DEP/DUA/1/27/11 (Normalised version)

Janet Ranken

(1781-1782)

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Janet Ranken.

Affection of this patient as well as former cannot be entirely considered as simple disease.

Here also in conjunction with another affection some complication of stomach complaints.

But these so slight, that as well as in former case hardly consider them as claiming attention while other complaints remain.

And affections for which came under our care, cough, dyspnoea & pain of breast with expectation of viscid matter.

Of these symptoms as entering different genera of disease have already had occasion to speak.

And here as in case of James Low have no doubt in pronouncing affection to be an example of chronic catarrh.

And was with view to treatment as such that here selected as subject of practice rather than lecture.

In history of complaint as introduced into register¹ does not appear to me that any singularity.

Unless perhaps we are to consider as such, its having first attacked her, in middle of summer.

For in history of affection are told, that disease began in June.

This however although somewhat uncommon, by no means to be considered as very singular occurrence.

And although look upon disease as effect of cold, yet when consider state of weather in this country, even in June, & accidents to which then often exposed, from being overheated & the like, perhaps rather surprising that does not even more frequently occur.

After first attack however during warmer part of season again got pretty free from it.

And little doubt I think that renewal of affection, about a month before she came under our care, proceeded from exposure to cold in consequence of change of season.

With regard to prognosis in this case, as far at least as [respecting] Chronic Catarrh nothing which can be considered as unfavourable.

Disease neither to great height nor attended with any very [distinct] symptoms

Flatter myself therefore that nothing at present to be apprehended from it.

At same time several particulars rather unfavourable to expectation of speedy recovery.

Season of year, probably also [habit] & mode of living of patient, much against it.

But have still more unfavourable circumstance in age, to which advanced

For is already you will observe on border of 70^th year.

So that with her, disease may with sufficient propriety be [termed] Catarrhus Senilis.

With regard to plan of cure here after what already observed of case of Low, need not add much.

Is in first place necessary to free breast of mucus already accumulated.

For in this way only that can alleviate or remove present urgency of cough or dyspnoea depending on such accumulation.

But after this for prevention of return of these symptoms is necessary that morbid discharge should be restored.

Of practices here employed with these views is now unnecessary to make many observations.

Will at once observe that was intention to try this patient with same course proposed for Low.

Ordered Emetics as means of discharging mucus accumulated in air vesicles of lungs.

And at same time prescribed powder of Uva Ursi as means of moderately restraining increased discharge.

[Lest] however sudden effect in this way should be attended with inconvenience ordered dose of ℥p only once a day.

The emetic exhibited previous to the Uva Ursi had wished for effect of producing full vomiting.

And to that perhaps fall more than to Uva Ursi, may ascribe demise of cough & of expectoration mentioned, in succeeding report.

Could at least however venture to say that Uva Ursi here product of no inconvenience.

And this sufficient inducement at least to continue trial.

Still however reckoned it most prudent to continue with former quantity only.

At this report however besides account of cough was told of a circumstance which had not formerly been mentioned.

Pain viz in left Mamma in consequence of stroke received upon it.

For this ordered friction to pained part with Camphorated oil.

An application from use of which in such cases have often seen best affects

From inattention on part of patient however, did not get either this or the Pulverised Uva Ursi as directed.

And whether from want of these, or from any other cause will not pretend to say, but both cough & dyspnoea again aggravated.

In this situation directed merely continuation of former measures.

And during course of last week when powders taken regularly cough again became somewhat easier.

From this at least some ground for presuming that by these alleviation obtained.

And therefore considered it as sufficient encouragement to increase quantity.

Have now therefore ordered ℥p twice a day.

And if can get patient to be regular in attendance or in use of medicine shall be anxious not only to continue use but to increase dose.

At same time from some [illegible] which have already had [often] irregular cannot confidently expect it.

Unnecessary therefore to suggest other modes of cure where some reason to doubt whether shall even have opportunity of giving fair trial to [present]

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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.