DEP/DUA/1/27/05 (Normalised version)

Isabel Alexr

(1781-1782)

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Isabel Alexander.

Of this case do not reckon it necessary to make many observations.

Has hitherto been irregular in attendance & if no return of affection shall probably see no more of her.

May however observe that although case apparently not urgent, yet in some instances affection obstinate.

And although temporary removal often easily obtained yet radical cure sometimes very different matter.

Almost only constituent of case inflammation & excoriation of pharynx.

And this are told occurring as effect of cold.

Must therefore consider it as an instance of Angina or Cynanche.

In this disease different species formed from situation of affection.

And even where simple inflammatory affection symptoms from thence [unquestionably] for much diversified.

So that in some instances precipitating affection of Respiration, in other of deglutition.

Yet where affection merely inflammatory & where entirely effect of cold from treatment in no degree varied by situation.

Such obvious appearance however often from other causes.

In some instances from peculiar febrile contagion giving Angina maligna in others from contagion of Syphilis giving venereal sore throat.

Form however in general distinguished by concomitant symptoms as well as peculiar appearance in throat itself.

Particularly by presence of fever & that too of typhoid type.

Of this therefore no suspicion in present case.

Same observations however cannot be made with respect to venereal.

And besides that know nothing of character of patient, two circumstances giving some suspicion of it.

viz Absence of Fever, & long continuation of affection.

Must indeed be allowed that inflamed sore throat from cold, for most part at least with fever

And that seldom continues for space of two weeks in place of two years, period for which this patient has been affected.

Notwithstanding these circumstances however still disposed to take own account of matter

For even independent of reliance to be put on veracity several circumstances against supposition of being venereal.

Has not common appearance of those ulcerations which from venereal causes observed to affect pharynx, palate & uvula.

Is situated back in pharynx where these rarely at least appear.

And there more under form of mere excoriation than of ulcer.

To these circumstances must also add that this not only case of similar kind which have met with in practice.

Have met with more than one instance where inflammatory affection of throat at first unquestionably effect of cold, renewed for long time by every trifling accident.

In these cases very much same appearance as in present.

Am inclined therefore to suspect that in case before us an instance of that affection.

With this view of the disease, from what have before seen, should not be disposed to give unfavourable prognosis.

And think it even very probable, that patient has already given up attendance from present attack of affection being favourably terminated

But although this even the case, can by no means look upon disease as removed.

For from same disposition in parts still remaining, again apt to be renewed, on any trifling cause.

Even by use of proper measures can hardly expect, that this disposition soon completely overcome.

But for use of these, as attendance of patient hitherto very irregular, probable that opportunity will not here be afforded.

May only remark, that in treatment of this case, two objectives naturally present [themselves]

1 The removal of inflammation & excoriation, which was present at time when came under care.

& secondly removal of that disposition, in consequence of which from every slight accident, patient exposed to return of affection.

First of these intentions hoped might soon be accomplished in consequence of natural convalescence.

But imagined also that might here be somewhat forwarded by gently astringent mixture.

For to be observed that inflammation in such cases often accompanied with laxity of vessels.

And as in some instances of Ophthalmia, removed from these being [braced] up.

With this intention, had here recourse to a gently astringent gargle.

Of this, you will observe, that basis was infusion rosarum.

This formula, derives name & [elegant] appearance from rose leaves.

But from these although some yet very little of medical quality

Astringent which its principle power is derived from vitriol acid

And this in certain state of dilution one of most powerful astringents of Materia Medica.

In ordinary state however considered as rather too strong to be immediately applied to a part somewhat excoriated.

And was merely with view to dilution that here employed in conjunction with equal parts of Hysop water.

That however might be more attached & applied, from some degree of adhesion, added small quantity of [mixture] of Gum Arabic.

By this addition, am inclined to think, that where infusion Rosarum indicated as a gargle, have often seen it product of greater advantage, than should have otherwise expected.

And in similar manner, I think is also useful addition, in cases of venereal sore throat, where gargle of Corrosive Sublimate employed.

Infusion Rosarum you will observe is one of new names in Edinburgh Pharmacopoeia¹.

But not to be considered as New [form]

For in reality nothing different from Tincture [illegible] of former edition.

All ingredients & even preparation of these still precisely same.

One change indeed made in mode of preparation.

For acid which formerly mixed with boiling water, now only added after infusion completed.

And this unquestionably an improvement, as well indeed as change of name.

For mere watery infusion could with no propriety be styled a Tincture.

If from use of this gargle, present affection of throat should have been removed, was intention still to have continued it, with a view of strengthening parts.

And at same time to have put patient on use of Peruvian Bark.

What however has been affect, as patient has not attended regularly have not been able to learn.

And now presumption that may not see more of her.

But if does return, unless circumstances [altered] shall still think of prosecuting [same] [illegible]

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.