DEP/DUA/1/46/10 (Normalised version)

Agnes Henderson

(1789)

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N^o10. Agnes Henderson at 2.

Of disease of this patient am I own at loss to form any decided opinion.

And here I think equal difficulty in forming proper conjecture either of name or nature.

Does not in my opinion correspond either with definition of History of Asthma, Dyspnoea or any other of affections in which respiration the function principally diseased.

And although are told proceeded from cold, & began under form of hoarseness, yet can as little consider it as an instance of Aphor. Catarrhus, or like.

In some respects when patient under fit, resemblance to a disease well [known] in the country under name of Croup.

What considered by most writers as a species of Asthma, but referred by Dr Cullen to genus of Cynanche.

And distinguished by title of Cynanche trachealis.

But from this affection into history of which, would at present be foreign to our business to enter differs also in [most] essential particular.

At least no doubt that does so from disease ordinarily known by title of Croup in the country.

But at same time under this title am inclined to think that diseases different very much in nature have been [comprehended]

Indeed the name given to every instance of difficult respiration attended with peculiar noise.

And this from what have seen in actual practice I am convinced may proceed from different causes.

Hence diversity in description given of it.

Most frequently is effect of a cause in some degree fixed & of considerable permanence.

And such the Cynache [illegible] described by Dr [Crawford] in inaugural dissertation¹

But in other instances entirely effect of spasm at head of Trachea.

And such again the Asthma inf. cum rauca voce & respiratione sibila described by Dr Simson in his inaugural dissertation².

But to neither of these can case of present patient which has now subsisted for space of month be considered as by any means exactly corresponding.

And as far as I can judge from own experience am inclined to look upon it as an anomalous affection.

Perhaps best distinguished by general title of peculiar modification of Asthma.

And as far as can form any probable conjecture of nature, consider as depending on spasmodic affect occurring in muscles of larynx.

At least this supposition, seems to me better to explain phaenomena than any other.

For by voluntary effort contracting these muscles, can in some degree produce both laborious respiration & peculiar noise which here occurs.

Among other phaenomena somewhat singular may perhaps mention fits generally recurring through day & never in night.

This very different from some other diseases affecting respiration, particularly the proper spasmodic asthma, & pertussis.

For these especially latter by much most violent in the night.

Then fits of coughing with inordinate action giving hooping, both most frequent & most severe.

From this analogy therefore, might here also, be led to expect aggravation during night.

But while present case contrary, does not differ from all spasmodic diseases.

Thus for instance in Chorea, where inordinate actions in almost all voluntary muscles during course of day, yet unless where disease very severe state of perfect rest during night.

To this then consider inordinate action here supposed to take place, as most analogous.

But without farther conjecture as to name or nature of disease shall only add, that equally at loss both with respect to prognosis & practice.

On idea however given of nature should look upon it as more alarming than dangerous.

Is also on this idea that have begun practice by an emetic & [oily] [mixture]

My intention in view by these shall afterwards more fully explain when again speak of case.

May only at present add that if disappointed have thoughts of trying vitriol aether or valerian.

But in this must be regulated by circumstances.

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Explanatory notes:

1) Thomas Crawford, Disquisitio medica inauguralis de cynanche stridula (1771).

2) Jacob Simson, De asthmate infantum spasmodico (c1769).