DEP/DUA/1/33/26 (Normalised version)

Elizabeth Reid

1784

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Elizabeth Reid. January 17^th 1784

Respecting disease to which this patient was subjected, some room for doubt.

And this principally as had never opportunity of seeing her, under fits to which subjected.

As far however as could form judgement from description given, should have concluded that her own conjectures with regard to affection well founded

That [viz] she laboured under Asthma.

Most indeed of symptoms most distressing to her, particularly difficulty of breathing & cough are also attendants of Catarrh

And especially occur with that affection when in chronic state.

Farther to be remarked also that among vulgar in this country, Chronic Catarrh very generally passes by name of Asthma.

A term indeed considered as applicable to every instance of difficult breathing

Is also somewhat in favour of this supposition that disease when first occurred attributed to imprudent exposure to cold

And at least nothing against it that had daily attacks of Dyspnoea every morning.

For in Chronic catarrh this almost never fails to be consequence of stagnation & accumulation of mucus, during night.

In all these particulars then, must be allowed, that at least very considerable resemblance to a disease, very frequently occurring particularly at this season.

But on other hand, several particulars from which should be inclined rather to supposition of asthma.

This particularly to be inferred, from suddenness of attack, with sense of stricture & danger of suffocation.

Still more from sudden termination

For in most instances ended in space of hour & that too without expectoration

Or at least without expectoration of those large quantities of viscid mucus which give relief in chronic catarrh.

But circumstance most of all in favour of Asthma, the peculiar noise with which respiration attended.

This very rarely, if ever happens in catarrh.

And when does occur in that affection is still probably consequence of some spasmodic stricture being induced.

Hence then, as far at least as description to be depended on, gives strong presumption of Asthma.

Age of patient likewise, more in favour of this supposition than of Catarrh

As is also severity of fits, particularly their being attended with Vertigo & Headache

From these circumstances then, inclined to consider this patients case as example of Asthma.

Yet as never saw paroxysms & cannot entirely trust to description no certainty.

But whether Asthma or Catarrh for present at least patient again free from it.

Hence any observations on prognosis unnecessary

May only observe that whether one affection or other, cannot consider her as free from danger of return.

For both, when once induced, very liable to recurrence.

[Latter] almost uniformly renewed from exposure to cold

And accordingly with many becomes habitually the disease of winter season.

Former without any regular period apt to be renewed sometimes at longer sometimes at shorter intervals, from different accidental causes.

Particularly from any circumstance either increasing irritability of lungs, or giving uncommon irritation there

Remission however after last attack as recorded in history continued for very considerable Number of years

Reason therefore to hope that present at least for nearly equal period.

And on this account I own, was less anxious that patient should continue attendance after relief of symptoms obtained.

How far favourable termination which has here occurred, the consequence of practices directed, may perhaps be matter of doubt.

For upon supposition of Asthma, no question, that affection has often salutary termination by mere operation of nature.

Here however, am I own inclined to attribute not a little to blister employed.

From this on supposition that disease asthma & that asthma depended on Spasms had reason to expect good effects as tending to removal

But with present patient the rather led to employ it, from relief which are told had formerly afforded to her.

At that time, as learned from [history] of [case], had effect of removing affection from which afterwards continued free for more than dozen of years.

Is therefore not unreasonable to suppose that relief again obtained to be attributed to same cause.

And that may look upon case of this patient as affording instance of good effects of blisters in Asthma.

Besides the blister however, another remedy you will observe, also had recourse to.

An electuary viz of equal parts of Cream of Tartar, & Sulphur.

From this expected some benefit from operation as gentle laxative, & diuretic.

By both determination to lungs [somewhat] diminished & such affections alleviated.

And here in quantity ordered [were] not disappointed at least in obvious effect of moving belly

In so much that at succeeding report, directed it to be employed only to half former quantity.

To this however, am inclined to attribute very little.

For in fact, relief obtained from the blister, before it began to operate

And continued rather as placebo, [that] might seem not inactive to patient, till should be able to judge how far relief permanent, than with any other intention.

After finding that was so, [reckoned] farther attendance unnecessary.

As have since heard nothing farther with regard to her may conclude at least that remission still continued.

And this I own am disposed to attribute very much to application of blister.