DEP/DUA/1/46/20 (Normalised version)

Martha Nixon

(1789)

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N^o3. Martha Nixon.

Formerly gave it as opinion that in case of this patient, complication of diseases.

And as has not returned since last spoke of case no circumstance has occurred to alter opinion. Hold symptoms to be affects of Catarrh & of Flatulence.

In both one & other affection have diseases very common in this Country.

And when occurring very obstinate particularly at this season of year.

What I here hold to be principal complaint is what I think best distinguished by title of chronic catarrh.

This disease abundantly characterised by cough, dyspnoea, & mucous expectoration.

And can I think be little doubt, that two former symptoms to be ascribed to latter.

That is increased secretion of mucus taking place into breast, gives dyspnoea from filling air vesicles fitted for reception of air.

And excites cough from acting as cause of irritation.

This however may be considered as natural [effort] for expulsion.

And accordingly when by any accident, cough wanting, dyspnoea augmented.

For, as from want of discharge, secretion not diminished, increased accumulation must take place in lungs.

Thus then principle morbid affection, or what produced leading symptoms, is increased mucus secretion.

And this soon at it were becomes a habitual discharge.

Or at least easily renewed by very slight accidents.

Among most considerable of these may mention cold to surface.

For by this means free circulation there being diminished, balance changed.

And of course determination takes place to internal parts.

This according to previous condition of internal parts, sometimes affect one organ sometimes another.

With greater part in health gives to determination to kidney.

And excretion by that organ, [compensates] [excretion] by surface, little or no inconvenience [arises]

In other cases in place of kidney determination occurs to intestinal canal.

And with them on every exposure to cold or constriction of surface diarrhoea induced

From this need hardly remark that when to great degree disagreeable & distressing consequences.

But consequences no less disagreeable & still more common from determination to lungs.

Is in this manner then that chronic catarrh subjected to periodic returns during winter.

And indeed best avoided, or after has taken place, best overcome by avoiding winter of this climate.

Accordingly know no disease, in which passing winter, in warm & steady climate, of more consequence.

And where this unattainable, by keeping much within doors, during winter & by [defending] when abroad by proper clothing

Though these however, proper precautions when disease has come on, yet not to be recommended to those in health.

On contrary [consider] that here best defence against climate is by habituating body to its vicissitudes.

But after such a morbid affection has taken place, this condition of habit no longer to be looked for.

And then relief alone to be expected by [proper] defence against cold.

This however with lower class next to impossible

Hence with them the obstinacy of affection & difficulty of removing it at this season.

But besides this disease, patient subjected also to another set of symptoms.

This [consisted] in distention & pain in alimentary canal.

Which as not fixed to any particular part, & as removed by discharge of wind on eructation we may with confidence conclude arose from flatulence.

Here however merely occasional flatulence & in no degree of tympanites kind

Probably even much more consequence of increase of power of extrication than of diminishment of resistance.

The circumstance from which tympanites perhaps entirely to be explained.

Nay there diminishment of resistance so great that perhaps even may be considered as paralysis at some parts of intestinal canal

But while proper tympanites a rare affection occasioning flatulence to such a degree as to give great distress a very common affection.

And particularly among lower class confined to sedentary life, & fed on [sparse] diet of flatulent vegetables.

Is also, it may be supposed naturally augmented, when state of weather unfavourable to exercise out of doors.

Hence this likewise in winter more obstinate

From all these considerations then may view patient as at present unfavourably situated for recovery.

And even if that should take place, will yet be constantly exposed to renewal of affection.

Hence utmost that can here reasonably expect is mitigation.

And that too even if patient were to give [fairest] trial to remedy employed.

In attempting removal for combating different parts of affection, different objectives to be had in view.

Relief & indeed removal of catarrh, chiefly to be expected, by discharging viscid mucus already accumulated in lungs.

And by restoring secretion to natural standing.

But where these not to be accomplished is of great consequence to prevent stagnation giving viscidity.

Relief of flatulence chiefly to be [expected], by removal of these spasmodic contractions, tending to retain wind in intestine.

By increasing action for expulsion after is extricated.

But still more by augmenting force tending to prevent extrication.

On these different grounds operation of greater part of remedy, commonly found beneficial in such affections may I apprehend be readily explained.

And of several different practices in both affections, shall afterwards have occasion to speak when treat of other cases already under [care].

Present patient however has hitherto been very little subject of practice.

Only remedy directed for her was what in Dispensary practice we style the Pill Foetid cum Aloe.

These consist, of equal parts, of Aloes, Assafoetida & Soap.

And while useful in different diseases, are I think in particular so in cases of occasional flatulence.

Was therefore against this part of affection, that chiefly calculated.

Need hardly remark that while Assafoetida as well as Aloes, is gently purgative operates also, as powerful antispasmodic.

While at same time gives that stimulation to action tending to expulsion of flatus.

Hence few articles considered as more powerfully carminative.

And few perhaps in actual practice more beneficial.

By these means then expected that should both open belly & remove flatus.

And thus alleviate pain & distension from wind.

But, even from producing these affects, looked for some influence, in removing catarrh symptoms, particularly dyspnoea.

For no doubt, that this not a little aggravated, by distension of alimentary canal.

Might also expect some benefit to catarrh, from keeping belly open.

For by this means, no doubt, that some determination from lungs, to alimentary canal.

And of all means of diminishing secretions at lungs, determination to other parts most powerful.

Accordingly open state of belly seldom fails to give some alleviation to this complaint, constipation again to aggravate it.

But besides this, expected also some benefit from Assafoetida as more immediately affects lungs.

Can be no doubt, that is a very powerful & penetrating stimulant, in [human] system.

And undeniable, that to remarkable degree, affects breath at least by smell.

Need hardly observe how much in sensible qualities approaches to garlic, squills, & others of alliaceous tribe.

All these however, from giving additional stimulation to excretion of mucus esteemed powerfully extractive.

And am much mistaken if this be not also property of Assafoetida.

On this ground therefore expect some benefit from it as combating that part of affection.

But at same time, far from thinking, that can look for removal of complaint from use.

And if patient continues attending, may find it necessary to direct other practices, particularly against catarrh.

May be necessary occasionally to unload lungs of mucus, by means of Emetic.

And of all expectorants action of vomit may I think justly be considered as most powerful.

Or may aim at diminishment of determination to lungs, by increasing discharge by kidney.

And for this purpose may conjoin powder of dried squills with present pill

But in directing these, must entirely be regulated by circumstances.