DEP/DUA/1/33/06 (Normalised version)

Betty Murray

1783

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Betty Murray 1783 November 22

Case of this patient appears of complicated nature

Here evident morbid affection of glands about neck & that too of very considerable standing

But besides this a more distressing complaint in cough to which also subjected for considerable length of time.

These in nature may at first sight appear very different affections.

And no doubt that often take place without least connection with each other.

Here however am inclined to think that both from same cause.

And that are to view whole as being a scrofula affection.

This the supposition which would naturally be led to adopt with respect to tumours in neck.

Both from situation, from glands nature, & from obstinacy, might reasonably conclude that were of scrofula nature.

But much more room for doubt with respect to cough.

For at least much more frequently from other causes than from any scrofula.

Well known that may be effect of any cause either operating as irritating lungs or increasing irritability.

By former these convulsive agitations in which coughing consists immediately induced.

While by latter, brought to such state than even ordinary stimulation of mucus a cause of uncommon irritation.

Both one & other of these effects however, consequence of scrofula affection, of glands of lungs.

For by tumours themselves a [constant] cause of irritation is afforded.

While again, when by any [accident], subjected to inflammation, irritability [ensues]

And when these tumours formed inflammation excited by very slight causes.

Thus readily consequence of any accidental cold.

To such a state, of such tumours in lungs then, was I own disposed to attribute this part of patients complaint.

For that here something more than simple catarrh might be inferred from many circumstances.

Among others may mention the long continuation of cough, & the state of expectoration.

For although subjected to it for several weeks showed no tendency to degenerate into state of chronic catarrh.

On contrary expectoration in small quantity, & of fluid & saltish tasted matter.

This however well known to be state of expectoration in general attending scrofula tumours & indeed ushering in tuberculous consumption.

Scrofula nature of cough also rendered probable from state of pulse

Not only weak but also remarkably quick at rate viz of 130 in minute.

Rendered probable also by pain of right side & affection of respiration.

And lastly by foetid breath.

For from this circumstance reason even to conject that some partial suppuration may have taken place.

Upon whole then, while viewed cough as most alarming part of disease was disposed to consider it as depending on scrofula affection of lungs as disease evident in another part

From this view of nature of affection necessarily led to very unfavourable prognosis.

For if idea well founded in reality to be considered as incipient state of tuberculous Phthisis.

A disease if not always at least in greatest number of instances certainly fatal

To this opinion however present state of patient may occur as objection.

For since treatment begun most alarming symptom cough has almost entirely left her.

A circumstance but rarely occurring when arises from tubercle.

This however though some objection to supposition by no means [sufficient] to invalidate what already urged in support of it.

For tuberculous Phthisis to be observed only takes place, when scrofula tumour terminates in state of suppuration.

These however when occurring in lungs as well as other parts do not necessarily terminate in that state.

And that too even when subjected to considerable inflammation.

Often observed that those under chin or in other parts suddenly increased in size & very painful, but again subjected if not to complete [resolution] & least to very considerable diminishment.

Same also may happen when seated in lungs.

And this I suppose to have been case in present instance.

As however in other parts are in end very liable to terminating in suppuration same may also occur with respect to lungs.

And must own that although at present should obtain complete recovery yet very [apprehensive] that at last this patient will fall victim to be tuberculous Phthisis.

For on every exposure to cold, will be subjected to successive inflammation, & in end probably suppuration of these tumours

This however an event which may not take place, for some years to come

And indeed more likely to happen at what styled consumptive period, than any [other] viz between 15 & 25

A period from which our patient yet at considerable distance.

But although this, increases present chance of recovery is no security.

For unquestionable that patients die of proper tuberculous Phthisis even at very early period of life.

Have myself witnessed, more than one dissection, where this fate of a child not three years of age.

And have met with several other cases as early, where although no dissection yet equally little doubt as to nature of disease.

Hence then would not at all surprise me here if recurrence of symptoms should have termination in fatal Phthisis.

At same time from relief already obtained reckon it more probable that event for present at least will be otherwise.

And that may have satisfaction of dismissing patient, if not completely cured, at least with very considerable alleviation of affection.

