DEP/DUA/1/24/12 (Normalised version)

Mary Watt

(1780-1781)

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Mary Watt

Case of complicated nature.

And affections not altogether depending on each other.

At same cannot venture to say that altogether unconnected.

Principal part of complaint and what at present most distressing is pulmonary affection.

viz Severe cough & difficult Respiration.

And when consider quantity as well as quality of matter expectorated little doubt that the effect of secretion into lungs.

Hence as already observed of other cases to be denominated Chronic catarrh.

At same time reason to presume that both cough & dyspnoea in some measure also supported by another circumstance.

Affection viz of alimentary canal which here takes place

This complaint at present consists chiefly of borborygmi & eructation.

Circumstances evidently indicating preternatural flatulence in alimentary canal.

This in systems of greater part of nosologists¹ considered by itself as a disease

And according to Mr Sauvages defined in following manner.

Est morbus cujus praecip sympt. est flatuum ex primis viis per super aut inferiora rejectio frequens

This indeed by Dr Cullen viewed only as a symptom of Dyspepsia.

And must be allowed that seldom takes place without other symptoms indicating [depraved] condition in function of alimentary canal.

Also little reason to doubt that in every instance ultimately depends on this.

Hence then inclined to think that with propriety referred to Dyspepsia.

Yet when other symptoms characterising that affection are wanting some advantage from giving it particular name.

Hence then would here denominate [affection] of alimentary canal to which patient subjected to be instance of Flatulentia.

And among different species which Mr Sauvages has included under this genus no one to which can with greater propriety refer it than Flatus Lochialis.

For great reason to suspect that supposition of patient well founded as to originating from delivery of dead child.

This affection according to history given of case commenced with patient no less than five years ago.

And during that time has always been subjected to it to greater or lesser degree.

While catarrhal symptoms on other hand neither of so long duration nor so constant.

Cannot therefore suppose Flatulence depends on these.

But on other hand reason to presume that flatulence may have some effect both on cough & dyspepsia.

For well known that cough in many instances entirely from irritation of abdominal viscera.

And from none more frequently than stomach

Equally certain that distention by Flatulence very great effect in preventing descent of diaphragm

Hence one of most common causes of Dyspnoea

Reason therefore to presume that both cough & difficult respiration in some degree supported by it.

But at same time no reason to conclude that entirely or even principally from this cause.

For while these constant this only at particular seasons.

And from aggravation during winter as well as from state of expectoration no doubt of being at least principally catarrhal.

Upon whole then may be considered as subjected to two distinct diseases.

viz Catarrh & Flatulence.

From this combination more uncertain with regard to prognosis.

And judgement to be given of different parts of affection not precisely the same.

Of the two hold the catarrhal affection to be most immediately dangerous.

For while this frequently fatally terminates Flatulence though very distressing is [rarely] so.

Or at least only fatal in consequence of degeneration into other diseases such for example as Tympanites or the like

But while esteem catarrh most dangerous affection, nothing alarming in instance before us.

Though some thirst yet has not excited what can be called fever symptoms

And by no means in very debilitating state

Reason therefore to hope that on return of warm weather will be relieved as formerly.

And that this may be facilitated & promoted by measures to be employed.

At same time with this patients rank & situation in life every mode of cure employed with great disadvantage.

And if weather should become more intensely cold cannot even be surprised at aggravation of affection.

At same time greater expectation of benefit in this part of complaint than in case of flatulence.

For although look upon it as less dangerous now reason to apprehend that shall find it more obstinate.

Has already resisted different means of cure

And notwithstanding every attempt has continued obstinately for space of five years

The rather to be expected on present occasion as now catarrh most urgent complaint.

And to this attempts to be first & principally directed.

This will more particularly appear from view of practices employed with this patient.

When first came under our care, [began] by directing use of Emetics.

This will readily suppose solely intended against catarrhal affection.

Have already had occasion to observe in more than one instance, that of all the tribe of expectorants none more useful than Emetics

And while in such instances of catarrh serviceable as discharging mucus accumulating in breast farther of use as tending to diminish secretion.

For in this way considerable influence in consequence of determination to surface.

Operation of vomiting however consider as being rather unfavourable as otherwise, to affection of alimentary canal.

For can be no doubt that by frequent repetition of such strong action, tone very considerably diminished.

Was necessary therefore to take some measures, as means of counteracting influence.

But besides this urgency of complaint of alimentary canal, even of themselves required some aid.

