DEP/DUA/1/44/45 (Normalised version)

Janet Baine

(1788)

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Janet Baine at 53.

When this patient came under our care, had no hesitation in pronouncing disease to be a distinctly marked catarrh.

And then of so recent date, that might be considered as in acute state.

From extent of expectoration however as well as from what had happened in former year, had every reason to conclude that would soon verge to chronic state.

And this accordingly might consider as in no long time taking place.

For all symptoms indicating slightest degree of fever soon left her.

And whole complaint might justly be considered as depending on augmented secretion of mucus

When began practice here, disease as have already observed but of recent date

Imagine therefore might be of some consequence to take off irritation to cough.

For no doubt that by this secretion of mucus augmented.

Accordingly with this intention had recourse to a mucilaginous mixture.

This, in cases of recent catarrh, often had recourse to with manifest advantage.

Particularly as diminishing frequency of cough.

There I am inclined to think acts merely by lubricating fauces.

And by involving acrid mucus [otherwise] proving stimulating at larynx.

Operates therefore, in same manner, as various demulcents taken into mouth in solid state & allowed gradually to [melt] as refined liquor etc.

And of this kind what I own I consider as one of best is [illegible] [illegible] cum Opio.

As with demulcent effect of liquor, obtains also sedative effect of opium.

Thus not only is acrimony of stimulation diminished, but influence as far as continues to be exerted has less effect.

And accordingly particularly useful in cases of mere tickling cough.

There however quantity of expectoration & tendency to chronic state seemed objection to it.

As then diminishment of sensibility apt to take off necessary coughing.

And thus preventing breast from being unloaded of that mucus giving dyspnoea.

Here accordingly had recourse to [simple] demulcent

And as no limit necessary with respect to dose ordered an ounce as often as cough urgent.

Under this no remarkable change induced in state of cough.

But while not thus product of good effect was in some degree apprehensive of bad consequences.

For with diminishment of expectoration, there had occurred aggravation of dyspnoea.

This I own suspect might be consequence of accumulated mucus.

And of course in some degree arising from mixture.

Hence in place of continued use thought it necessary to employ a medicine increasing expectoration.

And as such had recourse to an emetic.

Of all expectorants which Materia Medica¹ contains hold emetic to be most powerful.

At least next to action of coughing that of vomiting, most ready means of unloading lungs

And as emetic here, had recourse to what hold to be most certain viz Ipecacuanha

While directed Emetic ordered also composite powder of Cream of Tartar.

That is powder consisting of equal parts of Cream of Tartar and Sulphur.

An article often operating both as gentle cathartic & diuretic.

And thus by increasing determination to other parts diminishing flow to lungs.

On this ground at least, am inclined to explain benefit which have often seen reaped from it in Catarrh.

For very much deceived, if in number instances, have not seen patients derive great benefits from it.

From effects however of these medicines as well as former, had not all the good consequences that expected.

At same time little doubt in attributing to them, some degree of relief which patient now obtained.

From emetic had all obvious operation that could have desired.

That is full vomiting, without any excessive straining.

And to this would attribute relief of cough & dyspnoea which soon after experienced.

Probably also had some influence in diminishing expectoration which as now without augmentation of dyspnoea was inclined to attribute, to diminishment of secretion.

For this affect emetics often have by giving determination to surface.

But rather inclined to attribute it, to effect of Cream of Tartar as moving belly.

From this medicine however though gentle catharsis, yet no influence as inducing diuresis.

Hoped however that this might be effect, of farther continuation of medicine.

But while directed her to persist in use, imagined that something farther might with advantage be done, as diminishing secretion at breast.

And with this view had recourse to a gentle restringent medicine, the Uva Ursi.

This article in catarrhs of chronic kind have had recourse to in some former instances.

But cannot say that have yet had such experience of use, as to enable me to speak with confidence of effects.

As far however as I can judge, have sometimes seen good, sometimes bad effects resulting from use.

For in some cases seems to have had effect of diminishing secretion & thus alleviating disease

In others of diminishing excretion merely, & thus augmenting dyspnoea.

And thus very much in same situation with opiates.

Which however more frequently prejudicial as binding up breast as is called.

When therefore direct employment must always be regulated by effects.

And can only with [freedom] continue use when no bad consequences.

When first began use for some time at least saw no grounds for any alarm.

For at end of a week continued in every respect rather better.

Both cough less frequent & expectoration diminished

Still however affected with dyspnoea particularly in evening.

But this no more than might reasonably have expected.

And considered it as no reason for intermitting medicine.

At succeeding report indeed found that both cough & dyspnoea had been very distressing.

This however she herself ascribed to uncommon coldness of weather at that time

And in my opinion with great [appearance] of [probability].

For very few diseases on which cold has more manifest influence.

In many cases as was indeed case with this patient, considerable relief during summer, but recurrence on cold weather.

And indeed for my own part know no disease, where greater relief from passing winter in warm climate.

Hoped therefore that by milder week should find symptoms diminished at succeeding report.

Reckoned it unnecessary to make any alteration with respect to medicine.

Were however no less disappointed as to change of weather, than in mitigation of affection.

And whether consequence of continuing cold or of any other circumstance found her at next report even worse than before.

For cough very severe attended with much dyspnoea & little expectoration.

Did not still, as have already said, consider these circumstances as consequence of Uva Ursi.

But in this situation of patient thought continuation improper.

And at same time as a means of again freely unloading breast, had recourse to repetition of an emetic

With this however still directed continuation of Cream of Tartar.

As still hoped that might be product of benefits both as laxative & diuretic.

In these ways however operation still but inconsiderable.

Vomit indeed operated well.

But even from this did not obtain that relief of breathing which expected.

And cough even aggravated.

This however additional evidence that former aggravation not effect of medicine, but of state of weather.

And as thus disappointed of relief, became now necessary to have recourse to some other mode of producing determination from breast.

With this intention had recourse to a blister

Respecting good effects of these in cases of Catarrh all practitioners are [agreed].

Different explanations however given of mode of action.

By some entirely [referred] to antispasmodic power.

That in this way may have effect would not deny.

But for my own part ascribe much more to influence as evacuant & to changing mode of circulation.

Accordingly while discharge continued & supported had much relief.

But upon being allowed to dry up had again return of symptoms.

This naturally led to repetition.

And on this again experienced same relief as before.

But either found it difficult to support running or disliked so painful a remedy.

And accordingly as soon as considerable relief again allowed discharge to be stopped

Not however improbable that may again be obliged to have recourse to it.

Or to direct it, under form in which continuation more readily secured that viz of Pea issue.

In mean time however have directed only continuation of Cream of Tartar.

And if with this shall now have mild weather, will do more to alleviation of affection of patient than any remedy we can employ.

If however any other medicine necessary may here have recourse to Nicotiana or Squills, from both of which have in many instances seen considerable benefits.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).