DEP/DUA/1/16/08 (Transcript version)

Andrew Donaldson

(1777-1778)

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Andrew Donaldson.

Sympt. to which this patient affectd but few in number.

And at same time what you will not find constit disease in most nosol. syst.

When indeed patient came under care was affectd with cough, dysp. & pain of breast.

And these consider even without fever as of themselves suff. to constit. catarrh.

At least in that state which in [contradict] to acute is I think best charact by title of chron. catarrh.

Besides these sympt. howevr patient at time of admiss affectd with anoth still more distressing to him.

That was hoarseness with which affected.

Change of voice so consid. that could [scarce] be heard to speak.

And then with tone which if compared with any ordin voice totally [illegible]

But at same time such as in morbid state very freq. occurs.

And while other affections removed this part still remains.

Might then I appreh. be consid even at time when came under care as constit greatest part of affect.

In some syst. partic those of Lin. & Vog. this sympt introd as charact an affect under title of [illegible] or Remat.

Does not however as genus enter those either of Sauv. Cul. or Sag.

Not perhaps room for much surprize that does not enter syst. of Dr C.

As has evid been his obj as far as could prop. be done to reduce No of gen.

And indeed has pointed it out as falling under two others.

Catarrhus & Paraphonia.

With formr hoarness a sympt freq. occ in combin with others.

And under latter he compr. every inst of deprav. of sound of voice.

In this light however must view the later genus as by much too extens.

And as compreh affect in nature very little simil to each other.

Power viz of common ideas by language.

While at same time neither to be consid as const. sympt of catarrh, nor is it in every case attended with othr catarh affect.

If however from these consid to be concl. that should have had place in syst of Dr Cullen still more surp. that has not entered two others.

But especially that of Mr Sagar.

Who in last edit of his syst. to which gives pomp. title of Filum Ariadnaeum ad Lectulos Aegrorum, has described upw. of 2000 species.

Is indeed very improp. multip of gen., to consider as such every triffling sympt.

Yet appreh. ought always to give gener. appellat. where distinct affect even of one funct.

And in cases of hoarseness, manif [affec] occurs of that funct by which of all others human species most essent. char. from other parts of anim creat.

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From these diff. consid them conc. that [rauced] or [raucit] should constit genus of disease.

And to this affect consider pres. patien as subjected.

But after giving this name to disease may perhaps be expected that should next say somewhat of nature.

Here however would necess. be carried into very extens & very intric field.

Doctrine viz of Human voice.

A subj. concern. which Phys. writers by no means altog agreed.

Some viewing it as entirely wind instrumn

Others consid it as to certain degree at least a string instrumn.

And viewing look upon human voice as in great meas formd by vibrat of cords.

Into this controv however although not foreign to pres. inquir cannot here prop to enter.

May only remark that whether human voice wind or string instrum, no doubt that much affectd by state of solids.

Partic by diff. degrees of moisture or dryness

And want of due secret in partic freq. [rem] as cause of that rough & [obscure] tone constit hoarsness.

In this manner prob. is, that attends that, dry state of surface of Trachea common. occurring from inflam in incip [Catar]

In same way also may be affect of want of due secret. from other causes.

And in all probab. of diff. morbid cond. prod alterat in state of those solids chief concernd in first formul of voice.

In this way probab. is that often [occur] as sympt at latter stages of phthisis

Need not observe that when then does take place is univ consid as very unfav. app

From what partic circum proceeds in case before us consid as very obscure.

From connect with pector compl. stated in case may here perhaps be quest whether does not occur as conseq of Phth.

But to this unsurm obj. that pector. compl. now much [abated], almost entirely gone.

And that although affect of sever years standing, yet none of threatning sympt of phthisis, have ever occurred.

For such a suppos then very little foundat

Yet when consider that [catarrh] here preceded & has accomp [horseness] can hardly look upon them as altog uncon.

