DEP/DUA/1/19/01 (Transcript version)

Isobel Porteus

(1778-1779)

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Isobel Porteus

From slightest view of case must appear that patient subj to complic of affect.

And these too of very diff durations

When came under our care most urgent part of compl. affect of breast.

And these might either by catarhal or [Phthisicat].

For of both affect cough, soreness of throat, pain of side & diffic of respirat are common & in some meas even const sympt.

When came under our treatment affect but of fourteen days standing.

And at this early period, diffic perhap impossib to disting between catarrh & phthis.

Or at least impossib to pronounce that catarrh which by that period nothing mitig will not termin in Phthis

Yet can be no question that in many inst contin much longer where Phthis does not occurr.

Can only say that at time when case taken had no sympt giving certainty of Phth.

Nor do I think that any such has yet occurrd.

At same time with contin of affect has been in no respect mitig.

On contrary goes on with encreasing viol.

And sever sympt which have since superveend give even stronger presumpt of that affect.

Partic night sweats, & Not improbab. that diarrh which has now occurrd probab. of colliq kind.

Must own therefore that very appreh patient subj to this very danger affect.

And besides circum already mentiond suspicion corrob. by age, make of body, general appear & other partic.

Have not here indeed any appear of purul expector.

Nor is there reason to believe that is Phthis of that kind arising from tubercle.

For there seldom at least that so much fixd pain.

And seldom that colliq sweats to so great extent come on so soon.

From these circum, am inclind to suspect, that depends on vomica not yet [illegible].

This opin however I deliver not as matter of certainty but as most prob. conj.

And is a partic wish respect to which if have opport of seeing farther prog of disease may hereafter speak with more certainty.

At same time whether conject well founded or not can be little doubt that this part of affect of alarming nature.

But although most urgent not only compl of patient.

And indeed long before any appear of this subj to other affect in nature very distressing.

These were great debility, affect of alim canal, swelling of stomach pain of back &e.

Was inclind however to consider all these as proceeding from one cause.

Disch viz of white matter from Vagin.

Such a disch is one of most charact sympt in two diff affect. Fl. Alb & Gonn

Between these diagnos sometimes diff.

But here could be no doubt from all circum of case taken togeth, that was of former kind.

And indeed suffic disting by flowing only during absence of Catam & following as conseq of these.

This circum alone, when does occurr, & when can depend on veracity of patient, affords suff. distinct.

And from debility induced by Leucorr. all circum with which at first affected very common conseq.

This then opinion of affect, when took this patient under our care.

Considerd her as having been long subj to Leucorrh. on which Phth Pulm had superveend.

With this idea could form no very favour hopes as to termin.

And if opinion then unfav. must be still more so at pres.

First part of affect indeed when does prove fatal is only after very ted & slow exhaust of habit.

But recover. from Phthis so rare that by many, when once distinctly markd consid as certainly fatal.

With our patient however progress of this part of affect seems every week to be more rapid.

And consider it a a very unfav. [app.] that Catam have been for some time obstr. & that fluor albus has now left her.

In short shall be agreeably disapp if this patient recovers.

But for my own part do not expect she will hold out for many weeks.

When such sentim of disease need hardly say much respecting plan of cure

When takes place in Phthis is chiefly to be expected from operat of syst itself.

Is cheifly to be expected from operation of syst. itself.

Diff meas however by which urgent sympt may be somewhat mitig.

And even radic cure may be aided by means dimin dispos to inflam

And by means giving [illegible] from breast.

While on other hand after free disch has once taken place may be forwarded by exciting adhes inflam giving ulcers [tendency] to heal.

Is I appreh as tending to one or other of these ends that are to acct. for effic not only of clim, diet, & other affects artic of Regimen but also of medium as tending either to mitig or remov of this affect.

And was with one or other of these views that diff pract here ordered were intended.

First prescript was applic of blister to side.

By this hope that might mitig [intern] inflam with which then affected & then abate both pain & cough.

Prev to blister here might have had recourse to blood letting.

But to this constit of patient & long contin Leucorrh. afforded strong object.

By this therefore in some meas [illegible] to blister as most effic meas. which could employ

Was not however prod of great advant

For although obvious operat took place as could have wishd, yet pain very little dimin & cough aggrav.

In this situat directed a refrig cath with view also to determ from breast.

And to this the rather led, as imag that bound state of belly might aggrav other sympt.

As such here ordered an elect. the basis of which was Crem of Tart.

But in place of employing Crem Tart alone conj with it two other artic a proport viz of Lenit elect & of Sperm [Cet.]

From first of these addit had two intent.

With many people, Crem of Tart alone, from coldness excites uneasiness to stom.

And in some inst occas consid gripes.

Both these effects, in some meas counteracted, by Lenit elect.

While at same time renders operat more certain.

Lenit elect indeed as prepared by Ednr Coll. is not now same med that was formerly.

