DEP/DUA/1/28/15 (Normalised version)

Effy Darling

(1781-1782)

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Effy Darling.

Respecting disease several doubts.

Chiefly two following

1 Whether solely a pneumonia affection or whether disease of breast complicated with an affection of intestinal canal.

2. Whether pneumonia affection to which subjected was to be considered as Phthisis or Catarrh

Each of importance in practice.

But with regard to neither could in my own mind arrive at any certain or even probable conclusion.

Disease principally consisted in cough dyspnoea & copious expectoration of viscid white matter.

This matter according to account given us, of sensible quality, neither smell nor colour giving evidence purulent matter

And as far as could learn at no time with mixture of blood.

Notwithstanding these circumstances however might still have contained mixture of purulent.

And had no opportunity of determining by most accurate tests whether this really the case.

Hence then though sputum such as every day occurs in mere catarrh yet afforded no evidence of absence of Phthisis.

Might be thought in favour of supposition of catarrh that without fixed pain in breast & that patient could lie on [either] side.

These however, although constant symptoms where large abscesses, yet do not occur in every Phthisis.

Might be thought also, against Phthisis that had already continued for space of a year.

For in most instances at least Phthisis fatal before that period.

And if this not the case, is at least very distinctly marked in greater part of instances long before that time.

This have no doubt will happen wherever Phthisis strictly so called has subsisted for 12 months.

But where case beginning under form of catarrh degenerating into Phthisis may happen at much later periods

And in this way patients cut off by catarrhal Phthisis where catarrh itself had [previously] subsisted even for several years.

Upon whole had little doubt that affection of this patient, began under form of catarrh, & had subsisted in that condition for considerable time.

But was inclined to suspect that before she came under our care, had degenerated into Phthisis.

That is, with separation of mucus from lungs, now also considerable separation of Purulence.

To this opinion, in some degree led, from state of tongue.

For had peculiar moist & clean appearance.

A circumstance never failing to arise from purulent expectoration.

And without this, with such quickness of pulse as here occurred should have supposed very different state of tongue.

But quickness of pulse itself still stronger ground of presumption

For never almost observed under 100

Often at 120.

Both in great quickness then, & in considerable variety some indications of Phthisis.

To these would also add state of discharge by belly.

For here grounds for suspecting at least that looseness occurring was the colliquative diarrhoea often observed in Phthisis.

This indeed must be admitted not altogether without doubt.

For as already hinted some reason to suspect, that affection of alimentary canal & of lungs might be wholly unconnected.

For besides looseness, affected also with pains of belly, & uneasiness from wind.

And these had now continued for space of ten months.

Pains however not fixed to any particular part.

Nor accompanied with any circumstance which could give reason to suspect local affection.

Conclude them therefore, to be merely effect of flatulence, & that arising from weak state of alimentary canal.

And inclined to think that from this circumstance only, colliquative looseness had occurred sooner, than would otherwise have done.

Upon whole then though by no means certain was inclined to consider all circumstances as belonging to one disease.

And looked upon it as being now an instance of Phthisis originating from Catarrh.

With this idea of affection opinion as to termination, could be by no means favourable.

Phthisis a disease which although not always fatal, yet commonly so.

And indeed whether conjecture well founded or not, many circumstances in case threatening danger.

Besides severe looseness & quickness of pulse this indicated by marks still more striking

Her obviously exhausted appearance & great loss of strength.

Hence then from commencement of this case hopes by no means favourable.

And from what saw of patient while able to attend us, or have since learnt of her, no reason to alter opinion.

Will be much contrary to my expectation, if disease has not in end fatal termination

And indeed would not surprise me to learn that such event has already taken place.

During course of attendance, practice almost solely directed with view of mitigating urgent symptoms.

When came under care her most urgent symptom the severe cough.

Was with view to this that had recourse to mucilage mixture.

And no doubt, that from effect of lubricating fauces, has often in this way very considerable influence.

But here employed with addition of considerable proportion of Liquid Laudanum.

To extent viz of dram to six ounces

That is between 10 & 15 drops to ℥.

From this had in view also the mitigation of cough.

For unquestionable that from diminishing sensation has very powerful influence in restraining tendency inordinate action.

And accordingly where cough necessary for expulsion of matter from breast, bad affects.

This so much the case, in present instance, that should have been very doubtful as to employment had it not been for two other circumstances.

Pain of belly viz, & looseness.

Expected that from gradual introduction in manner here proposed would be useful against both

And that in such affections often serviceable is subject of daily observations

Even when cause such, that cannot be expected to cure, yet in general product of temporary relief.

Cannot however say that found this to be case in present instance.

From employment at first indeed, cough whether from vegetable mucilage opium, or any other accidental circumstance, considerably diminished.

But looseness still continues nearly in former state.

And in every other respect, no mitigation of affection.

Pulse in particular still so frequent as 120 in [minute]

Now however nothing at least more urgent than before.

And imagined that by continuation of medicine formerly ordered, advantage then expected might be obtained.

Directed therefore that should persist in use as formerly.

But during this in place of farther mitigation, cough very considerably aggravated

And looseness so far augmented that had in general 4 or 5 [motions] during course of every night.

Neither of these effects however could in any degree be attributed to the medicine.

On contrary cause from which arose obvious

And could have no hesitation in attributing them, as she herself did, to exposure to cold during night.

For from looseness then frequently obliged to rise & that too even when sweating.

This of itself sufficient to induce both cough & looseness.

Still more to aggravate these when already existing.

Now therefore became requisite to do something farther to counteract them.

And at same time to prevent future influence of this cause of aggravation.

For these purposes however nothing seemed better suited than pushing the opiate to a greater extent.

Hence then with continuation of Liquid Laudanum as formerly ordered opium to be taken in form of pill to extent of grain every night at bed time.

Under this medicine, cough appeared to be at first somewhat easier.

But had no affect in diminishing frequency of stools.

Now conclude therefore, that not to be restrained by quiet disposition to action, in intestinal canal.

But that necessary to employ astringent to prevent deposit of serous fluid in intestines.

Or at least expected more advantage from conjunction of astringent with opiates, than from employment of latter alone.

To mucilage mixture therefore, substituted infusion Japonica.

Which formed by solution of Succus Japonica to extent of ℥i, in ℥VIII. [Ag.] [Ca.]

In this mode of preparation when succus Japonica not very pure, gets rid of impurities.

For clear liquor pounded or strained off from sediment contains all earthy matters.

Is therefore one of best forms for exhibiting Succus Japonica in most [pure] [state]

To this infusion superadded the Laudanum.

And to save the having recourse to different medicines increased proportion of Laudanum & augmented dose at bed time.

From use of this medicine, were [informed] at succeeding report, that looseness somewhat abated.

But cough & other symptoms still continued as before.

And now strength had so far failed that unable to attend.

As medicine however product of relief directed continuation.

And afterwards learnt that both cough & looseness continued still somewhat diminished.

Could not however consider her as upon whole benefited.

For weakness & faintness so great that little able to be out of bed.

Since that have heard nothing farther of patient for space of some weeks.

And must own that am inclined to suspect, that if still alive, is not in more favourable situation, than when last heard of her.