DEP/DUA/1/27/10 (Transcript version)

Margaret Proudfoot

(1781-1782)

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Margt Proudfoot.

Compl of this patient evid not all connected with each other.

And whether to judge from state of sympt. when came under care or to from origin & progr of these can have no hesit in pron that affect of throat & stomach unconnected.

To latter has been subj for sever years.

But although not to be disregarded yet less alarm to her than affect of throat.

Was on acct of this princip. that applied for assist at the Disp.

And was with view to it, that selected her as subj of lect.

For affords in my opin an inst of that affect not without singul.

Evid cannot be referrd to any of five species into which the genus of Cynanche divided by Dr Cullen.

Nor do I think even, that with strict prop. can consid it as examp. of any of 15 species referrd to this genus by Mr Sauv.

Yet in as far as disease charac by pain & heat in throat with diffic of respirat. deglutition have unquest. the charact of that affect.

And if affect were not so deep seated should also have those of tumour redness & perhaps also likewise of ulcer.

Here however affect deeper seated than visib from insp of fauces.

And began also in very diff manner from what commonly the case.

First commen under form of exter tumour, not very dist at least from place where at pres most pain internally.

In proport as this began to disapp internal affect aggravated.

Such a success however well known to occurr. in case of many glad effect.

And from remains of obvious tum when patient came under our care had appear of being of that nature.

May therefore with probab. concl. that simil. gland tumour seated internally.

And on such a suppos. all sympt of this affect. may I think be readily exp. as far as respects compl. of throat.

Diffic of swallowing, pain & other circum, necess conseq of situat & nat.

While throbing sensation well known to be const. concom of suppurat. going on, in such tumours.

And great reason to presume that before patient came under our care not only some suppurat but even actual rupt of it had taken place.

Of this at least strong presumpt from bloody disch which had taken place.

And while viscid matter, expect under form of mucus, which she think comes from affected part of throat, probab. cont. mixt of pus.

This then opin as to affect of [illegible] when patient came under care.

And what have since had occas. to learn tends still more to confirm that conject.

For during treatment in this place affect of throat for some time rather aggrav as otherwise.

And that too with augment of throbbing sensat. indic, tenden to fresh suppurat.

This however again very consid relievd.

But did not take place till after a consid disch of blood, which again according to feelings of patient, came from affected part of throat.

In all probab. therfore arose from some rupt. of small vessels there

And whether attended with any purul disch or not, cert. that might here afford dimin of pain & swelling in same manner as topic bleeding.

Hence then consid this appear as in some meas corrob. former opin.

With this idea of nature of dis. may readily suppose, that could not entert hopes of speedy & fav. term.

Entire resolut & remov. indeed of such gland swelling, even without interpos of art, could by no means be consid as extraord.

But much more freq. the case that contin obstin for great length of time notwith use of most powerf med.

Very common also to find it, in such inst, altern declin & encreas, without any obv. cause.

Here from what had already happened reason to suspect that this might be case.

And after having already contin for space of two months had no reason to imagine that nature such as to admit of easy resolut.

And must observe that do not consid pres tempor relief as afford grounds for very fav sang hopes.

Should not therefore be surprised if soon again in same state as formerly.

Yet at least chance that intern as well as extern tumour may decline

And hope that may yet be able to dismiss patient, if not free from affect, at least consid relievd.

Hitherto however cannot say that meas. here empl. have had much influence in that way.

For must own that am much more disp to attrib [ease] which patien now has, to accid haemorh, than to any thing we have done for her.

And indeed from diff occurr have not hitherto been able to pros. with prop stead, any partic plan of cure.

At first ordered merely a simple gargar., basis of which Inf. Rosar.

This prin intended against slight topic [excorriat], which will obs. from hist of case, could be discov on insp.

Imagind that although such inter tumour as have susp, realy exist; yet consid part of uneas. might arise from this cause.

And that simil affect. might be still farther extended where not obv.

But had still farther in view, the observing at least for course of week what change might occurr in the disease

Here will observe that mixt. comm employd as gargle directed to be swallowed

This however not with any view to effects in stomach.

But merely for topic applic to parts of oesoph below what could reach if used only in form of gargle.

