DEP/DUA/1/44/39 (Normalised version)

Ann Ross

(1788)

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Ann Ross at 61. N^o10.

Formerly remarked that considered disease of this patient as somewhat complicated.

But that principle part of affection, was distinctly marked instance of catarrh of chronic kind.

And during continuation of patient under our care have had no reason to alter opinion.

In treatment endeavours almost solely directed to catarrh.

And have I think had at least some influence in alleviating it.

Began practice by directing for this patient the use of an Emetic.

These in instances of catarrh particularly when degenerates to chronic state often useful on different grounds.

Are first & perhaps even principally useful as tending to unload breast.

For can be no doubt that operate both as most powerful & most immediate expectorant.

And as little that all most distressing symptoms of this disease consequence of increased secretion of mucus at lungs.

And especially of accumulation in air vesicles & branches of Bronchia.

This mucus however the action of vomiting tends very effectively to expel.

And thus gives very immediate relief both of dyspnoea & cough.

Indeed few practices better effects in giving good night.

But besides promoting expectoration, emetic useful also on other footings.

Particularly as giving determination to surface.

By this means some chance that balance of circulation restored.

And from diminishing determination to lungs some prospect that of diminishment of secretion of mucus.

These ends, in some degree accomplished, by every medicine operating as an emetic.

But consider Ipecacuanha as preferential to all others.

For by means of this, can most readily obtain full vomiting.

And at same time, without either too great severity, or distressing nausea, which is consequence of some emetics.

While however emetics in general, & Ipecacuanha in particular thus useful, are by no means altogether free from objections.

Not indeed from single employment, but from frequent repetition.

For can be no doubt, that by this, tone of stomach very much weakened.

Are therefore particularly to be employed with caution, in such instances as present, where with catarrh, some degree at least of dyspeptic affection.

And that here indicated by nausea & pyrosis, with which at times affected.

Of these symptoms indeed as well as catarrh, emetic often affords immediate relief.

But when so employed as to weaken tone of stomach, after affect to increase them.

Hence then temporary benefit should not lead us, to overlook future consequences.

But though these evils from frequent repetition of severe emetics yet from single emetic or even repetition at proper intervals, best effects may be expected.

Accordingly in obtaining these, not disappointed in present instance.

For at succeeding report both cough & dyspnoea easier.

This however could not entirely ascribe to Emetic.

For at same time with vomit, another medicine also prescribed for patient.

Use viz of Squill pills.

These also need hardly remark, a remedy in daily use in this affection.

In so much indeed that often become as it were a habitual medicine, with those subjected to this complaint.

And perhaps as often prescribed by patient themselves as by practitioner.

Hence Edinburgh College¹ who rejected them from Pharmacopoeia² of 1774, have again been obliged to restore them to 1783.

When formerly rejected, was not done either from supposition of inactivity on one hand, or danger on other.

But from idea, that was better to have no fixed formula.

For by this imagined that [quantity] of squills more readily varied at pleasure & proportion to circumstance of case.

And that such corrigents also might be occasionally added as peculiar state of patients stomach, seemed to require.

That these varieties, in particular instances, attended with advantage not to be denied.

But from these are by no means precluded by having fixed formula, under name of squill pills.

And after many patients much in habit of ordering them for themselves, become even necessary.

Accordingly as have already observed to present edition of Pharmacopoeia, has been [restored].

Now however in some respects altered from what formerly was.

Then appeared a much larger proportion of squills than in present.

But at that time directed to be prepared with recent squills.

A substance, which to same weight, much less active than dry, as great part of weight, from water.

And accordingly as water more or less exhausted [activity] various.

But besides this uncertainty, another disadvantage from recent Squills.

When formed into pills, very apt to corrupt & mould.

And thus activity totally destroyed & altered.

For avoiding these inconveniences, now directed to be formed with dried squills.

And thus obtained an article both more certainly active & easily preserved without injury.

Into each pill of grain V Squills [enter] to extent only of grain p.

And in this state of activity such division necessary.

For in quantity of one or two grains with some stomachs, apt to excite sickness & vomiting.

And thus disappointed of effects as acting upon the system.

Though other articles enter pills, yet both now & formerly, have derived name from Squills.

And on these activity may be considered as justly depending.

Not indeed that other articles, entering composition to be considered as inactive.

For now as well as formerly, are [compounded] with Gum Ammoniacum & Cardamom seeds.

But these are articles, which for producing much effect, require to be given in considerable doses

And in quantity to which here employed can be considered as having no other effect than to give form.

In former however, have a medicine in some degree supposed to coincide with power of squills.

And from operation in promoting expectoration, to act as an adjuvant.

While in latter, a warm aromatic operates as a corrigent.

Besides these in former Pharmacopoeia there entered also a proportion of Balsam Copaiba.

But from this no other effect than that of exciting nausea, with a medicine, where nausea particularly to be avoided.

Hence with much greater propriety, mass now directed to be formed with simple Syrup.

And upon whole, in Squill pill, as now enters pharmacopoeia have elegant & [conservative] formula for exhibition of that article in most active state

Here given to extent of five grains m & ve.

That is to extent of grain only of squills in course of day.

From this quantity had little to fear from action on stomach.

And accordingly better chance of entering system.

For where either vomiting or looseness induced from use, disappointed in this effect.

Of influence as entering system, different opinions entertained.

Now however very generally considered as having no effect, in common mass of blood.

And chief difference in opinion, as to collection at [excretion] particularly those of breast.

Accordingly while some support, others as strenuously deny expectorant powers.

Very generally agreed however, that has effect as increasing secretion by kidney.

Or at least, although no medicine [constant] & uniform diuretic, squills so frequently so as justly to be ranked among most powerful diuretics.

And for my own part as little doubt that acts also upon lungs.

Nothing certainly more extraordinary in supposing that should act upon one, than other.

And for my own part, from what I have seen, entertain no doubt that by increasing tendency to excretion promotes expectoration.

And thus from previous stagnation, have apparent effect, of rendering mucus more fluid.

Or as has commonly been called of [cutting] phlegm.

A property which can in no degree suppose them in reality to produce.

But without producing any alteration on mucus, which has already acquired viscidity, consider them as useful in Catarrh both as expectorant & diuretic.

And in these ways have often before seen benefit from them, in other instances of this affection.

Of this had I think manifest example in present case.

For from commencement of use had obvious effect of increasing diuresis.

And expectoration though copious yet free.

Relief indeed thus obtained did not continue uniformly.

But although affected by changes of weather yet so far relieved that reckoned farther attendance unnecessary.

To this the rather led as unwilling to render Squills an habitual medicine with her.

As imagine that even more advantage from returning to use, after some intermission.

Am far indeed from considering disease as what may be called cured.

Have no doubt that on exposure to cold will again be subjected to severe returns of it.

But have at least here good effects of Emetic & Squills as alleviating chronic catarrh.

And in prevention of return more to be expected from avoiding cold, than from anything in way of medicine which we can direct.

Hence patient as much benefits from keeping house as from attending here in this weather

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Explanatory notes:

1) The Royal College of Physicians of Edinburgh, established in 1681.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.