DEP/DUA/1/31/24 (Normalised version)

Ann Breakenrig

(1782-1783)

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Ann Breakenrig.

In case of this patient no circumstance which can be considered as any great singularity.

And although symptoms numerous yet probable that whole to be considered as connected.

Nay as depending on some common cause

Most alarming part of affection pectoral complaints.

And here some room for doubt whether these to be considered as Catarrh or Phthisis.

But besides these in this case still a third supposition.

This viz of Pertussis.

Of this affection however although her mother at first inclined to that supposition in my opinion from beginning very little probability.

Founded almost solely on two circumstances severity of fits & patient having not had that disease

On neither however could any stress be laid.

And two others by which these more than counterbalanced.

Want viz. of Contagion & want of [hooping] or back draught.

Pertussis well known to depend on specific contagion.

And on this account in general observed to occur as an epidemic.

In present case however no contagion to which could be traced

And though fits of coughing severe, yet without that peculiar noise occurring at conclusion of fits which seldom wanting after disease of any continuation.

And which has justly been considered as almost if not altogether peculiar to Pertussis.

Besides this nothing of vomiting or indeed of any other of these symptoms by which Pertussis distinguished from other coughs.

Here then little difficulty in rejecting this supposition.

And of two others have been all along I own most inclined to supposition of catarrh.

To this chiefly led from absence of hectic fever.

For although pulse quick & skin hotter than natural yet neither manifest shivering fits nor febrile exacerbation.

Besides this no reason to imagine from what had opportunity of observing with respect to expectoration that contained purulence.

No presumption of this from state of tongue, which with purulent expectoration in general obtains particular cleanness.

And in [swallowing] expectorated matter no more than happens to almost every infant at age of our patient.

While again quantity of matter raised from breast much more in favour of Catarrh than of Phthisis.

This opinion that pectoral affection merely catarrhal now still farther corroborated by mitigation of cough

An event which could hardly have expected to take place if

But although from these circumstances inclined to supposition of Catarrh, yet not without strong apprehensions that will at length terminate in Phthisis.

And this the rather to be apprehended if idea respecting present catarrh well founded.

For hold that here disposition to increased secretion by the lungs connected with Scrofula habit.

Of this habit in mother have evidence by large glandular swellings about neck.

And although not thus characterised with our patient, yet here I apprehend other marks of it.

For in pains of belly, especially as accompanied with swelling & tension, have grounds for suspecting such an affection in mesenteric glands.

To Scrofula then am I own inclined ultimately to refer both pectoral & abdominal affections.

And this I think the rather probable from attending to origin & progress of affection.

Particularly from bad health even from [illegible] periods of life & from considerable aggravation since laboured under the measles.

A cause from which well known that scrofula in the habit particularly as affecting internal parts often very much aggravated.

With this view of disease prognosis cannot be favourable.

From appearance indeed do not consider patient as in any immediate danger.

And should not be surprised to find even considerable temporary relief.

At same time apprehension is that from scrofula affecting internal glands, patient will at length fall victim either to Phthisis Pulmonalis or to Tabes Mesenterica

But still more immediately than either of these have I think reason to dread the occurrence of rachitis.

This an affection not unfrequently in some degree complicated with Scrofula.

And tendency to it in present case evidently indicated by general weakness, by dullness, inability to walk & pains in joints.

From occurrence of this therefore, not improbable that patient may have [inconsiderable] inconvenience.

At same time reason to think that consequences will more immediately [inconvenience] than danger.

And is chiefly from one or other of affections already mentioned that reason to dread fatal conclusion.

Am however hopeful that neither of these have as yet taken place.

But with such tendency in habit to that affection as here suppose to exist expectation from use of remedy cannot be very sanguine.

In practice here somewhat restrained from circumstances of pectoral & abdominal affections conjoined.

And by catarrhal affection particularly prevented from free use of remedies, in which [otherwise] should be disposed to place here greatest confidence.

Such for example as cold bathing & Peruvian Bark.

From former reason to apprehend bad affects from increased determination to breast.

And from latter as restraining free expectoration.

Hence then in counteracting Scrofula tendency was naturally led to think of [other] [medicines]

And was with view to this that had recourse to Cicuta

Of effects in Scrofula causes have already oftener than once had occasion to speak

Am very far indeed from considering it as adequate to cure in every or in most instances.

Yet inclined to think that not without good effects.

And that too both in resolving Scrofula tumours & in giving ulcers disposition to heal

Am even inclined to think that does more in Scrofula than in any other affection.

On these grounds then inclined to hope that might be of some service where here suspected incipient affection both of mesenteric glands & of those of breast.

But besides this in use of Cicuta had another intention in view.

Among other affections of late much employed for allaying obstinate coughs.

Need hardly observe how highly has been extolled as cure for Chin cough by Dr Butter of London.

And although account which he gives of virtues certainly much exaggerated yet these not without some advantage.

Particularly as mitigating severity & diminishing frequency of fits of coughing.

Use in this disease has led to employment in other coughs.

And in these also often found attended with benefit.

Effect in such cases in generally explained from narcotic power.

And thought that by diminishment of irritation less tendency to inordinate action though stimulation from mucus continued.

Hoped therefore that besides [countering] scrofula tendency might also mitigate cough.

And was with that intention that here gave it rather as diffused in mucilaginous mixture than in form of powder.

As thus hoped that influence in allaying tickling cough might be somewhat augmented.

While this remedy chiefly directed against pectoral complaint had recourse to another, principally intended with view to affection of alimentary canal.

A mixture viz of Magnesium & Rhubarb.

To this remedy in affections of alimentary canal occurring during infancy have often recourse.

And where wish to conjoin with effect of opening the belly that of strengthening tone of intestines few better fitted for the purpose.

But to this medicine still farther led in present case from another consideration.

Effects viz formerly observed to result from it.

Before given when subjected to similar complaint.

And then found product of good effect.

Here therefore suggested by attention to juvantia.

And was in hopes that might again be product of same good effects as formerly.

These then reason for putting patient on course with which here began.

From commencement of use cough somewhat mitigated.

An affection which am I own inclined to attribute to the Cicuta.

But did not appear that derived any other advantage from it.

And therefore after continuation for space of more than month when cough had altogether ceased, directed use to be omitted.

To this the rather led as wished to substitute to it the use of Peruvian Bark.

As from removal of cough & expectoration now no farther objection to it.

And seemed still more indicated by great weakness with which patients [appetite] affected.

But before beginning use wished that cicuta should be intermitted for some little time

As by this best able to judge when cough for present at least entirely gone

But during this intermission continuation of Magnesium & Rhubarb seemed as necessary as before.

And to this from [appearance] there was of pain in joints another prescription was added.

Camphor oil viz to be employed in way of external friction.

With these medicines if circumstances of case continue as they were is intention soon to conjoin course of Peruvian Bark.

And if this duly taken perhaps no article from which can reasonably hope for better effect.

At same time must be allowed that case a very hazardous one.

And if even taken to fullest extent will probably be found inadequate to cure

But that will be duly taken not very probable.

For well known that every endeavour to cover taste with infants often ineffective.

As best means of doing this however is intention to order it as diffused in solution of Succ. Glycyrrhiza.

And if as thus taken shall prove means of restoring health to patient will I think be a strong factor in its favour.

At same time this I own more than I expect.

And if does fail much at loss what can afterwards employ with any prospect of success.

May however if circumstances continue much the same make trial of [illegible] or when season will permit of it recommend cold bathing.

At same time future measures must be very much regulated by future circumstances.