DEP/DUA/1/27/10 (Normalised version)

Margaret Proudfoot

(1781-1782)

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Margaret Proudfoot.

Complaints of this patient evidently not all connected with each other.

And whether to judge from state of symptoms when came under care or from origin & progression of these can have no hesitation in pronouncing that affection of throat & stomach unconnected.

To latter has been subjected for several years.

But although not to be disregarded yet less alarming to her than affection of throat.

Was on account of this principally that applied for assistance at the Dispensary.

And was with view to it, that selected her as subject of lecture.

For affords in my opinion an instance of that affection not without singularity.

Evidently cannot be referred to any of five species into which the genus of Cynanche divided by Dr Cullen.

Nor do I think even, that with strict propriety can consider it as example of any of 15 species referred to this genus by Mr Sauvages.

Yet in as far as disease characterised by pain & heat in throat with difficulty of deglutition have unquestionably the characteristics of that affection.

And if affection were not so deep seated should also have those of tumour redness & perhaps likewise of ulcer.

Here however affection deeper seated than visible from inspection of fauces.

And began also in very different manner from what commonly the case.

First commenced under form of external tumour, not very distant at least from place where at present most pain internally.

In proportion as this began to disappear internal affection aggravated.

Such a succession however well known to occur in cases of many glandular effects.

And from remains of obvious tumour when patient came under our care had appearance of being of that nature.

May therefore with probability conclude that similar glandular tumour seated internally.

And on such a supposition all symptoms of this affection may I think be readily explained as far as respects complaint of throat.

Difficulty of swallowing, pain & other circumstances, necessary consequences of situation & nature.

While throbbing sensation well known to be constant concomitant of suppuration going on, in such tumours.

And great reason to presume that before patient came under our care not only some suppuration but even actual rupture of it had taken place.

Of this at least strong presumption from bloody discharge which had taken place.

And while viscid matter, expectorated under form of mucus, which she thinks comes from affected part of throat, probably contains mixture of pus.

This then opinion as to affection of [illegible] when patient came under care.

And what have since had occasion to learn tends still more to confirm that conjecture.

For during treatment in this place affection of throat for some time rather aggravated as otherwise.

And that too with augmentation of throbbing sensation indicating, tendency to fresh suppuration.

This however again very considerably relieved.

But did not take place till after a considerable discharge of blood, which again according to feelings of patient, came from affected part of throat.

In all probability therefore arose from some rupture of small vessels there

And whether attended with any purulent discharge or not, certain that might here afford diminishment of pain & swelling in same manner as topical bleeding.

Hence then consider this appearance as in some measure corroborating former opinion.

With this idea of nature of disease may readily suppose, that could not entertain hopes of speedy & favourable termination.

Entire resolution & removal indeed of such glandular swellings, even without interposition of art, could by no means be considered as extraordinary.

But much more frequently the case that continues obstinately for great length of time notwithstanding use of most powerful medicines.

Very common also to find it, in such instances, alternately declining & increasing, without any obvious cause.

Here from what had already happened reason to suspect that this might be case.

And after having already continued for space of two months had no reason to imagine that nature such as to admit of easy resolution.

And must observe that do not consider present temporary relief as affording grounds for very sanguine hopes.

Should not therefore be surprised if soon again in same state as formerly.

Yet at least chance that internal as well as external tumour may decline

And hope that may yet be able to dismiss patient, if not free from affection, at least considerably relieved.

Hitherto however cannot say that measures here employed have had much influence in that way.

For must own that am much more disposed to attribute [ease] which patient now has, to accidental haemorrhage, than to any thing we have done for her.

And indeed from different occurrences have not hitherto been able to prosecute with proper stead, any particular plan of cure.

At first ordered merely a simple gargarism, basis of which Infusion Rosarum.

This principally intended against slight topical excoriation, which will observe from history of case, could be discovered on inspection.

Imagined that although such internal tumours as have suspected, really exist; yet considerable part of unease might arise from this cause.

And that similar affection might be still farther extended where not obvious.

But had still farther in view, the observing at least for course of week what change might occur in the disease

Here will observe that mixture commonly employed as gargle directed to be swallowed

This however not with any view to effects in stomach.

But merely for topical application to parts of oesophagus below what could reach if used only in form of gargle.

