DEP/DUA/1/27/20 (Normalised version)

Helen Lamb

(1781-1782)

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Especially as patient happened not to be affected with any fits of coughing at times when brought to us

Helen Lamb.

From symptoms as described in history of this patients case no possible judgement could be formed as to this patients affection

But when these taken in conjunction with other particulars no room for doubt.

Especially situation of patient & prevailing epidemic at time of first attack.

When came under our care complaint entirely consisted in severe fits of coughing.

These return at uncertain intervals succeeded by peculiar sonorous inspiration.

Or to use vulgar language which on this occasion not [inexpressive] with back draught

In these symptoms have description very exactly corresponding to pertussis in most simple state.

In that affection indeed frequently remarked that fits terminate either in vomiting or in expectoration of clear watery mucus.

Here however neither one nor other of these circumstances took place.

But this by no means any objection to supposition of Pertussis.

For neither one nor other can with least propriety be considered as constant symptom

And indeed this so much the case particularly with respect to vomiting which of the two the most frequent that when taking place very generally ranked among favourable symptoms

And by some even considered as [illegible] that danger of disease passed.

From absence of these symptoms then no objection to supposition of Pertussis.

But again from concurrence of all others cannot with certainty pronounce it present.

For in many instances severe fits of coughing even with what may be called hooping where yet not pertussis.

Pertussis one of those febrile epidemics depending on peculiar & specific contagion.

And a disease with which according to most accurate observations patients affected only once during course of life.

Although therefore mentioned in history that no children in neighbourhood at same time affected with similar complaints yet readily exposed to contagion in different ways

Hence then in forming diagnosis two circumstances naturally occur to be taken into account

Whether viz Chin Cough prevails as epidemic so that patient exposed to contagion.

And whether patient has or has not had the disease before.

As in latter case only that liable to be affected by contagion.

Answers to both these questions would lead us to conclude disease to be pertussis.

For this affection for space of many months particularly at time when patient first affected was very common in Edinburgh & suburbs.

And from tender age of patient who when came under our care did not exceed first year might have concluded that not before subjected to it, although had not learnt this circumstance from parents

During summer indeed when but few months old cough in every circumstance similar to present.

Except that at that time both vomiting after fits & some discharge of blood

But these rather confirm supposition than afford objection to Pertussis.

And confirmed also from long continuation of affection as well as from renewal after some intermission

For both one & other if not peculiar to chin cough at least very frequent in that complaint.

Of all the febrile contagions [chin] by much the most tedious.

Would not indeed contend that during whole of that time contagion so far [prevailing] as to be capable of giving infection.

But consequences at least will run on for many months even for years without interruption.

And nothing more frequent than to observe it disappearing during summer months & again renewed in winter.

Hence then every leading circumstance in case before us corresponds very exactly to supposition of chin cough.

And this supposition corroborated by every other particular with which any [accession] to be acquainted.

This then opinion as to name & nature of affection when patient came under care.

With regard to prognosis observations superseded from [termination] which disease has already had.

Here however may remark that from beginning saw no reason to apprehend danger

Not indeed that pertussis does not frequently prove fatal.

And particularly so in early infancy.

But then does not in general happen after disease of long continuation.

Unless indeed where terminates in suppuration of lungs giving Phthisis.

More frequently infants cut off early in disease when febrile symptoms run most high, & before what is called formed.

Or by severe paroxysm at that time terminating in convulsions.

These dangers however now passed with present patient

And no symptoms indicating any tendency to Phthisis.

Was therefore led to conclude that in this case no imminent danger at least.

But must own did not expect speedy termination in favourable manner.

Such a termination however soon took place

In so much that after few weeks [illegible] patient dismissed from any farther attendance.

This am inclined to think in some degree at least proceeded from [treatments] here employed.

Circumstances however by which this rendered probable will more particularly appear from remarks on treatment to which next proceed.

Pertussis one of those affections which most commonly at least terminate by what may be called natural cure.

And great objective of practice to moderate such urgent symptoms as may occur during course.

But besides this with view to artificial termination of disease great variety of different practices recommended.

Of these many from which unquestionably no ground to entertain any favourable expectations.

Yet others, good effects of which in certain cases at least, attested on good authority.

Some of them however such as influence of fear, action of other febrile contagions etc which dare hardly venture to employ.

From these however appears that artificial check to disease from such circumstances as have very powerful influence on Nervous System.

And if at all acquainted with principles on which remedies here employed operate in this affection is I apprehend in this way.