And to these principally at least, other prescriptions at same time with the vomit was chiefly directed.

I mean the pills the basis of which was the foetid gums.

For to this class the Gum Ammoniacum has been, & I think with propriety referred.

Was however here conjoined with one still more powerful viz Assafoetida.

Efficacy of this article from action on alimentary canal well known.

Can be no doubt that has remarkable influence both as inducing action tending to expulsion of wind, & as removing spasmodic stricture by which retained.

Hence has been long & justly considered as one of most powerful carminatives.

Possesses however such active power that can with safety be given only in small doses.

And while this one reason for conjoining with Ammoniacum had farther in view the obtaining from latter some effect as expectorant.

For by many of most observant practitioners has long been considered as having effect in this way.

And, I am inclined to think, with good reason.

Hoped therefore that pills might be both useful against flatulence, & catarrh.

And while vomit afforded immediate relief expected that by pills benefits then obtained might be secured.

Imagined also that would counteract effects of emetic on stomach, & that might relieve patient in another way viz as obviating costiveness.

Cannot however say, that from use, expectations in these different particulars by any means answered.

In obvious operation of vomit indeed were not disappointed.

And according to account given us Cough & Dyspnoea for short time somewhat alleviated.

From pills also had at least satisfaction to find that patient suffered no inconvenience.

But notwithstanding use cough & dyspnoea soon recurred again with same severity as before.

An evident proof that secretion not diminished & that secreted matter no less disposed to be accumulated than before.

Were also disappointed in effects expected from them as promoting discharge of wind.

For at succeeding report found that patient had derived no relief either from borborygmi or eructation.

And although taken to extent of scruple² in day had no effect in keeping belly open.

Notwithstanding these disappointments however thought it at least advisable to make trial of repetition for another week.

Accordingly with continuation of pills, ordered also repetition of emetic.

Second trial however had not same influence as first.

For from this notwithstanding free operation of emetics, no alleviation either of cough or dyspnoea obtained.

And from pills no influence either in moving belly or counteracting unease from flatulence.

From these considerations then was led to think of trying some other course.

Or at least with same intention of trying effect of other remedies.

In place of emetics therefore, as mean of obviating cough & dyspnoea had recourse to blister.

And with view to flatulence costiveness & other affections of alimentary canal gave assafoetida conjoined with aloes.

Former article still continued with intention already mentioned

And latter now added as more effective means of moving belly.

While from blister expected relief of cough as giving determination from breast.

And was intention to render this change in circulation more permanent by [supporting] discharge under form of issue.

Effect of first application of blister was discharge as copious as could have expected

And to this may I think reasonably ascribe alleviation of Dyspnoea & Cough which at same time took place.

From pills in operation as moving belly, were not disappointed.

For had in general two stools & these rather loose as otherwise in space of 24 hours.

And what to be considered as a [matter] of more consequence under use Borborygmi & eructation less [distressing].

On this course therefore patient has now been continued for space of two weeks longer.

Cannot however say that progress to cure has been considerable.

Or even that patient continued to derive from practice same relief as at first.

This however in as far as respects cough & dyspnoea am inclined in some measure to attribute discharge not being duly supported.

And from this led again to order repetition of fresh blister.

Must however observe that from present course after trial which has already had expectations not now [sanguine]

And if do not find patient soon derives more considerable benefit from it shall think of changing for some other [manner]

At same time know none from which to expect equal advantage against cough as from Emetics & Blisters.

At least nothing more effective unless were in our power to send her to warmer climate

Or what next to that affording her warm clothing & comfortable lodging in this country

And from latter of these circumstances must observe that in some respects more proper for hospital than Dispensary Patient.

Here however must content ourselves with aiming at that relief to be obtained by medicine.

And if at present think of alteration shall next probably have recourse to Garlic

And as most convenient form shall exhibit it in state of Pill ex Allio.

From this some hopes of good affects both as relieving cough & dyspnoea & likewise as counteracting flatulence.

But upon whole more to be hoped for from change of season than any other circumstance.

If cough alleviated, with respect to stomach complaint & flatulence many different measures may be tried.

Particularly vegetable bitter, & aromatic infusion.

But [there] in some measure [contrary] [indication] till alleviation of cough & dyspnoea can be obtained.

And if that shall be effected [future] plans then to be accommodated to circumstances of case 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.

2) A unit of weight equal to 20 grains, used by apothecaries and physicians.