DEP/DUA/1/24/06 (Normalised version)

Margaret Ainslie

(1780-1781)

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Margaret Ainslie

Disease of this patient consists of set of symptoms very commonly met with in this country particularly during winter season.

And I think constitutes a disease which though may not have place in nosologies¹ should enter practical systems.

I mean chronic catarrh.

An affection which both in appearance & method of cure very different from catarrh in acute state.

Here most distressing symptoms to which patient subjected severe cough & dyspnoea.

Can however be little doubt that both one & other effect of that [material] which separates from lungs.

And this we are told expectorated with difficulty under [form] of thick viscid mucus

Such a matter lodged in [illegible] [ramification] of bronchia & in air vesicles of lungs must prevent ingress & egress of air thus giving rise to dyspnoea.

While again from irritation, cough a natural consequence.

And severity, from that difficulty with which the matter, in consequence of viscidity is discharged.

If matter expectorated then entirely mucus, no doubt with regard to disease.

But at same time this not certainly the case.

And by no means impossible that though principally mucus, may yet contain mixture of pus.

If this the case must view it as much more dangerous disease.

And have not yet had opportunity of having recourse to any test by which certain determination can be formed.

On this subject many proposals such as swimming in water – smell in burning etc on which formerly [reliance] put.

But now fully demonstrated that none of these on which dependency can be put.

Of late another test proposed by means of caustic alkaline lixivium.

Said to be solvent of mucus even in most viscid state, while again renders pus more viscid.

For this test are indebted to the late ingenious Mr Darwin.

And although all who have tried it not agreed as to result, for own part disposed to think it a certain criterion.

But to such test in present instance have not had opportunity of having recourse.

From symptoms of case however should be inclined to conclude that still merely catarrhal.

Some evidence of this from quantity of expectoration.

For at least certain, that considerable proportion mucus.

Still more from period at which cough most severe, & expectoration most difficult.

viz in morning after collected during night, & when from absorption viscidity increased

But most of all from recurrence in cold weather during successive winters.

These are particularly serving in great measure to characterise Chronic catarrh.

While again very rarely if ever holds with respect to Phthisis Pulmonalis

And in particular after patient once affected with it to considerable degree, but rarely that [recovers] to give opportunity for future attacks.

Upon whole then, conclude patients disease to be merely catarrh.

And from continuation both in present & former years no hesitation in pronouncing it Chronic

From this view of affection must pronounce it less dangerous than if much grounds for suspicion of Phthisis.

And especially favourable for patient that yet at an early period of life.

For although disease not unfrequently fatal yet is chiefly at advanced period.

And accordingly in greater part of practical systems has name of Catarrh Senilis.

Prospect therefore of patient being cut off by it under this form still very far distant.

To be observed however that another way in which may prove more suddenly fatal.

Although at present conclude that no Phthisis yet may soon occur.

For hold degeneration of inveterate catarrh into Phthisis to be less rare than commonly imagined.

At same time hope that by proper means, this also may be proved

And flatter myself that at length affection may be alleviated, if not removed.

For this purpose chief intention of cure in first place to discharge or facilitate discharge of mucus already secreted & accumulated.

But in second still more important objective to restore action of secreting vessels to natural state.

Is with view to these intentions that have employed measures already directed.

Began by directing application of blister between shoulders.

Such a practice useful not merely by discharge but as giving alteration in mode of circulation.

Is thus I apprehend that often [serviceable] in relieving different affections of breast.

And whatever by principles on which operates no doubt that in these often attended with very great benefits.

Accordingly in present instance on first application while discharge continued both cough & dyspnoea considerably relieved.

But besides blister at first also recourse to another measure.

Use viz of Mistura Oleosa

Of this need not observe that basis oil.

And on this basis consider whole activity of the formula as depending

Few stomachs however particularly in this country that can bear vegetable oil for purpose of medicine by itself.

Hence requisite that should be diffused in water.

May be effective in many different ways

Often in particular by vegetable mucilage.

But perhaps no form better than union with water by means of alkaline with addition of small quantity of sugar.

And this the form under which was here exhibited.

May seem that such a demulcent better fitted for recent than advanced state of catarrh.

And no doubt that chiefly [influential] as taking off irritation in fauces

Was with this view that here directed.

For notwithstanding what have said as to period of disease & state of mucus here reason to suspect that in part also proceeded from irritation at fauces.

At least was inclined to think that from this in some measure proceeds severity of cough when first went to bed.

While therefore blister intended for preventing farther accumulation in lungs, this meant for taking off irritation.

And hoped also that from use might be freed from inconvenience [which] blisters sometimes occasion, as exciting affection of strangury kind.

On this course then have continued patient.

And on second repetition of blister have directed that discharge should be supported under form of issue.

But besides this from circumstances mentioned in last report, led also to another measure.

Use viz of Nitre combined with Gum Arabic as in case of James Ingram just mentioned.

For here also will observe that patient has had some bloody expectoration.

Am however inclined to consider it as merely of passive kind & depending on severity of cough.

Hope therefore especially if shall be able to mitigate cough that no other measures will be necessary.

And after what just said of Nitre with Gum Arabic need add nothing farther.

For some time longer shall try patient with issue & demulcent

But if these unsuccessful have next thoughts of having recourse to emetic & expectorant.

Particularly Gum Ammoniacum or Squills.

At the same time must observe that more to be expected from [temperate] weather or from proper defence against inclemency than from any other measure.

This therefore must strictly enjoin

And indeed from this circumstance attendance here rather unfavourable as otherwise.

If therefore mitigation produced by means already suggested, shall be less [amp] considerable distance for recommending continuation of attendance.

If not must be directed in future course by state of complaint at the time.

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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.