DEP/DUA/1/38/71 (Normalised version)

Isabel Renton

1786

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Isabel Renton January 29^th 1786

Of case of this patient very little to be said.

For since formerly spoke of her have seen nothing more of her in this place.

Then observed that considered her disease as a distinctly marked instance of Catarrh.

And in that condition which may I think with greatest propriety be termed chronic state.

For though this patient at 46 year, could not even in her case with any degree of propriety be styled Catarrh Senilis.

Here indeed in cough, dyspnoea & pain of breast, have, as have often already had occasion to remark, symptoms of Phthisis as well as of catarrh.

And must be allowed that in diagnosis in some instances great difficulty

Must candidly acknowledge often this respect fall into mistake.

Sometimes on one hand considered as incipient Phthisis what have [alternative] reason to believe merely catarrh.

And on other viewing as merely catarrh what in short time lands in distinctly marked Phthisis.

But in present instance there is I think very little room for doubt.

Here no symptoms occur [marking] in any degree hectic fever.

Copious expectoration such as is the common attendant of catarrh.

Is considerably past that period of life, when Phthisis chiefly occurs.

And at least verges towards period when catarrh a very common disease.

But above all affection marked to be catarrhal by long continuation & exacerbation during winter.

For at least a very rare case, that any one can be said to be subjected to Phthisis for space of three years.

And seldom happens that after commencement any considerable remission & exacerbation for any length of time.

With catarrh however nothing more common.

Many with whom when beginning even at earlier period of life than that to which our patient arrived will continue for number of years.

And during all that time regularly subjected to it during summer & regular exacerbation in winter.

From these considerations then conclude with some degree of confidence, that this patients case catarrhal.

At same time as already observed do not pretend to say that is altogether without doubt.

Yet if in this case Phthisis should be termination would I own rather be disposed to consider it as supervening affection than as having been primary disease.

But with respect to termination, as shall probably see nothing more of patient, unnecessary to make farther remarks.

May only observe that on idea of affection being entirely catarrhal became [first] here objective to unload lungs.

And with this view directed an Emetic.

For although do not agree with those, who look upon Emetic as being only expectorant yet consider them as both most immediate & most powerful.

Accordingly where large quantity of viscid mucus collected in lungs, product of [greatest] relief.

And in such cases from repeated employment patient often very great benefit.

To such repetition then had patient continued attending should probably have found it necessary to have recourse.

But from very frequent repetition bad affects arise from action on stomach.

For can be no doubt, that by overexertion if may be allowed to call it so, which takes place in vomiting, tone of stomach weakened.

Hence then urgent symptoms alone which should lead even to frequent repetition.

And although Emetic most immediate yet in catarrhal cases more permanent relief by other means.

Particularly by those which diminish determination to breast.

In this way nothing more effective than warm temperature as giving determination to surface.

And perhaps no disease where change to warm climate & thus avoiding winter of more use.

But with patient in such rank as ours, this a practice not to be thought of.

And can be supplied only by warm clothing or keeping house.

Benefit however also obtained by determination either to intestinal canal or kidney.

And thus advantage both [from] gentle laxatives & diuretics.

Particularly latter which less effective in debility.

As such had here recourse to what in some respects may be considered as a nervous diuretic.

Vinum Nicotiana – Hoped here for opportunity of trial.

But from desertion of patient has not been afforded.

Shall only conclude then with remark that have of late tried remedy with some other patients similarly [affected] & I think with manifest advantage