it by experience not merely useful in Smallpox, but one of most convenient cathartics in almost every case with infants.

In present instance expectations were not disappointed

For by this means easy discharge by belly was readily procured.

While at same time from blister also obtained all effects that could be wished.

In this situation however urgent symptoms being removed, reckoned it advisable to employ some measures with view to artificial termination

As such have here had recourse to Cicuta.

Cicuta of late highly extolled as certain cure for Chin cough by Dr Butter of Derby.

And although can by no means subscribe to all praises which he bestows upon it yet think very favourably of it.

And is I think, particularly where tendency to costiveness, in many respects preferable to Laudanum.

In order however to reap advantages must I think be given in larger dose than done by Dr. Butter.

And these advantages more affectively obtained by exhibiting in powder than any other form.

In this case however something farther required to give form.

For this purpose have directed Mercury in hopes that will at same time tend to keep belly easy.

On this medicine, in as far as patient can be object of practice is intention to keep him till have at least fair trial of effects.

And hope that may afford us some evidence of virtues of the medicine.

If however after fair trial disappointed still another measure which have in view with this patient.

On this authority have myself oftener than once employed it.

That is the use of Vitriol Aether.

This, as far as I know at least, still a more recent practice than the Cicuta.

For a long time indeed, different antispasmodics Caster, Opium etc in use.

There was therefore natural [analogy] for employment of this most powerful.

But never either saw of indeed heard of its being employed in this disease till used last spring by my Colleague Dr Webster in some of his Dispensary patients.

And with such advantages too as are at least sufficient to encourage to future trials.

If therefore shall be requisite will here employ it.

May however be first necessary to employ other measures with view of obviating such occurrences as may take place.

Of these however cannot at present say anything.

---

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.