DEP/DUA/1/14/06 (Transcript version)

Ann Monro

(1777)

---

Ann Monro.

An othr patient who as well as former, probab. subj. to a disease which has been subj. of remark. in formr case.

Like last patient also have seen very little of her since first applied for our aid.

And from this circum in a case which in sever. respects doubtful can speak with less confid.

Must howevr from slightest perusal appear that this patient subj. to many of same sympt which occurrd in case of Kath Hally.

Here also princip compl. cough & dyspnea.

And these attended with expect. at least somewhat augm in quantity & more viscid than natural.

Presumpt therefore that state of [illegible] princip cause both of cough & dysp.

That is that affect catarrhal.

And when had already cont for space of thirteen years no doubt in consid it to be of chronic nature.

Here however evid did not occur as a simple or uncompl. affect.

Can hardly indeed consider vomiting as of itself indic disease of stomach.

For well known that may be excited merely by irrit of fauces.

And that in this mannr often [induced] by severe fits of coughing.

But then disch which takes place either merly contents of stomach which have been employd as alim.

Or there take place only, efforts to vomit without any disch.

With pres. patient howevr are told vomiting accompanied with disch of watery fluid.

And besides indic of affect of [stomach] which this affords have farther evid of it in flatul. with which affected.

These then would lead to suspicion of debilit state of alim canal.

But besides these sympt anothr [giving] still greater diffic.

That is prof. sweating to which subjected

This we are told has returned period every [morning] for space of between three & four years.

With regard to this sweating must own am not a little puzled.

No reason to hope that can by any means be consid in light of critic evac.

And well known that colliq. sweats a freq. occurr in diseases of worst tendency

Are partic common especially affect patients towards morning in cases of Phthis

And this well known to be in its nature a disease highly insid.

Will therfore have always addit reason for suspecting it where such sweatings the attend of cough or other pector. compl.

And to all this may add that with this patient circul. greater than natur.

But notwith these circum. think that in this inst. may venture to [promise] against suppos of phthisis.

Besides that many sympt of Phths wanting, consid contin of affect alone as an unsurmount. object.

Colliq. sweats as well as diarrhoea generally an occur towards close of disease only.

With our patient howevr as already observd had cont. for space of above three years.

And cough had subsisted for no less than thirteen

Can hardly however suppose that either vomic or tubercle would have cont. so long without proving fatal.

Upon whole then would not here consider it as in any way sympt from cough.

And that cough may be easier where last is a circum which may sud happen without their having any [app] connex.

And must own that rather inclind to consider this in light of a distinct affect

That disch by surface may suffer morbid encrease cannot be [refused].

And when does so is observed to be prod of loss of strength dimin of appetite & simil affect.

Can see no reason then why should not as well as other [encreased] disch be consid as constit an idiopath affect.

And accordingly find that although not adopted as genus by all nosol. yet [enter] some of best [syst].

Partic those of Sauvage & Linnus.

Latter disting by title of [suder] latter former of Ephidros. term employd by Hippoc

Under genus of Ephidrois of Mr Sauv many diff species are compreh.

And indeed may be supposed to arise from all variety of causes either encrease force propelling blood to surf. or dim. [illegible]

For with certain [ballance] sweating [must] occur.

From what partic cause took rise in pres. case totally at loss to conject.

May therefore I appreh. with greatest safety referr it to species which Mr Sauv disting under title of Spont.

Informs us that had met with several inst in which took place to great degree for consid length of time without any obv. cause

And although here other affect pres. yet none which could reasonably pres. immed connected with it.

Must however be allowed that [of] this are in many cases very inadeq. judges.

And anoth pecul. in case before us which [whatev] might be mode of operating was not improbab. found of all compl.

That is condit of Menst disch.

Patient but forty five years of age a period at which menses not usually [stym]

For with most women cont till about fifty.

With our patient however had not appeard for space of thirteen years.

That is had left her when little past thirty fifty

And from that period dated commen of prin compl. partic cough & dyspnea.

To be observd also that obstr. did not ensue without evid cause.

But how far was affect of labor. [illegible] of cold to which exposed during this, or of conjoind influ of both immatter. to determ.

May presume that whatevr cause, [indeed] change of circulat. affect. lungs.

And that thus gave rise to catarrhal affect. which has cont. ever since.

Morbid disch by sweat indeed of much more recent date.

Yet not impossib that may have operated as cause of this also.

But in what mannr cannot pretend to say.

With this uncertainty respecting nature of the disease will not be expected that should be very decis. in opin as to Prog.

Even in most alarming sympt see nothing which can give reason to dread immed danger.

And equally little reason in a [compl] & obstin affection to look for speedy favour termin.

Especially as while so much at loss respecting nature of disease must necess. be so as to [practice] to be followd.

And therfore less ground to hope for artif termin of affection.

When began practice with this patient must own that by no means determ as to plan of cure to be followd.

And in this was intent to be cheifly directed by effects which should obs. from med.

Here exhib. the vomit. with intent as as far could of unloading breast.

For if except coughing itself no mean more immed as promot. expector.

From this therefore hoped that might at least obt. tempor. relief both to cough & breathing.

And was in expectat of some good effect as prev. return from use of Per. Bark.

For if consider great cause prod catarh to be augm secret. of muc. cure must unquest. depend on restor to nat. state.

And if Peruv. Bark capab. of [restor] excess. disch of mucus from other parts of system may unquest have same influ on secret. by lungs.

That does possess power howevr of [restor] mucus disch is I think incontest proved by good effects in Gonnorr.

And on this ground have freq. sugges it in chron. catarrh although must own that hitherto have employd it but little.

Cannot be [refused] that although in some respects promises good effects in others a doubtful meas.

And utilit as moder. secret. may be more than counterbal. by bad effect. as restraining excret.

This then an obj. to use in ordin cases

But in inst before us an addit argt to employment.

That was profuse disch. by sweat [which] here occurrd.

Although this tempor. releif to cough yet to be consid as exhaust habit.

Lookd upon it therfore as obj. [claiming] attent in cure.

And as well as othr excess disch. consid it to be one which might be rest. by use of tonic.

How far however Peruv. Bark had good effect either on this or other part of affect. have not been able to learn.

To which future practice therfore might have directed us cannot pretend to say.

Ann Jeffrey.