DEP/DUA/1/45/03 (Normalised version)

Isabel Middleton

(1788-1789)

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N^o22. Isabel Middleton at 39.

Of disease of this patient at a loss to form any decided opinion.

And several different suppositions may on probable grounds be entertained with respect to nature of affection.

Chief symptoms those which the common occurrence in catarrh.

But well known that between catarrh & phthisis often difficult to form a distinction.

And here some appearances giving at least grounds for alarm.

Such for example as debility, feebleness of pulse, want of menstrual etc.

May perhaps among others [mention] alleged symptoms of intermittent fever.

For with this hectic fever often confounded.

And particularly at commencement patients often flatter themselves, that entirely of that nature.

Here however if these had been symptoms of hectic, should have expected that would rather have been increased than diminished.

And allegation of former intermittent leads to still third supposition.

That viz present affection to be considered merely as sequel of that disease.

With this uncertainty as to nature can say nothing of prognosis.

Upon whole however look upon supposition of catarrh as most probable & and inclined to expect favourable termination.

For obtaining this, have in first instance at least had recourse to treatment of catarrh

But in future practice must be directed by circumstance & future opinion.