And in opin of greatr part of [illegible] with whom I have conversd change which has been made rathr for worse.

Formerly Senna in subst did not enter compos.

But this togeth with sever other artic, formd into purgat [syr.] with large prop of Sugar.

And in this state pulps added to it formd a mass by no means unpleas.

By change which has now taken place Senna & Corriand seeds entr it in subst.

From these med unquest renderd more rough.

While as far at least, as my exper. goes purgat quality not augm.

And while othr pulps thrown out that of prunes which of all others most apt to run into state of ferment thrown out augm.

Perhaps in some meas from this reason but probab. still more from want of form quantity of sugar, that now keeps worse than formerly.

And accordingly often met with in shops, in such a state, that can hardly suppose it to retain much of propert.

But although from these circum imagine that is less to be depend upon than formerly, yet where in sound state still look upon it to be a very useful & effect formul.

And as such directed it to pres patient.

Was in hopes that might both com influ of Crem of Tart as exciting gripes & render operat as purgat more certain.

But besides this added also to Elect anoth artic. viz Sperm [Ceti].

Influ of this, as far as has any [effec] on disch by belly, rather to render it easy as otherwise.

But here prin intent which had in view, from use, was that might operate as demul.

And this effect, am inclind to think, may exert, after entering syst, at mucus excret.

Some indeed who contend to demul no other influ than as lubric fauces.

But for my own part can see no great diffic in these entering circul, than diff stimul. acting on most remote parts of syst., as organs for secret of urine, saliva or like.

And cannot help thinking that evid for one as little less strong as than for other.

Hold therfore that by this med as taken into stomach irrit at lungs may be dimin.

And imag that the accompl. this end might be of advant in pres. case.

How far in any degree had influ in this way, can not, pretend to say.

But in operat as purgat a good deal disappointed.

For to extent to which first ordered to be taken at least had little affect.

And as demulcent did not think of [trust] alone to Sperm [Cet.] introd into [Elect].

For with same intent, but still more especially with view of lubric fauces directed patient use of mucil mixt or [julep], of which basis G. Arab.

If conject as to cause of cough well founded could not expect that from this med would be removed.

Yet hoped that might at least have some share as dimin irrit by which sometimes excited.

And whether from this, from elect or from any other cause was at least for some time consid mitig.

But from being disapp. in purgat effect of elect. augm dose.

And with view to mitig of pain of side ordered repet of blister.

Neither one nor other however [attended] with desired effect.

As mitig of pain, an end which did not expect to accompl. did nothing [father] with that view.

And hoped that by still encreasing dose of elect might at length move belly to suff. degree.

While by contin of mucil mixt although did not look for remov, yet expectd some mitig of cough.

While in this state menses formerly regul. did not appear at usual period.

This in many inst of Phthis not the case even when patient highly extr.

But when [ammenorh] does happen at at late periods. [Ammen] always to be lookd upon as conseq of disease

And I think to be rankd among worst sympt.

For imagine that best to be explaind from failure of circul in extreme vessels.

And happens on same princip as [red] [vessels] entirely disapp on [illegible] [illegible] of eyes.

Although therefore with this mitig of Leucorr. consid it as indic more dang state.

And must own that since, have had very faint hopes, not merely of recov but even of any consid mitig of sympt.

As elect however, after utmost dose to which encreased, still ineffect. was led to alterat of it.

And in place of Lenit of Elect [endeav] to mitig effect of Cr. of Tart. by Flor. Sulp

While at same time by addit of Jallap was obj to render operat more secure.

From this at first desired effect.

And on repet even more effect than could have wishd for.

In conseq of use had freq. loose stools.

From this however even more to be dreaded than from constip.

As in exhausted state of patient [unfit] for any evac.

Especially while so much [wasted] by prof. colliq sweats.

This therfore led me to interm empl.

With intent however as have since done of having again recourse to it when occur might require.

With this palliat contin also with nearly same intent both use of mucil mixt, & drain from side.

From latter had some hopes that benef might both arise by deriv from lungs, & that outlett might be afforded to absorbd pus.

For hold that by every issue new secret as it were formd from syst.

And that will afford more ready outlett to some matters than other.

In this mannr is often I think useful even in very late stages of Phthis.

Yet where disease far advanced so little prosp of benef. that hardly to be urged upon patients contrary to inclin.

And on this acct here gave up [contin].

Or at least after being allowed to cease did not urge renewal.

In pres. situat of patient do not imag that any meas advis with view to radic cure.

And of natural, must own have very little expect.

As this howevr still a possib event shall at least go on with gentle [illegible] meas.

And as such can employ nothing either more innocent or that has greatr prop of easing patient than Mucil mixt.

At same time direct repet of laxat elect. when occas requires.

Do not howevr imagine that shall even have long occas to cont this course

For suspect that Death will soon termin compl.