Under use in this manner for space of eight days only obv. effect. some encrease of spitting.

And that too as she imag. dep. on matter coming from paind part of throat.

But at same time as far as could judge from taste or smell of patien no reason to concl. that purul.

Or even that contained any great mixt of it.

With this state of disch however diffic of swallowing encreased.

This was inclind to ascribe to farther encrease of tumour enlargem of which might be attended with most serious conseq.

Judged it necess therefore with contin of former meas. to have recourse without delay to most powerf. [disc]

And for this purpose put patien on use of Mercury.

Was intent to have steadily contin this course for some length of time.

And even at next report if no obj should occurr meant to have ordered double quant of Mercury.

But before that time affect took somewhat of diff turn.

Was again attackd with bloody expec.

And disch of sever ounces seemd to her to come from affected part of throat.

With this also disch of viscid white matter still cont.

But at same time no more evid of being purul. or cont. greater mixt of purul. than before.

Was therefore rather inclind to look upon it as proceeding from rupt of some superf. vessels on tumour, than from rupt of integ of abscess formed from that tumour.

To this the rather led from diffic of deglut still contin.

For if rupt of abscess would soon have been perfectly easy.

Must however at same time obser that was by no means without doubt as to case.

And although patient imag. that blood from throat, yet was not cert. that might not in reality come from lungs.

In this state of doubt reckond it imprud to contin the Mercur.

Hence before any suffic trial by which could even judge of effects deserted use.

And here substit another med. operat of which, of very diff nature from former.

Directed for patient a powder const of Ji of G. Myrrh. comb. with ℥i. Cr. T.

Former of these artic, have in my own pract. of late years very freq. empl.

And in some inst of one of most danger affect which occas to treat I think with good effect.

Disease to which I allude is Phth. Pulmon.

And same opin of it, has also been formd by my Coll. at Disp Dr Webs. from his exper of use of it, in such cases.

Our pract in this partic derived from sever emmin pract. about London.

Only persons who have written on use use in this affect. Dr Griff & [Simmo]

But also very much empl. by Dr Saund. Dr Fordyce & others.

And these gentlemen also very fav. opin

If during pres course shall have occas to employ it in any consumpt cases, will then state more fully my sentim resp. it.

Here may only observe that opin as to utilit in that disease, has led me to extend its empl. to some others.

And am inclind to think that ancient opin as to power of giving disp to heal in obstin ulcer. by no means without found.

With this intent need hardly observ that long in freq use under form of Tinct. Myrrh.

Am for my own part inclind to think, that when taken into stom in subst. same powers carried to extrem dist parts.

With this intent then if tumour in throat had degen into state of ulcer. imag. might be benef.

But comb. it with Cream of Tart with view of obviat stim affects on stomach.

This also if whether haemorrh from lungs or throat, imag. might be of some use from refrig. power.

And likewise as having tend at least to keep belly gent. open.

These consid then led me to use of this remed.

And own wishd for some little time neither to be altog inactive nor to do very much.

For wishd to see what would be effects result from spont. haemor.

Was indeed a matter of doubt with me, whether these effects in end, would be salut or otherwise.

At same time, hoped so much from them, that should have been unwilling to do any thing to restr haemorrh. while contin moderate.

And was on this acct that gave up mixt with infus. Rosar.

Has now for space of week contin on use of G. Myrrh, with Crem of Tart.

And if no other conseq. has at least had good effect of keeping belly gently open.

But must also be observed, that at last report, both pain & diffic of deglut so much dimin, that consid herself as entirely free from affection

And this she herself was disp to attrib to powders empl.

Must however entert diff opin with regard to both these partic

Had little doubt indeed that throat much better than formerly.

But this as already obs. was inclind to ascribe to the spont. haem

And would not be very surpriz. if shall prove means of comp. cure.

Reckon it however more probab. that will again have some return.

And therefore anxious notwith pres. tempor ease that attend should still be cont.

Have therefore gone on with med already prescr.

And if no farther occas for any other meas, shall ascribe cure to natur haem.

If disease returns, & still hold same opin as formerly – Again Mercur.

Prob. Calomel with Cicuta.

If sentim attend. cure accomod to sentim opin then [formd]