DEP/DUA/1/21/23 (Transcript version)

Kitty Smith

(1779-1780)

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This inclind to ascribe more to season during which this prev than to any other circ.

But whatever might be cause cases which have of late occur to me more sever than formerly.

Kitty Smith.

One of many patients lately treatd at the Dispen for Chin cough Pertussis

For this disease, as have already observd in case of Jas Scott has of late prev epidem, in very gener. manner.

Have already remarked, that upon whole consid pres epidem to be more mild than former one.

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Yet And pres. case not without hazard.

Occurrd with patient at early period of life.

A circum in such cases always unfav.

For in order to withstand concuss from fits, strength to consid extent is necess.

And at early period of life fits of coughing not unfreq. give rise to fatal convuls.

Hence while with some other diseas of infants even desirab. that should be affectd at early period of life, with this of conseq. that should be late occur.

But besides early period of life sever other circum also unfav.

Disease here without any spontan vomiting.

A circum occurring indeed in severe as well as in slight cases.

Yet when occurring always tends to mitig disease.

Serves both to shorten severity of fits & to render occurr less frequent.

Is a sympt usually taking place only after disease of some contin.

And compar speaking very few written in which becomes freq. which have not a fav. termin.

Here however notwith contin of disease for space of two months had not been observd to occurr

And while absence rather unfav as otherwise, not less so that after such contin, in no degree observed to decline

True indeed that affect often of much longer durat where yet very fav conclus.

And in place of few months will contin even for year together

Yet long contin without dimin severity must always be distress to tender frame.

But if these sympt unfav. still greater ground for alarm in occurr of febrile sympt.

For besides quickness of pulse fever here indicated, by heat of skin, bound belly & thirst.

These sympts are told had commencd only about fourthnight before came under our care.

But during that time, till admiss on our list had gradually encreasd.

Well known that in this manner many childr. partic in infant state cutt off in Phthisis Pertussis.

And fever perhaps even more danger at late periods than before disease formd.

Upon whole therefore was inclind to consider this as being bad case

And reckond fatal termin more prob than recovery.

In this respect however appreh now happily disappointed at an end.

For both febrile sympt & chin cough so much mitig than now fair prosp of fav. conclus.

Would not pretend to say that this entirely to be attrib to meas here pros.

At same time cannot help thinking that these had at least consid share.

Here however am not disp. to attrib. this to any one partic remedy but to meas. directed to urgent sympt as this occurd.

This however will more manif fully appear from remarks on partic pract to which had here recourse.

Will observe that short time before treatm of this case comm. patient had taken a vomit.

And that from this vomit had derived some relief.

Attent therefore to [prevent] naturally indic here repetit of med.

But besides formr benef. led to it also from anoth circum.

When patient came under our care breathing will observe remarkd to be labor.

And although may arise from diff causes yet here some reason to pres. was affect of mucus

For after parox. of coughing disease here attended with consid disch of this matter.

From evid therefore of encreasd secret. presumpt that accumul in breast might be cause of dyspnoea

While emetics then tenden to [reliev] it as prod disch. hoped also that by frequent artif vomiting dispos to natural might be induced.

Hence then from repetit lookd for advant in diff ways.

As means of excit vomiting here had recourse to emet tartar.

Must own that in gener. am disp rather to give pref to Ipecac.

Especial as means of certainly prod effect, and of excit full vomiting without danger of doing too much.

With infants in partic however often [choose] rather to employ Tartar

Both as in small doses oper more gently & as from want of taste or smell more easily introd.

Besides this more influence as tending to oper on intest canal & move belly.

And hence, in cases like pres. where constip occurrs an addit cause of [pref].

With pres. patient were not disap in effects at which here aimd.

For while emet prop operat consid mitig obt of all sympt

Not only was affect of breathing removed & all febrile sympt abated but freq of cough also dimin

And what to be reckond perhaps not worse sympt than any of these, appetite before much imp now consid mended.

With this fav. change in appear from emet. matters now in such train that chance of recov. much encr.

Although however inclind to attrib this to vomiting did not reckon it advis to persist without longer interm

And circum formerly inducing to employm if not entirely removed now less urgent.

In this situat then resolvd to interm use at least for week.

And during that time to try patien with Cicuta

Use of Cicuta in med altogeth but of late date.

Formerly ranked among most virul of the veget poisons.

If Even with this charact however still in freq. use as externally applied.

Dr Stork of Vienna prob. first who ventured to recom intern use.

On his acct of effic however in schirrous & cancer cases, foreign to pres purp, to make any remarks.

May however remark that first introd & recom in Chin Hooping cough by Dr Butter of Derby.

Not long after public of his essay on Kink [cog] as he calls it had very fair frequent trial at this place.

And may safely venture to say that most of those who had recourse to it by no means prejud in fav of remed.

For to be observd that whatever might be in Dr Butters pract. his reasoning upon subj was what few could adopt.

While at same time public in many respects an empyr. appear.

As inst of this may mention his repres it as cert & infalib remdy in every case & in very small dose.

But still more his assert. that would not be answ for effects & would not be surprizd at failing if extract prep by any other pers. than his own apothec.

Under those prejud then not to be expectd that pract. would be disp to draw more fav termin than merited.

And from exper. of every one who made trial was I believe found that his expect of effic greatly exagger.

At same time as gener allowed that had some effect.

And although by no means gives speedy conclus of disease which Dr Butter contended yet had manif effect of dimin freq of fits.

This many disp to attrib to perhaps with just to its effects as a narcot.

And that narcot powers consid cannot be denied.

Has accord led to use of other narcot in this affect.

And now much more freq than formerly recourse had to opium.

If however cicuta merely operates as sedative here must still be allowd that a pecul. one.

And here as in stimul, perhaps no two give same impress.

And Sedative impress from Cicuta seems to me to have pecul influence as counteracting inordin action which takes place in pertussis.

And such I think reason to pres. was conseq of employm in pres inst.

For although compl somewhat allev. before commen. yet after use began grad to decline.

And while no inconv from mixt fits of coughing less freq. than before.

But during use was attackd with some distress sympt of which no appear to comm of affect.

In place of bound state of belly became subj to severe looseness.

And that too attended with consid disch of blood.

These sympt could in no degree attrib either to the med or the disease

And was inclind to consider it as a complic totally accidental.

Probab however connected with disch of some worms of ascarides kind which at same time took place

But whether looseness brought off ascarides, or pres of ascarid induced bloody stools matter of greatr doubt

In this situat thought it most advis to take meas with view to both.

And while as means of restraining looseness had recourse to Laud. directd inject of Lime water with view to [illegible]

From situat of ascarid princip about rectum few artic taken by mouth much influ.

And among various artic used in way of inject have found none more effic or more safe than Lime water.

Here also hoped that from absorb & astring power might have some influ on looseness.

How far operated in lattr way perha a question.

But in former did not seem to have any influen

Or at least as conseq of use dead ascarid not observd to be disch.

This however might perhaps have proceeded from none remain in rect.

For after use no longer affected with any sympt indic pres.

And whether from this pract. from Laud employd, or from looseness operat as cure for itself, was freed both from bloody stools & from freq of disch.

In this situat have omitted inject but contin the mixt with Cicut.

And am hopeful that as disease contin to decline no farther meas will be necessary.

And Although fits of coughing should in some meas remain that will not even be requis for patient to cont attend.

Is indeed true that without recurr. occurr of fresh new disease fits of Pertussis after being for some time abated will again return with greater viol.

But if this even should be case have still I think in this inst seen good effects both of Emet & Cicuta