DEP/DUA/1/28/19 (Normalised version)

Margaret Robertson

(1781-1782)

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Margaret Robertson

In case of this patient nothing singular or uncommon.

Selected as subject of Collegium Casuale¹ chiefly with view to practice.

That might have opportunity of another trial of Uva Ursi in Chronic Catarrh.

For here no doubt in considering this principal part of affection.

And when patient applied for our assistance most urgent part.

Here presence of this disease sufficiently characterised by cough dyspnoea & viscid expectoration.

For with these symptoms here no circumstance which can be considered as giving least suspicion of Phthisis Pulmonalis.

These indeed not only complaints with which patient affected.

Besides this much distressed also with borborygmi & acid eructation.

These stomach complaints however consider as totally unconnected with the other

Of this should have very little doubt in most cases where such combination takes place

But although grounds for hesitation in [some] here all doubt removed from difference of continuation

For to stomach complaint had been subjected for several years.

While catarrhal affection but of recent date

Or at least though subjected to it in former winters & even patient here on that account had often entire remission for many [months] together.

Difference of continuation then, & of course, alone sufficient to show that accidentally combined.

But besides these still another circumstance distressing to patient.

Affection viz of head occurring under form of vertigo.

This however can have no hesitation in considering as merely symptom of stomach

For besides that such an occurrence very common here demonstrated by evident connection.

Well known that from affections of stomach headache often proceeds.

Here then when both present together always grounds for suspicion.

But here farther remarked that headache observed to supervene on aggravation of stomach complaint.

And that on mitigation of these again terminates.

This then opinion as to affection of patient when applied for assistance here.

And while viewed catarrhal affection & stomach complaint whether most properly distinguished by title of dyspepsia or flatulence as being unconnected, so also had different opinion as to termination.

Though catarrhal affection at that time most severe yet inclined to think that would be least obstinate.

Have already indeed had occasion to observe that few affections more difficult to overcome than chronic catarrh.

Particularly in this country & during winter season.

In so much that with many [ceases] only from more serious complaint.

And hence do not wish entirely to want it.

With present patient however not yet of that obstinate nature.

For although had in former winter been subjected to it, yet had not come length of being constant.

On present occasion had continued only for few weeks.

And then took its rise from accidental exposure to cold.

Reason therefore to hope than even without interposition of art might not be of very long continuation.

But that spontaneous termination in recovery might occur as often happens when catarrh does not degenerate into chronic state.

This farther hoped might be [assisted] by artificial means.

And if neither sufficient to produce speedy termination yet hoped that might thus alleviate affection.

Opinion therefore as to [termination] of this part of complaint favourable.

From other equally little reason to apprehend danger.

For in but few instances at least that dyspnoea even to highest degree proves fatal

And when does so is not without many other symptoms than here occur.

Particularly severe & [incapacitating] vomiting.

To this however in present case no disposition

And although belly rather bound, yet not to that degree which in dyspnoea product of inconvenience.

Here however affection had already continued without any perfect interruption for considerable length of time.

And well known that when stomach complaints of such standing very liable to be renewed by slight causes.

And that in general only completely eradicated by change in mode of life.

This however with one of rank of our patient and at period at which had arrived not to be expected.

Hence therefore with regard to this part of affection looked only for temporary mitigation.

And that the rather as had [formerly] occasion to treat patient for stomach complaint.

Then found that besides other ailments had to combat also dejection of spirits & tendency to complain.

A state of mind often connected with stomach complaints.

And even of itself, capable both of aggravating & [renewing] them.

To this part of prognosis indeed state in which have already dismissed patient may seem to be some objection.

But although then free from this as well as other parts of complaint do [next] expect that will be permanent

And the rather dismissed patient as [claimed] to be object of practice for that affection which had principally in [summer]

Was glad therefore to take opportunity of so good remission.

But how far this to be attributed to practices here used next to be considered

Have formerly had occasion to state sentiments respecting Uva Ursi in cases of chronic catarrh.

And have already mentioned that chief intention in selecting present case was with view to trial of it.

Have already treated of two cases in which employed during present course.

In first of these affection had soon a fatal termination.

So that thus deprived of opportunity of making that trial which intended.

In latter case patient left us with complaint considerably alleviated.

But some doubt how far this to be ascribed to Uva Ursi.

Whether however any effect in this way or not, had every reason to conclude that in both cases product of no bad affects.

This therefore some inducement at least to future trials.

Accordingly ordered Uva Ursi here to [extent] of ℥p. bis indies

But besides this prescribed also another article.

This however intended with view to affection of alimentary canal which have already observed considered as altogether unconnected with pectoral complaint.

That article was the Pill Foetid cum aloe

These pills consist of equal parts of aloes, assafoetida & soap.

And in many instances where flatulence combined with bound state of belly have often found them remarkably useful.

From combining antispasmodic with purgative power at once serves to facilitate discharge of flatulence & to expel faeces.

In obtaining these effects in present case were not disappointed.

For from these pills taken to extent of grain V at bed time found effect of keeping belly gently open.

And this also attended with alleviation of borborigmi & stomach complaint.

While this favourable change on these symptoms similar change also on pectoral complaint.

For at next report found cough much easier & expectoration diminished

This change for better had occurred from commencement of use of powders.

Hence then probable that proceeded from that cause.

At same time to be observed that here catarrh had been of no long continuation.

And may have been principally consequence of spontaneous decline.

Or may have proceeded from alleviation of stomach complaint or from opening belly.

But whether this really the case or not patient as being no longer in situation which required assistance was dismissed.

Yet no less probable that was entirely effect of Uva Ursi.

These then sufficient reasons to induce to continuation in same course.

And after continuing for another week found both pectoral & stomach complaints continued still easier.

Still however complained of headache.

But considering this as merely symptom of affection of alimentary canal hoped that by persisting in same course might be overcome

Accordingly directed continuation for another week

And at end of this period entirely free both from stomach complaint & headache with very little remains of cough.

In this situation reckoned farther continuation of pills unnecessary.

And therefore directed that should go on with Uva Ursi alone.

After continuation for another week cough also had now entirely left her.

And must own cannot help being of opinion that [illegible] at least in producing effect

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Explanatory notes:

1) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.