And most freq. at least catarrh gives rise to hoarsness from affect of state of circulat. secretion

While secret encreased by [some] parts of mucus memb. may yet be dimin by others

And notwith state of expect may be [want] of usual moist at [larynx].

This what am disp to conject is cause of hoarsness in pres. case.

Give this opin howevr not as founded on what by any means strong evid but as what consid to be most probab.

Thus then conject as to name & nature of affect. next Prognos.

And here must own hopes by no means sanguine.

Do not indeed think that any reason for appreh danger from pres. case.

Or that will even be more distressing to patient than is at pres.

For as already remarked do not here consider it as in any deg. connected with Phthis

And this perhaps only condit in which to be lookd upon as danger. affect.

In some inst indeed change of noise from natur state still greater than that occurring with pres. patient.

And such may here possib take place

Yet when consid. that for some time past has not been upon encrease think it more probab. that will not now be [aggrav]

At least without farther recurr. of affect by which first ushered in.

And wish here we are told now easier than have been for some time past.

Unless therfore fresh exciting cause may hope that catarrh. affect will cont. more moderate.

And now state of weathr may at least be expected to be such that [course] of catarrh less common.

From this however can hardly flatter ourselves with hopes of mitig of [hoarseness]

While change on catarrh this if at all very little dimin.

And has already in some degree subsisted for space even of sev. months.

Known however that although freq. a transit affect, yet that when does not soon yeild often even cont. for whole remainder of life.

In such cases to be appreh. that [change] induced in state of solids cheifly conc. in [vom]

Partic in head of wind pipe Trachea or Larynx

And when such take place delicate [illegible] & [illegible] necess. for partic sound as well as in other cases of intrum fitted for sound may never again be restored.

On these grounds then must own that very doubtful respecting recov. from hoarsness where has been of long contin.

Although at same time in 98 of 100 recent cases, may with confid. foretell that will be very soon termin.

Would not however be understood to say that consid every long cont. case as being affect of irrem diseased condit of solids

Or as depending on loss of condit [where] cannot again be restored.

For inst unquest to be met with [where] voice perfect. recover after long cont. hoarsenss

And when this happens as freq. [occurrin] with out any manif. cause as follows a affect of med.

Upon whole then if pres. patient speedy recov. is more than expect.

And should it take place think it [prob] that will rather happen, by some spont [change] in syst., than by any thing we are able to do

While howevr patient cont. attend. will afford us opport for trial of diff. [prac]

Both those commonly employd & [such] also as from observat now thrown [out] respecting nature of affect may be [sugges]

This naturally leads us to remark on practice here.

And here with regard to treatmnt of pres case must own greatly at loss respecting general princip on which to proceed.

Have indeed given it as what reckon most probab. conject. that here affect of want of due secret. natur. serving to lubric [Lary.]

Have already however had occas. to [remark] that besides this may arise from sev. other causes.

Partic from diff. changes in condit of solids themselves.

And sometimes even presumpt that is effect rather of augm. or vitiated secret than of defic.

In such circum then general prin of cure must be very diff.

But have at least begun treatment on that suppos which reckon the most prob.

Where from want of secret. attempts to comb. will necess. proceed on one of two princip.

To be removed either by restorat of natural secret or by introd of what will serve to [compen.] [want].

Of these, first however first in such case not readily affected.

Cheifly to be affected by stimuli

And these may either act as immed applied to excret or as entering circulat

That in both ways state of secret here may be altered have no doubt

Yet of means by which to be affected [som] inconven. others not to be dep. on.

And besides this in slight cases [from] short time alone soon return to natural condit.

Artic most gener. employd then such as intended to afford [confir.] of want

And with this view cheif are those of lubric nature.

Partic mucil. & oily med.

Princip now pointed out will at least expl. intent in greater part of pract. here empl.

Began treatment of this case by ordering emet. for patient.

This however intended rather against catarrh. affect. than with view to hoarsness.