With respect to practice in this case on idea given of affection great objective to be aimed at is to prevent inflammation & obtain resolution of scrofula tumours

And is with this view that practices already employed have been directed

With a view to topical action on affected glands on side of neck had recourse to friction with Camphor oil.

Camphor I need hardly observe a substance of very peculiar [pungency] & activity.

And in whatever manner may operate that has often very considerable effect in producing resolution of swellings undeniable.

Probably I think consequence of renewing circulation & promoting absorption.

But in whatever manner obtained was with a view to this effect that here directed it.

And although cannot say that have yet derived much evident benefit from it tumours since began use nothing increased.

Am inclined to entertain hopes that by due continuation favourable resolution may be obtained

While used this topical application with view to glands of neck had recourse to another remedy chiefly at least intended with view to pectoral affection.

This consisted in mixture of powder of Peruvian Bark & Cicuta in such proportions that every ℥p of former contained nearly four grains of latter.

This dose twice a day with girl of age of our patient thought sufficient at least for commencement of Cicuta.

And on this part of composition I own chief confidence here put.

Need hardly observe that [internal] use of this remedy, first introduced into practice about 20 years ago by Dr Stork of Vienna as remedy in cases of Cancer.

Though in that disease has by no means answered expectations which his account led practitioners to entertain yet free use extended to other affections

And among these none in [which] more frequently & in my opinion more advantageously employed than Scrofula.

Where scrofula in state of open ulceration has often effect of changing & meliorating discharge.

Where in state of tumours often considerable influence in promoting resolution.

And where in state of giving very violent pain, often attended with effect of producing very considerable mitigation.

Here then on supposition that severe fits of coughing from scrofula tumour hoped that might have influence in removing cause.

But besides this expected some benefit from it as immediately allaying cough.

For among other affections also introduced against this.

Not long since proposed as a remedy for Chin cough by Dr Butter of London

And although experience of other practitioners has by no means confirmed his accounts, yet has since been frequently used against different kinds of cough

And where before very urgent has unquestionably had considerable influence in diminishing frequency of attacks.

On this also therefore as well as former ground, hoped that might be useful to patient.

These effects, might in some degree have expected from it, even if exhibited alone.

But imagined that influence in both ways, might be increased, from Peruvian Bark.

The use of bark indeed very doubtful, or rather generally considered as hurtful in cases of Phthisis.

And particularly where in order to [preserve] [ease] of respiration, free expectoration must be supported.

In case before us however no such objection occurred to use.

And here expected benefit from it both as combating scrofula affection & cough

For with other means of [counteracting] former is unquestionably useful, at same time to strengthen system.

And with increase of tone given by the bark, can be no doubt, that considerable effect produced as diminishing irritability, on which frequency of cough often depends.

Accordingly in former practices have often used this combination both as in cases of Scrofula & against cough.

And I think with better effect than when either article employed separately.

Consider it therefore as well meriting trial in present case.

Soon after began use a very considerable mitigation of affection was obtained.

And this I own was disposed to attribute in very considerable degree to the medicine employed.

At same time would be very far from denying that other concomitant circumstances [with] which we are unacquainted, may also have operated.

And far from being confident, that relief obtained, whether effect of medicine employed or not will be permanent.

Supposing conjecture well founded, can as little imagine, that complete removal of affection in lungs has taken place, as of glands about neck.

May therefore look for return of affection from exposure to cold, or any other trifling cause, either renewing inflammation or increasing irritability.

At same time not less probable that benefit will be more permanent.

And if remedy has really had as much effect, as am willing to suppose, by continuation return of affection may be prevented.

While at same time measures employed may also be product of considerable [diminution] of obvious glandular swellings.

If however shall remain for some weeks free from return of cough though these not entirely removed shall not reckon it necessary either that she should persist in use of medicine or continue attendance.

And shall be much satisfied if have it in my power to dismiss her without having recourse to any other practices.

If on other hand complaint shall return hard to say what practice may yet think necessary.

Probable however may have [recourse] to opiates & blisters

At least these the measures which had formerly in view, if trial then made, had not been product of relief.

But after change which has already taken place, measures hereafter to be directed, must be accommodated to state in which shall then find patient.