DEP/DUA/1/36/39 (Normalised version)

Margaret Morison

1785

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Margaret Morison. January 29^th 1785

Disease to which this patient subjected one very frequently occurring in this country.

And in case before us so distinctly marked that could have no hesitation with respect to it.

Had no doubt in considering it as being an example of chronic catarrh.

A disease with which the only one in much danger of being confused is Phthisis Pulmonalis.

And of this from many circumstances there could not in present case be any suspicion.

And indeed present affection sufficiently characterised not merely by cough & dyspnoea with which attended, but by age of patient length of time for which subjected to it, period of attack & remission & various other circumstances.

May indeed in some degree consider as peculiar pain of breast with which affected.

And especially as affecting with so much severity a particular spot.

This however merely consequence of violent agitation produced from coughing.

And probably from some injury which in consequence of this, parts have received.

May also perhaps be considered as particular, that most affected with it, in spring & autumn.

For very generally remarked, that most severe during cold weather.

And many who though regularly subjected to it, during winter, very much free from it, in summer months.

This there can be little doubt, is entirely to be attributed to cold on surface.

And accordingly those long subjected to the disease passing summer in warm climates often entirely escape.

And even in this country nearly similar relief obtained by keeping house during winter months.

Although however winter generally coldest season of year, yet probable that aggravation met in case before us still to be attributed to influence of cold.

As patient at these periods may be most imprudently exposed to action.

And then at least must be universally admitted, that from frequent vicissitudes even greatest danger of exposure.

In this manner then, few peculiarities which take place in this case to be explained.

And upon whole respecting nature of affection no room for doubt.

May also add that for present attack at least as little with [regard] to Prognosis.

For patient already dismissed free from affection.

This however, when reflect on nature of the disease, can by no means consider as a radical cure.

And indeed am for my own part very doubtful how far at an advanced period of life disease can be said to admit of such.

At least have not for my own part, met with any instances where those frequently subjected to it, have not again been liable to recurrence from slightest accident.

And this have every reason to apprehend, will be case in present instance.

Hence then would be by no means surprised, to find patient, soon again applying for assistance, as subjected to former affection.

But for present at least has got rid of complaint.

And this temporary relief may I think, in part at least attribute to practices here employed.

In this affection immediate cause both of cough & dyspnoea is mucus accumulated in air vesicles of lungs.

Disease therefore chiefly to be [combated] in first place by expelling mucus already accumulated.

And secondly by preventing fresh accumulation.

While former chiefly to be effected by mechanical agitation particularly by emetics latter again may be answered in one of two ways.

Either by diminishing secretion, or by promoting, more ready excretion.

From the former, chief morbid condition which here occurs or what may hold to be proximate cause of the disease, immediately & directly diminished.

While from latter both less quantity accumulated at a time, & can acquire less viscidity.

On these grounds may I apprehend explain operation of different remedies most successfully employed in this affection.

And will I apprehend fully illustrate benefits reaped from practices here employed.

Began treatment of this patient, before case introduced into register¹, by directing an Emetic.

This, in such cases, chiefly & most immediately useful, by unloading breast.

For whether as some suppose vomiting the only expectoration or not, yet cannot be doubted, that in this way, has very powerful influence.

Hence where patient in state to bear operation of emetic, few articles more successful, in giving immediate relief.

And very generally after use, an easy night, if not longer remission is obtained.

Hence then in most instances at least very proper practice for beginning cure.

But besides unloading breast, are also of farther advantage as giving determination to surface.

For in this way have at least temporary good affect in same manner as warm weather.

Hence then often of service not merely as beginning cure but as repeating at proper intervals.

Was then intention here, to have again had recourse to use, if from urgency of symptoms rendered necessary.

But this hoped, might not be necessary from prescribing at same time, with the Emetic, the use of Pill Scillit.

These pills, as now directed to be prepared in our Pharmacy, formed of powder of dry squills.

Which unquestionably most active state under which this article can be exhibited.

While at same time, less apt than most others, to affect stomach in way of nausea or vomiting.

Can be no doubt that active parts of squills, thus introduced into circulatory system.

And accordingly every day examples of influence, as acting on urinary organs.

In my opinion no less in promoting [expectoration] by breast.

In both ways then, useful in this affection.

For by former, determination to the breast is diminished.

While by latter mucus not allowed to stagnate, so long, as to acquire that viscidity, which chief cause of distress.

From these, succeeding emetic patient derived some advantage.

Could therefore have no hesitation in directing continuation.

But with these combined also the composite powder of Cream of Tartar.

An article formed of equal parts of the Tartar & Sulphur.

And which very generally operates both as gentle diuretic & laxative.

In former of these ways, had reason to expect, that would here be [serviceable] as aiding operation of squill pills.

While in latter may look for benefit, as giving determination to intestinal canal.

And can be no doubt, that as thus operating often product of very considerable relief.

As a diuretic however, neither this nor squills, seem to have had any obvious influence.

But with gentle operation as laxative cough & dyspnoea very much relieved.

And under use had, although not uniform, yet speedy recovery.

In no long time therefore dismissed free from affection

And probably may continue so till fresh renewal from cold.

But even in that case if patient shall again apply for assistance may still expect alleviation or removal by repetition of same means.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.