DEP/DUA/1/22/15 (Transcript version)

Helen Brown

(1779-1780)

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Helen Brown.

When selected this case at some loss with regard to it

Consid. it however as exhib a [collec] of sympt which do not every day [occur]

And had some suspic that afford examp of an affect not very comm.

Here, most remark part of affect const in dyspnoea.

Respirat accord to acct given us nevr without diffic

But partic so, on certain exert. & on certain posture.

Is especially encreased during action necess for going up hill.

That so much case, that are told, is then at times deprived of breath altog.

A certain evid that strongest volunt efforts necess for contin of this action.

And therfore that liab to interrup when mind concernd & occup, with other exertions.

But if diffic on such action, still more from change of posture.

This so much case that incap of breathing in horiz positi.

And therefore during whole course of night can sleep only when erect.

From these condit then, naturally led I think to seek for dysp. here from fixd cause.

And of this conject to be formd from concom circum.

That is not so much from defect or morbid state of action in moving powers, as from uncommon resist which these have to overcome.

Such resist however may be of very various kinds.

And of this conject to be formd only from concom circum.

Was in hopes that during course of attend such circum might here [occu] as to give if not cert at least high probab.

Since this patient however under our care have seen very little of her

And probab. has now deserted farther attend at this place.

Still left therefore in same state of doubt as before.

Here may observe that dyspnoea with these sympt, by no means an uncommon affect, at age at which our patient arrived, from accum of mucus in breast.

And this also, not unfreq conseq of that cause to which affect of our patient here attrib, viz cold.

Of this kind by much greater part of those cases of diffic respirat in old people which even by pract termd Asthma, although indeed, with great [imp]

But against such a suppos in this inst. an unsurmount object.

For when mucus accum in [Bronchia] never fails to give cough & viscid [expect]

Here however neither cough nor any expect of mucus.

And for most part has very slow adva

But besides this other causes also

May proceed either from other fluids imped enlargem of lungs or from solids.

Here however when consider that disease of no very long contin, that has had comparat rapid progr, & that much agrav by an horiz post. prob that [not] of former latter kind.

For in dysp from affect of solids, diffic of breathing not encreased from horiz post. but from lying on one or other side.

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Besides mucus lungs liab to compress either from water or from blood

Latter of these fluids partic, this affect as containd within varicose aneurism or distend blood vessels.

And of such a cause may be thought that here some presumpt from palpitat at heart.

But for most part this attended with some [rupt] at least of small vessels giving bloody expect.

And in gener pulse subj to irregul

To all these circum farther to be added that is at least a much more rare cause, than compress from water.

Water in chest may give dyspn, either from exist in state of Anasarca of lungs, or of Hydrothorax

Here however could not suppose it of former kind, as patient no other anasarcous sympt.

And as that dyspnoea in general attended, both with cough, & watery expector.

While again not aggrav by change of posture.

Next then to consider how [far] [prob] that this affect depended on water within cavity of chest.

In syst. of Nosol. Hydrothorax [various] defind.

But in most, sympt introd as essent to the disease which do not here occur

In all great charact sympt is diffic of breathing encreased by horiz post.

And this according to acct given us here occurrs to very great degree.

But to these sympt Mr Sauv has added pecul paleness of counten, with swell of hands and feet.

Of first of these can hardly judge from want of former acquaint.

But if alledged that may be pres, yet oedmat swelling of legs & feet [unq] [abat]

Nor is patient affectd with that pecul stupor in either arm, which he seems to consider as charact of the disease.

This indeed though an occurr very distin marking the affect does not enter into definit of others.

Partic has no place in defin of D Cullen.

And for this unquest good reason since by no means always pres.

Dr Cul however has introd another sympt which he again consid as a [path] or essent sympt

That is sudden starting from sleep with pecul uneasy sensat & remark palpit

To this cannot be alledged that this patient subj.

And if be a sympt always occurring in hydrothor. disease unquest does not here take place.

But even in my own pract, have met with more than one inst, where after death certain evid of Hyroth, & where this appear did not yet take place.

Besides in case before us freq palpit observd to occurr.

And in thirst to which patient subj while moist tongue have at least a common dropsic sympt.

To this may add as farther [presum] circum, pains of which compl. at infer part of Thorax

Proper pain indeed not markd among sympt of this affect.

But sense of uneasiness & weight then in gener attends it even from commen.

And indeed may be consid as necess conseq of weight of water upon [diaph.]

Upon whole then from all circum taken together was inclind to susp. that patient subj to Hydroth.

Yet from circum which have now [stated] cannot deliver this opin without doubt.

And could only expect here from future opport of exam patient & from marking progr of disease to form decis opin.

Whether however shall now have such opport extremely doubtful.

And rather so, as although have not seen patient, learn that sympt are upon whole aggrav.

From this circum joind to opin of disease, progn cannot be fav.

Hydrothor occurring even in most fav circum always danger.

But partic so when takes place very late in life.

Notwith any meas which could have taken [ground] I think to appreh that patient would have fallen victim to [it]

If however should again return to attend here diff meas which might at least be tried.

Here unquest first & princip obj to be aimd at in, cure is remov of water

And although often more diffic effected than in some other cases, yet to be aimed attempted at on some general princip.

[If] [however] doubts as to artif opening into cavit cont. water, in other cases, still greater in this.

And partic till absolute certainty of pres of water by distinct fluctuat, could nevr be thought of.

Here therefore may be consid as [entrly] reduced to use of attempt cure, by nat [outlets]

At least by remov water in first inst from cavity of breast by absorbents

But after thus taken up may be as it were artif disch.

And in pract, few modes of cure found more effect than applic of Blister.

Where strongest reason to susp diseases have in partic best effects from applic to chest.

To this pract therefore was intent to have had recourse with pres patient

Began therefore by directing Blister in hopes that might both promote absorp from Breast and disch of water after [absorp]

But notwith. severity of affect. would seem that to this pract. patient [herself] very averse.

And accordingly was not applied.

With use of Blister here directed also cream of Tartar to extent of ℥i every morning.

From this had princip in view the obv. costiveness to which patient subj.

And hoped that while had effect of gently opening belly might also both in some degree mitig thirst, & encrease quantity of urine.

Under this med, was intent to [cont] patient regularly, while employd blister at short intervals.

And during this course, hoped that affect might have been removed

If this however had not been case & if from progr of disease certain evid that not been mistaken as to nature of it, two other remed to which had [view] of giving trial in succession.

viz Digitalis purpurea & the Melampod or Helleb. nigr.

First of late introd in dropsy & has been found partic success in hydro. from evac both as cathart & diuret.

Latter rather [revivd] than introd partic by Mr Bacher of France.

And under form of his Pilul. Tonica should here have thought of employin it.

Must however at same time obser, that if have yet opport of trying either, consid case as unfav.

With patient at 70^th year of age much freedom cannot be used with [active] med.

And if again returns to attendance shall wish to give first trial to blisters & cream of Tart as before proposed.