DEP/DUA/1/45/28 (Normalised version)

Isabel Middleton

(1788)

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Isabel Middleton N^o22.

When formerly spoke of case of this patient expressed doubts with regard to it.

And was not decided in opinion, whether pulmonary symptoms at that time principal part of affection, were Phthisis, or Catarrhal. Of two however rather inclined to latter opinion.

And on that ground disposed to give favourable prognosis.

Cannot however say that in this particular expectations yet fulfilled.

At same time conjecture as to affection being catarrhal more [confused].

And even reason to imagine that has had more connection with preceding intermittent than was then inclined to think.

Formerly suggested that not impossible catarrhal affection merely to be considered as sequel of that disease.

But has since [appeared] that rather to be considered, as concomitant, & perhaps even symptom of it.

For since came under our care, intermittent has appeared under different forms

And [to] this, no inconsiderable part of treatment directed.

Practice however, it must be allowed, at first begun on different footing.

Began by directing for patient the use of an Emetic.

This on idea either of Catarrh or Phthisis, might be [attended] with some benefit & nothing to be dreaded

But before employed menstrual flux which had been obstructed for some time spontaneously appeared

And upon this our patient though it inadvisable to employ the emetic.

By this means delayed for few days.

Finding her then however in same situation considered it as equally [indicated] as before.

And at same time as farther [means] of mitigating cough, directed a mucilaginous mixture, with proportion of Thebaic Tincture.

To this added a proportion of Spirit Vitriol [ten]. Of effects of which, as combined with opium have already oftener than once had occasion to state opinion.

But from neither one nor other, of these medicines was any remarkable benefit [observed] in way mitigating cough.

And in other respects several symptoms with appearances even more unfavourable than before

Particularly observed to be subjected to profuse sweatings.

A circumstance always unfavourable where any reason to be apprehensive of Phthisis.

For colliquative sweats one of those evacuations by which more than any other Phthisis patients reduced.

Here however some grounds for hope, from its occurring with a patient, before subjected to an intermittent.

And from its being now attended with frequent shivering fits.

These also it is true common symptom of the Hectic fever.

But still more frequently occur as symptom of an intermittent.

In this state of doubt however seemed not improper to employ medicine [countering] it in both views.

And to this the rather led as these in no degree uncomplicated with [each] other.

Accordingly on supposition that might be colliquative sweats of Phthisis, augmented proportion of Vitriol acid in mixture.

And on supposition of Intermittent had recourse to Peruvian Bark.

After both however continued for space of a week, yet symptoms nothing alleviated.

And during that period, had been much affected with looseness.

This she herself was disposed to attribute to bark.

And this the rather probable as in some instances such an effect known to arise from bark.

While at same time patient [nothing] affected with it prior to use of that medicine.

On this account then thought it [proper] to intermit Bark & continue mixture alone

And probability of looseness proceeding from bark, strengthened from its now [ceased]

Cough also & expectoration [much] [diminished]

But now subjected to return of fever accessing in more regular manner & more strongly indicating existence of intermittent.

On this account seemed again advisable to have recourse to bark.

And although formerly looseness from use yet did not follow that would now occur.

For very much depends on state of alimentary canal at time

Now however mixture seemed less necessary than before.

For cough very much abated.

And sometimes happens that bark disagrees when given in conjunction with other medicines, but product of no inconvenience if employed by itself.

Hence then that might give trial to bark alone ordered mixture to be intermitted.

On this occasion no inconvenience from bark.

And while less affected with febrile fits cough also continued to be still more diminished than before.

From this therefore led to hope that by continuation complete recovery might be obtained.

But although for some time appearance continued favourably, yet again as it were subjected to relapse not indeed of all complaints but at least of symptoms of Intermittent.

For even during continuation of bark & without any manifest cause, became subjected to regular febrile attacks recurring even daily.

And as happens in most [distinct] intermittents each terminated by profuse sweating.

In this situation in place of [persisting] in bark & augmenting quantity thought it more advisable to intermit use for some time.

And in interval directed a mixture with remedy employed in last case min [Solu].

If successful will at once be proof of opinion respecting disease & of efficacy of the medicine.

But if not, which in quantity here employed, have rather reason to suspect shall probably again have recourse to Bark.