DEP/DUA/1/24/12 (Transcript version)

Mary Watt

(1780-1781)

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Mary Watt

Case of complic nature.

And affect not altog depend on each other.

At same time equally little reason to belive cannot venture to say that altog. unconn.

Princip part of compl. and what at pres. most distress. is pulm affect.

viz Severe cough & diffic expect. Respirat.

And when consid quantit as well as qualit of matter expect. little doubt that the effect of secret. into lungs.

Hence as already obs of other cases to be denom Chron. catarrh.

At same time reason to presume that both cough & dysp. in some meas also supported by anoth circ.

Affect viz of alim canal which here takes place

This compl at pres. consists cheifly of borborigm & eructat.

Circum evid indicat praeternat flatul in alim canal.

This in syst. of greater part of nosol. consid by itself as a disease

And accord to Mr Sauv. defind in following manner.

Est morbus cujus praecip sympt. est flatuum ex primis viis per super aut inferiora rejectio frequens

This indeed by Dr Cullen viewd only as a sympt of Dyspep.

And must be allowed that seldom takes place without other sympt indic [deprav] condit in funct of alim canal.

Also little reason to doubt that in every inst ultim depend on this.

Hence then inclind to think that with prop. referrd to Dyspep.

Yet when other sympt charact that affect are wanting some advan from giving it partic name.

Hence then would here denom [affec] of alim canal to which pat. subj to be dyspep. inst of Flatulent.

And among diff species which Mr Sauv. has referrd to included under this genus no one to which can with greatr prop referr it than Flat. Lochialis.

For great reason to suspect that suppos of patient well founded as to origin from that cause deliv of dead child.

This affect. according to hist given of case commen. with patien no less than five years ago.

And during that time has alw been subj to it to greater or less degree.

While catarrh sympt on other hand neither of so long durat nor so const.

Cannot therfore suppose Flatul depend on these.

But on other hand reason to presum that flatulence may have some effect both on cough & dysp.

For well known that cough in many inst entirely from irrit of abdom viscer.

And from none more freq than stomach

Equally cert. that disten by Flatul. very great effect in prev desc of [diap]

Hence one of most com cause of Dysp

Reason therefore to presume that both cough & diffic respirat in some degree supp. by it.

But at same time no reason to concl. that entirely or even prin from this cause.

For while these const. this only at partic seasons.

And from aggrav. during winter as well as from state of expector no doubt of being at least prin catarrhal.

Upon whole then may be consid as subj to two distinct diseases.

viz Catarrh & Flatul.

From this combin more uncert with regard to prognos.

And judgem to be given of diff parts of affect not precis. the same.

Of the two hold the catarrh. affect to be most immed danger.

For while this freq. fatal termin Flatul though very distress. is [rarely] so.

Or at least only fatal in conseq of degener into other diseases such for ex as Tympanit or the like

But while esteem catarrh most danger affect, nothing alarm in inst before us.

Though some thirst yet has not excited what can be calld fever symp

And by no means in very debilit state

Reason therefore to hope that on return of warm weath will be relievd as formerly.

And that this may be facilit & promot by meas. to be employd.

At same time with this patient rank & situat in life every mode of cure employd with great disadv.

And if weather should become more intensly cold cannot even be surp. at aggrav of affect.

At same time greater expectat of benefite in this part of compl. than in case of flatul.

For although look upon it as less danger. now reason to appreh. that shall find it more obstin.

Has already resisted diff. means of cure

And notwith every attempt has contin obstin for space of five years

The rather to be expected on pres occas. as now catarrh most urg. comp.

And to this attempts to be first & princip directed.

This will more partic appear from view of pract employd with this patient.

When first came under our care, [begn] by direct. use of Emet.

This will readily suppose solely intended against catarrh affect.

Have already had occas to obser in more than one inst, that of all the tribe of expect none more useful than [Emet]

And while in such inst of [catar] serviceable as disch. mucus accum. in breast farther of use as tend to dimin secret.

For in this way consid influ in conseq of determin to surface.

Operat of vomiting however consid as being rather unfav as otherwise, to affect of alim canal.

For can be no doubt that by freq. repet. of such strong action, tone very consid dimin.

Was necess. therefore to take some meas, as means of counteract influ.

But besides this urgen of compl. of alim canal, even of themselves requird some aid.