Remedy to which had here recourse the powder of Cicuta.

And this employed with intention of trying how far would give artificial termination to the disease

Need hardly observe that Cicuta under use of which in practice of medicine introduced by Dr Stork of Vienna first [recommended] as cure for scurvy by Dr Butter now Physician in London.

He published not many years ago a short treatise [professedly] on this subject.

In which holds forth [illegible] as an expedient & almost infallible remedy in that affection.

But from many [unmeasured] directions which gives with regard to exhibition & from small quantity to which employed it exposed himself very much to attack.

And indeed not altogether without some grounds of imputation of quackery.

For among other particulars observed that would not be answerable for success if hemlock employed was not prepared by his own Apothecary.

From this circumstance while publication severely lashed not many disposed to follow him in practice.

And the rather as Cicuta [on] that time had fallen into considerable disrepute

Am however acquainted with several practitioners of accurate observation who have made trial of it & from there have formed favourable opinion of [use].

For my own part the results of my practice leads me to adopt same sentiments

Would [by] no means indeed agree with Dr Butler in supposing that in every case capable of giving speedy artificial termination

But in several instances think that have seen manifest good effects from it as mitigating severity & frequency of fits of cough.

And reason even to believe that had considerable influence as shortening disease

With expectation of similar effects then had recourse to use in present instance.

Cicuta here employed in substance & under form of powder.

Which of all modes of exhibiting Cicuta consider to be most certain & most efficacious

Here given as combined with Pulveris Cretacea.

This however principally meant with view of giving form.

But expected from it also some good effects as destroying acidity

And by this means checking looseness to which patient subjected by which influence of Cicuta might otherwise be counteracted.

[Exclusive] of Pulveris Cretacea however Cicuta given to extent of grain VI indies

Which with child so young utmost dose that thought could be ventured [upon] at least at commencement.

After continuing on this medicine for space of week fits of cough had almost entirely left her.

This change however could not with confidence entirely ascribe to Cicuta.

For during that time another circumstance had also occurred to which uncertainty whether relief was not to be attributed.

Discharge viz of worm of lumbricus kind.

Symptoms arising from worms in different cases very much varied.

And indeed hard to say to what symptoms may not give rise.

Among others well known that irritation which occasion in alimentary canal not unfrequently gives rise to severe cough

Hence then notwithstanding circumstances already mentioned as evidence of pertussis might be supposed that complaint here principally from worms.

Or at least that by presence in alimentary canal affection much aggravated.

And therefore that change which here took place for better principally arose from discharge of worms

If this however really the case could in no degree be attributed to Cicuta.

For worm discharged before any of powders taken.

Here however was for my own part disposed to attribute relief to Cicuta.

Principally as one worm only discharged [when] not followed by immediate relief of affection.

But that relief had occurred in gradual manner during time for which Cicuta used.

But whatever might be cause of relief cough now so far gone that did not seem to be any longer immediate object of attention.

At same time discharge of one worm gave reason to presume presence of others.

And this the rather as patient now subjected to some other symptoms commonly reckoned [testification] of presence in alimentary canal.

Particularly picking of nose & appetite [rather] more voracious than natural.

These appearances indeed may arise from different causes.

But perhaps more frequently from worms than from any other.

And from circumstances of worm before discharged presumption not a little heightened.

On this account therefore to Cicuta now substituted remedies directed against worms.

Was with view of expelling these that directed pill with Calomel to be succeeded next morning by brisk cathartic.

And as such notwithstanding tender age of patient employed Tincture of Jalap.

Which when combined with simple Syrup & thrown in by small doses in manner here directed one of easiest cathartics with which am acquainted.

While at same time equally safe & certain.

From the Mercury & Purgative as here directed have seldom failed to observe good effects in worm cases.

I [mean] in cases of lumbricus particularly with infants.

Do not indeed represent this practice as with these an infallible mode of cure.

Yet in most cases sufficient for cure

And where worms present will very rarely fail of bringing away some

Here however notwithstanding brisk operation no appearance of any more worms.

From this concluded that no more existed in alimentary canal at time.

While by this practice however led to intermit cicuta, severe paroxysm of pertussis again returned.

In this situation had again recourse to Cicuta in same manner as formerly.

And relief once more arising upon use gave strong presumption that that mitigation formerly obtained proceeded from use of medicine.

At succeeding report so far free from affection that thought might be safely dismissed from future attendance.

And upon whole consider this case as affording example of good effects of Cicuta in Pertussis.