DEP/DUA/1/32/05 (Normalised version)

Ann Mason

(1783)

---

Ann Mason. May 27

This patient can have little doubt in considering as subjected to one of most common diseases which have occasion to treat in this country.

Catarrh viz which has degenerated into what may be called Chronic state

For although already at 40^th year of age yet even with her, may with much greater propriety get name of Chronic Catarrh than of Catarrhus senilis

Several of symptoms indeed which here occur, are it must be allowed the characteristics of a much more dangerous affection viz Phthisis Pulmonalis.

For in that disease as with present patient cough dyspnoea & difficult expectoration.

Must also be admitted that Phthisis a very insidious disease.

In so much that in many cases has made remarkable progress before discovery

This however principally the case when little or no cough to give alarm.

And when Phthisis rather feigns appearance of other diseases than of catarrh.

That here catarrhal symptoms not Phthisis may be inferred from many different circumstances.

Strong objection to that supposition in state of pulse

Here of natural standing while in almost every instance of Phthisis greatly accentuated

Same observations may be made of heat.

Although not permanently augmented yet almost no instance of Phthisis in which this does not occur at least in temporary way.

And in most instances takes place in partial manner.

Not only local flushings as in [face] but also partial heats at particular [parts]

And especially observed that at times sense of burning heat as in palms of hands soles of feet & the like

Objection also afforded by state of tongue.

While in fever white & dry in Phthisis notwithstanding [symptomatic] fever peculiarly moist & clean.

This particularly the case after expectoration of purulent matter.

And if Phthisis here existed should be of that kind attended with purulent expectoration for in copious discharge of expectorated matter have cause adequate to production both of cough & dyspnoea.

To these circumstances as farther objection to Phthisis might mention absence of pain of breast natural state of appetite, thirst etc.

But above all continuation of the affection age of patient & progress of disease.

And when attend to these particulars affection of chronic catarrh very distinctly marked.

Patient already at 40 year. A period of life at which Phthisis very rare chronic catarrh very common.

Has now subsisted for several years.

A term by no means uncommon for chronic catarrh but very rarely so for Phthisis.

During that period has particularly occurred in winter months & been absent during summer, disappearing in spring.

Such remission however never observed in Phthisis which of all seems most severe & most frequently fatal in spring.

In chronic catarrh again this almost constant course.

In so much that perhaps no disease where change from cold & variable & steady & warm climate of more service to patient.

And in which where this cannot be obtained more advantage from keeping house as defence against cold.

Upon whole then with regard to affection to which this patient subjected no room for doubt.

Without any suspicion of purulency can have no hesitation then considering affection as depending merely on increased mucus secretion

From quantity giving dyspnoea

From irritation giving cough

And from viscidity giving difficulty of discharge.

To this affection in my opinion name of chronic catarrh may be given with greatest propriety.

Has indeed in different practical systems obtained different denominations.

And in particular in Nosology¹ of Dr Cullen arranged under genus of dyspnoea being distinguished by specific name of dyspnoea Catarrh.

This appellation however to me appears a very improper one.

In first place draws name of the disease from a symptom merely accidental.

This I apprehend no one can deny to be the case with the dyspnoea.

When indeed affection long continues & has arisen to great height is it must be allowed often a very distressing symptom.

But then only that takes place to any considerable degree.

And even then not a constant symptom.

For on free expectoration will be entirely [removed]

In cough & copious mucous discharge again have symptom attending the affection through whole course.

And cough, which is immediate consequence of mucus to be expectorated, is at all times most distressing symptom.

In so much that very common as is indeed case with present patient for severity of fits to excite profuse sweating.

But besides this from referring present affection to genus of dyspnoea is [illegible] with a set of affections of very different nature.

Thus in Aquosa in affection belonging to the dropsy.

And in [ pingued] a symptom of corpulence

And indeed may here by way observe that the genus altogether an unnatural one.