From state of expect. reason to think that cough supported by mucus accum in breast

Well known that with view of prom [disch] of such nothing more affect than concuss. given by emet.

Besides which as determ to surface often also has affect of dimin prev. fresh accumul.

These then prin. obj. in view from this prescript.

But besides this imagind also that [might] exert some affect on hoarsness itself.

And that on general prin of concussion.

For by this means some chance of restor of circulat where defic.

And thus renewal of secret.

Emet however, it must be allowed, not a remed, in common use for such an affect.

And accord. was not disp. to put great confid in it.

Besides this therefore prescribd also common oily mixt.

In which, by aid of Alkali, oil united with water and thus brought to state of dilut.

By this means sits at least easily on some stom, which otherwise would reject it.

And when does so unquest few more powerful means of lubric fauces.

But even in this state of dilut. many stom, partic those little accust. to oil which will not bear it.

Becomes therfore necessary to begin use at least, with small doses.

And by commen in this mannr may reap advant of which by employing it to greater extent at once, would be disap.

With pres. patient answerd so far at least as to occas. no incon. [from] affect. of stom.

While at same time in operat of emet were not disappointed.

From neither however was condit of voice in any degr. altered.

Yet affect. in other respects somewhat mitig

And both cough & dyspnea consid. [reduced].

By this then at least encour. to farther trial.

And while ordered repet. of emet. directed oily mixt to greatr extent.

But, while from these other affect [eases], still no influence on hoarsness.

And after imagined that had made suff. trial for determ whether woud be affect determ resolvd to change oily mixt for anoth [demul].

And with this view had recourse to spermaceti.

In this changed from veget oil to [anim] oil

For Spermceti, notwith diff. suppos. entert with regard to it unquest to be viewd as pecul. anim fat.

Has then, in state of prop. divis. gener. lubric qualit of other oils.

But besides affect on parts to [which] immed applied which prob. sole influ. of veget. oils, [seems] farther to act as [illegible] at excret.

In pres. inst howevr neither in one way nor othr did prod any change for better.

At least while cough cont. easier yet hoarsness nothing dim.

From such fruitless trials then lead to concl. that in this case was not from demul. that patient to be cured.

From this then lead to trial of med of very diff. nature.

That is use of electric.

From this trial must own entertained no sanguine hopes of success.

Yet was not merely a random trial without any intent in view.

Have already observd that among other causes of hoarsness am incl to think that may arise from affect of solids.

And thought it not imposs. that if did not proceed here, from paraly state of parts, might at least be affect, of somewhat appr. to it.

Wishd therefore to try how far any affect in remov. it from augm nerv. energy, & capab of action, in parts of Larynx, by which voice first modif.

Although now howev cont. for some length of time has not been prod of des. affect

And if do not soon see influ. shall be led to desp. of benef. from it.

Without some appar. affect also shall not think of pros. much farther, other med on which patient at pres. put.

Elect viz of Sulph. & Flor. Iris.

To this led rather from what have heard of affects than from knowledge of prin on which acts.

Orrice however a veget of acrid & powerf nature.

And shall be very happy if any can sugges to me any remed which in obstin case of [illegible] kind have seen success.

And has at least been supposed to exert influ on state of secret by muc. gland at breast.

From use with pres. patient however have not hitherto reapt much affect.

But although, which now very probab. does fail yet have thoughts of trying some other remed with same intent.

And may prob. try how far as [allow] secret good affect from squills comb. with mercury.

But before this shall probab. first try affects of more immed applic to dis. [patien]

With this view have thoughts of [direct] for patient inspir of vap. impreg with veget. acid.

If this abort may perhaps also try in same way inspir of Aether.

Or may ordr it [exter.] to that part of throat at which supp. dis to be cheif. seated.

Besides these might suggs [other] [pract] to which may also have recourse.

But must own that if from these no benef shall be very appreh. of being of any [use]

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