DEP/DUA/1/46/34 (Normalised version)

Agnes Henderson

(1789)

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N^o 10^th Agnes Henderson at 2.

Formerly stated at some length my opinion or rather difficulty with regard to this case.

In some respects considerable resemblance to Cynanche Trachealis or Croup.

Was however upon whole disposed to consider, difficult respiration & peculiar noise with which attended as being effects of spasmodic action of muscles of Larynx.

As being an example of that affection described by late Dr Simson of St Andrews in Inaugural dissertation under title of Asthma infant spasmodica cum nausea voce & respirat sibila¹

To this however admitted that could by no means be considered as having exact resemblance.

Particularly from duration & also from frequent recurrence of fits.

Was therefore inclined to view it, merely in general light, of being peculiar modification of Asthma.

And that depends principally on affection of muscles of Larynx.

On this idea of the disease began & indeed have hitherto [continued] treatment.

In first place directed for patient the use of a gentle emetic.

And from this was inclined to expect benefit on different footings.

Emetic I need hardly observe a very common practice in cases of proper croup, to which present disease some resemblance.

And indeed for my own part am inclined to think that no practice there equally beneficial.

At least have met with some instances in which by means of them, patient saved from immediate danger of suffocation.

And where in consequence of discharge of [apparently] viscid mucus & in one instance of a [illegible] formed tube, respiration immediately [seemed] perfectly easy.

For whatever opinion we adopt as to primary morbid affection in this disease, can be no doubt that suffocation in these immediate consequence of matter obstructing Trachea.

Here then expected also that might be of some use on same principle.

And if mucus operates even as cause of irritation any influence as inducing affect would tend to remove it.

For no doubt that next to coughing of all means of discharging mucus [whether] from Trachea or lungs action of vomit the most powerful.

But besides this expected still more benefit from Emetic here on another footing.

Well known, that by one inordinate action, another often removed or suspended.

Thus even severe instance of hiccough stopped by sneezing.

Hoped therefore that here by inordinate action of vomiting, spasmodic affection at larynx might be removed.

For whether supposition that vomiting solely a convulsive affection of stomach, as in opinion of some, or admit with others that is extended also to diaphragm & abdominal muscles can be no doubt that the inordinate convulsive motion which takes place very [considerable].

And if, an inordinate action occurs, capable of being allayed by any other, may be expected of this.

Cannot however with confidence say that in this way had here considerable influence

Seems however probable that had at least some affect.

For while operates briskly mother sensible that during whole of succeeding day respiration easier.

Emetic however a practice, which could not daily repeat, without considerable [inconvenience] & even some danger.

When order emetic therefore directed also what we call Mistura Oleosa.

Of all these mixtures the basis oil diffused in water by means of some active promoting union.

In many cases the volatile alkaline as for example Spirit of Hartshorn employed for this purpose.

But to many has affect of rendering the medicine disagreeable by purging.

Others again direct mucilaginous, the yolk of egg or other glutinous matter.

But from these proper & permanent union cannot be obtained.

In our Dispensary formula two ounces of olive oil, united to four of water, by means of grain V of fixed vegetable alkaline.

And from this either with or without addition of syrup one of most pleasant of [oily] mixtures with which I am acquainted.

To this then had here recourse.

Such mixtures employed in medicines with various intentions.

Most frequently used as what called [ hector] medicine.

But perhaps more proper to be considered as demulcent.

And can I think be no doubt as appears from affects in cases of Catarrh of Hoarseness & similar affections that have very great influence as lubricating fauces.

On this ground might here be supposed of some service.

For no doubt that with this affection a certain degree both of Raucedo & Catarrhus were connected.

But in present instance chiefly expected benefits from it on another footing.

Can be no doubt that oil applied to sensible surface gives peculiar [impression].

And that from this not unfrequently an effective means of allaying violent inordinate actions.

In this way have I think seen it effective in allaying severe cramps.

And often employed in that species of Croup, if can be so called, which depends on spasm.

In one case of that kind, which however I must confess, put on a very anomalous appearance when patient subjected almost to strangulation, from spasmodic affection of tongue introduction of small quantity of oil into mouth seemed product of immediate good affect.

And I think probably operated in allaying spasm from peculiar impression which it occasioned.

From operation [then] in similar manner hoped that might here be of service to our patient.

But in this our expectation disappointed.

For although her mother imagined that noise in respiration less considerable, yet fits of Dyspnoea returned with same severity as before.

And were even observed to be of longer continuation.

In this situation, still holding same opinion as to nature of the disease considered a more powerful antispasmodic as necessary.

And with this intention had recourse to one of most active with which I am acquainted the Vitriol Aether.

This directed under form of Mixture with proportion of Syrup & Mucilage, to cover taste & prevent escape of Aether from volatile.

This mixture directed to be taken to quantity of ℥p. containing five drops of Aether which for an infant only two years old consider as a sufficient dose.

And this dose to be repeated every hour during course of fit.

To this extent taken not only [without] inconvenience but apparently with good affect.

For as soon as began use violence of fits mitigated

And in short time altogether ceased.

This event it is true, might perhaps have taken place without the mixture.

But was at least more probable that they were connected as cause & affect.

For if idea of the disease well founded might at least be considered as a cause adequate to the affect.

And this opinion that disease remedied by Aether, rendered I think still more probable by what has since happened.

The recurrence viz of affection when the medicine given up.

Had become so well that [reckoned] farther continuation of the medicine unnecessary.

And directed merely the application of simple liniment against slight excoriation of lip.

But in place of continuing free from affection, which had been case for several weeks before, had now a return of complaint.

And that too with some symptoms more alarming than formerly.

Such for example as bloody expectoration.

In this situation have again had recourse to the mixture with Aether.

And if again similar alleviation of complaint shall ensue, will not only tend to corroborate opinion that former relief to be attributed to it, but also confirmed conjecture as to nature of disease.

But if similar remission again obtained shall now think of doing something with view of preventing returns.

And with this intention may perhaps have recourse to Peruvian Bark, or Zincum praecipitate.

But in this must be entirely regulated by circumstances.

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Explanatory notes:

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