For even as simple in system of Dr Cullen still contains eight different diseases which have no other connection with each other but in single circumstance of dyspnoea.

And which with much greater propriety consider as symptoms of other diseases.

This example not only in dyspnoea catarrh but also in two others just mentioned.

Thus dyspnoea Aquosa merely symptom of dropsy of breast.

Particularly of Anasarca of lungs.

While again dyspnoea [ pingued]. is a symptom merely of the Polysarca or general increase of fatness.

Of a nature equally dissimilar from each other are dyspnoea extrinseca thoracic terrea [areae] & other species

Upon whole then can have no doubt in looking upon this genus of dyspnoea as containing a very unnatural assembly of affections

And in considering term of dyspnoea catarrhalis as improperly applied to such cases as present.

While again with strictest propriety referred to genus of catarrh.

For essential & leading morbid affect is increase of mucus discharge.

And in by much greatest number of instances degenerates to this state, from that of catarrh under acute or febrile form.

From this circumstance then as well as long continuation may very justly obtain name of chronic catarrh.

This then idea as to name & nature of affection of present patient.

With regard to prognosis may observe that is a disease in the end often fatal.

Particularly in this country.

From repeated severe attacks especially during hard winters patient exhausted at length incapable of raising mucus & necessarily falls victim to affection.

That this may yet be case with present patient would not deny.

But in most instances unless from accidental occurrence happens only at late period of life

And indeed by much greatest part of those subjected to it fall victims to other affection.

In present case no appearance of an alarming nature.

[Since] patient came under our care severity of complaint even considerably mitigated

And from this circumstance [joined] to season of year, appearance viz of warm weather have now reason to hope for speedy removal of affection.

Not indeed that may not be liable to return during another winter

But have at least reason to hope that attendance here will not be much longer requisite in present affection.

And this event have reason to think may in some degree forward by treatment here.

In treatment of this affection in general two objectives present themselves as principally claiming attention.

When breast much loaded with mucus is first objective to discharge what already accumulated.

But after this effected is of still more consequence to prevent fresh accumulation.

An end to be accomplished either by promoting more free expectoration.

Or by diminishing morbid secretion.

In certain circumstances especially where symptoms very urgent practices may be requisite with all these intentions.

But in present case use of many medicines did not seem requisite.

In this affection many remedies employed.

Particularly those supposed to operate as promoting [expectoration].

For by this means accumulation in the air vesicles of lungs prevented.

Those in my own practice particularly squills often employed with this intention

And I think with best effects.

But of all remedies none to which have more frequent recourse the Emetic Blister Diuretic & gentle cathartic.

Two first most immediate means of obviating urgent symptoms either in way of cough or dyspnoea.

Two last as giving most permanent relief & preventing recurrence of affection after mitigation once obtained.

After these observations need hardly add anything as to particular practice in present case.

Began by directing an emetic with view of unloading breast from [mucus] already accumulated.

And in this not disappointed.

For while operated briskly, consequence was that cough & dyspnoea considerably [relieved]

At same time that ordered emetic directed also laxative electuary of equal parts of Cream of Tartar & Sulphur.

This need hardly observe one of most gentle refrigerant cathartics which we possess.

Accordingly in frequent use in cases where such necessity such for example as haemorrhagic [affection].

But no affection in which have seen more good effects from it than present.

And here probably particularly useful from operating also as increasing urine.

Under this medicine while obvious operation what wished, complaints have also been considerably diminished.

And hope that by continuation may be able to effect at least temporary cure.

Is intention therefore unless some circumstance shall require alteration to persist in use.

And if from present cold weather, or other accidental circumstance, affection should be aggravated only additional remedy which shall probably employ will be repetition of Emetic.

And under this treatment am hopeful that in no long time patient may be dismissed from any farther attendance here.

If however disease shall take any unexpected turn, measures must be accommodated to circumstances which shall then take place.

---

Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.