Under use in this manner for space of eight days only obvious effect some increase of spitting.

And that too as she imagined depended on matter coming from pained part of throat.

But at same time as far as could judge from taste or smell of patient no reason to conclude that purulent.

Or even that contained any great mixture of it.

With this state of discharge however difficulty of swallowing increased.

This was inclined to ascribe to farther increase of tumour enlargement of which might be attended with most serious consequences.

Judged it necessary therefore with continuation of former measures to have recourse without delay to most powerful [disc]

And for this purpose put patient on use of Mercury.

Was intention to have steadily continued this course for some length of time.

And even at next report if no objection should occur meant to have ordered double quantity of Mercury.

But before that time affection took somewhat of different turn.

Was again attacked with bloody expectoration.

And discharge of several ounces seemed to her to come from affected part of throat.

With this also discharge of viscid white matter still continued.

But at same time no more evidence of being purulent or containing greater mixture of purulence than before.

Was therefore rather inclined to look upon it as proceeding from rupture of some superficial vessels on tumour, than from rupture of integumentary of abscess formed from that tumour.

To this the rather led from difficulty of deglutition still continuing.

For if rupture of abscess would soon have been perfectly easy.

Must however at same time observe that was by no means without doubt as to [cause].

And although patient imagined that blood from throat, yet was not certain that might not in reality come from lungs.

In this state of doubt reckoned it imprudent to continue the Mercury.

Hence before any sufficient trial by which could even judge of effects deserted use.

And here substituted another medicine operation of which, of very different nature from former.

Directed for patient a powder consisting of Ji of Gum Myrrh. combined with ℥i. Cream Tartar.

Former of these articles, have in my own practice of late years very frequently employed.

And in some instances of one of most dangerous affections which occasion to treat I think with good effects.

Disease to which I allude is Phthisis Pulmonalis.

And same opinion of it, has also been formed by my Colleague at Dispensary Dr Webster from his experience of use of it, in such cases.

Our practice in this particular derived from several eminent practitioners about London.

Only persons who have written on use in this affection Dr Griffith & [Simmons]

But also very much employed by Dr Saunders Dr Fordyce & others.

And these gentlemen also very favourable opinion

If during present course shall have occasion to employ it in any consumptive cases, will then state more fully my sentiments respecting it.

Here may only observe that opinion as to utility in that disease, has led me to extend its employment to some others.

And am inclined to think that ancient opinion as to power of giving disposition to heal in obstinate ulcers by no means without foundation.

With this intention need hardly observe that long in frequent use under form of Tincture Myrrh.

Am for my own part inclined to think, that when taken into stomach in substance same powers carried to distant parts.

With this intention then if tumour in throat had degenerated into state of ulcer imagined might be beneficial.

But combined it with Cream of Tartar with view of obviating stimulating affects on stomach.

This also whether haemorrhage from lungs or throat, imagined might be of some use from refrigerant power.

And likewise as having tendency at least to keep belly gently open.

These considerations then led me to use of this remedy.

And own wished for some little time neither to be altogether inactive nor to do very much.

For wished to see what would be effects resulting from spontaneous haemorrhage.

Was indeed a matter of doubt with me, whether these effects in end, would be salutary or otherwise.

At same time, hoped so much from them, that should have been unwilling to do anything to restrain haemorrhage while continuing moderate.

And was on this account that gave up mixture with infusion Rosarum.

Has now for space of week continued on use of Gum Myrrh, with Cream of Tartar.

And if no other consequence has at least had good effect of keeping belly gently open.

But must also be observed, that at last report, both pain & difficulty of deglutition so much diminished, that considers herself as entirely free from affection

And this she was disposed to attribute to powders employed.

Must however entertain different opinion with regard to both these particulars

Had little doubt indeed that throat much better than formerly.

But this as already observed was inclined to ascribe to the spontaneous haemorrhage

And would not be very surprised if shall prove means of complete cure.

Reckon it however more probable that will again have some return.

And therefore anxious notwithstanding present temporary ease that attendance should still be continued.

Have therefore gone on with medicine already prescribed.

And if no farther occasion for any other measures, shall ascribe cure to natural haemorrhage.

If disease returns, & still hold same opinion as formerly – Again Mercury.

Probably Calomel with Cicuta.

If sentiments attending cure accommodated to opinion then [formed]