And to these princip at least, other prescript. at same time with the vomit was cheifly directed.

I mean the pills the basis of which was the foetid gums.

For to this class the Gum Ammon. has been, & I think with prop. referrd.

Was however here conj with one still more powerful viz Assafoetid.

Effic of this artic from action on alim canal well known.

Can be no doubt that has remark influence both as induc action tend to expuls of wind, & as remov. spasm strict by which retaind.

Hence has been long & justly consid as one of most powerf. carmin.

Possess however such active power that can with safety be given only in small doses.

And while this one reason for conj with Assafoetid another was Ammon. had farther in view the obt. from lattr some effec as expectorant.

For by many of most observ. pract. has long been consid as having effect in this way.

And, I am inclined to think, with good reason.

Hoped therfore that pills might be both useful against flatul, & catarrh.

And while vomit afforded immed relief expected that by pills benef. then obt. might be secured.

Imagind also that would counteract effects of emet on stom, & that migh relieve patient in anoth way viz as obv. costiv.

Cannot however say, that from use, expect. in these diff partic by any means answ.

In obv. operat of vomit indeed were not disappointed.

And accord to acct. given us Cough & Dysp. for short time somewhat allev.

From pills also had at least satisfact to find that patient suff no inconven.

But notwith use cough & dyspn. soon recured again with same sever. as before.

An evid proof that secret. not dim & that secreted matter no less dispos. to be accum than before.

Were also disapp. in effect exp. from them as prom. disch of wind.

For at succeeding report found that patient had derivd no relief either from borborigm or eructat.

And although taken to extent of scruple in day had no effect in keeping belly open.

Notwith these disapp. howevr thought it at least advis to make trial of repet for anoth week.

Accord with contin of pills, ordered also repetit of emet.

Second trial however had not sam influ as first.

For from this notwith free operat of emet, no allev either of cough or dysp. obtaind.

And from pills no influ either in moving belly or counteract uneas from flatul.

From these consid then was led to think of trying some other course.

Or at least with same intent of trying effect of other remed.

In place of emet. theref, as mean of obv. cough & dysp. had recourse to blister.

And with view to flatul costiv & other affect of alim canal gave assafoetid conj. with aloes.

Former artic still contin with intent already mentiond

And latter now added as more effect means of moving belly.

While from blister expected relief of cough as giving determ from breast.

And was intent to render this change in circulat more perman. by [supp] disch under form of issue.

Effect of first applic of blister was disch as copious as could have expectd

And to this may I think reason ascribe allev. of Dysp. & Cough which at same time took place.

From pills in operat as moving belly, were not disapp.

For had in gener. two stools & these rather loose as otherwise in space of 24 hours.

And what to be consid as a [matter] of more conseq under use Borborigm & eruct. less [distress].

On this course therefore patient has now been contin for space of two weeks longer.

Cannot howevr say that progr. to cure has contin been consid.

Or even that patient contin to derive from pract. same relief as at first.

This however in as far as respects cough & dysp. am inclind in some meas to attrib disch not being duly supported.

And from this led again to order repetit of fresh blister.

Must howevr observe that from pres course after trial which has already had expect. not now [sang]

And if do not find patient soon deriv more consid benef. from it shall think of changing for some other [mann]

At same time know none from which to expect equal advant against cough as from Emet & Blisters.

At least nothing more effect unless were in our power to send her to warmer climate

Or what next to that afford her warm cloathing & comfort lodging in this country

And from latter of these circum must observe that in some respects more prop for hospit than Disp Pat.

Here however must content ourselv with aiming at that relief to be obt by med.

And if obliged to othr trials may yet again perhaps have recourse to Emet & Epispast.

And if at pres. think of alterat shall next probab. have recourse to Pil. ex Allio Garlic

And as most conven form shall exhib it in state of Pil. ex Allio.

From this some hopes of good affect both as relieving cough & dysp & likewise as counteract flatul.

But upon whole more to be hopd for from change of weather season than any other circum.

If cough allev, with respect to stom compl. & flatul. many diff meas may be tried.

Partic vegetal bitter, & aromat infus.

But [there] in some meas [contra] indic till allev of cough & dysp. can be obtaind.

And if that shall be effected [futur] plan then to be accom to circum of case at the time.