DEP/DUA/1/28/15 (Transcript version)

Effy Darling

(1781-1782)

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Effy Darling.

Respect disease sever. doubts.

Cheif two following

1 Whether solely a pneum affect or whether disease of breast compl. with an affect of intest. canal.

2. Whether pneum affect to which subj was to be consid as Phth or Catarh

Each of import. in pract.

But with regard to neith could in my own mind arive at any cert or even prob. conclus.

Disease prin consisted in cough dysp. & copious expect. of viscid white matter.

This matter accord to acct given us, of sensib qualit, neither smell nor colour of giving evidence purul. matter

And as far as could learn at no time with mixt of blood.

Notwith these circum however might still have cont. mixt of purul.

And had no opport. of determ by most accur. tests whether this really the case.

Hence then though sputum such as every day occurs in mere catarrh yet afforded no evid of abs. of Phth.

Might be thought in fav of suppos of catarrh that without fixd pain in breast & that patient could lie on [either] side.

These however, although const symp where large abscess, yet do not occur in every Phthis.

Might be thought also, against Phthis that had already cont. for space of a year.

For in most inst at least Phthis fatal before that period.

And if this not the case, is at least very distinctly markd in greater part of cases inst. long before that time.

This have no doubt will happen wherevr Phthisis strictly so calld has subsisted for 12 months.

But where case begining under form of catarrh degen into Phthis. may hapn at much later periods

And in this way patients cut off by catarrh Phthis where catarrh itself had [prev] subs even for sever. years.

Upon whole had little doubt that affect of this patient, began under form of catarrh, & had subs in that condit for consid time.

But was inclind to susp. that ere she came under our care, had deg into Phthisis.

That is, with separ of mucus from lungs, now also consid separ of Pur.

To this opin, in some degree led, from state of tongue.

For had pecul moist & clean app.

A circum never failing to arise from purul. expectorat.

And without this, with such quickness of pulse as here occurd should have supp. very diff state of tongue.

But quickness of pulse itself still stronger ground of presumpt

For never almost obs. under 100

Often at 120.

Both in great quickness then, & in consid variety some indic of Phthis.

To these would also add state of disch by belly.

For here ground for susp. at least that looseness occurring was the colliq diarrh. often obs. in Phthisis.

This indeed must be admitted not altog. without doubt.

For as already hinted some reason to suspect, that affect of alim canal & of lungs might be wholy unconnected.

For besides looseness, affected also with pains of belly, & uneasiness from wind.

And these had now cont for space of ten months.

Pains however not fixd to any partic part.

Nor accomp. with any circum which could give reason to suspect local affect.

Concl. them therefore, to be merely effect of flatul, & that arising from weak state of alim canal.

And inclind to think that from this circum only, colliq looseness had occurrd sooner, than would otherwise have done.

Upon whole then though by no means cert was inclind to consider all circum as belonging to one disease.

And lookd upon it as being now an inst of Phthisis origin from Catarrh.

With this idea of affect. opin as to termin, could be by no means fav.

Phthis a disease which although not always fatal, yet comm. so.

And indeed whether conject well founded or not, many circum in case threatn danger.

Besides severe looseness & quickness of pulse this indicated by marks still more stricking

Her obv. exhausted app & great loss of strength.

Hence then from commen of this case hopes by no means fav.

And from what saw of patient while able to attend us, or have since learnt of her, no reason to alter opin.

Will be much contrary to my expect, if disease has not in end fatal termin

And indeed would not surp. me to learn that such event has already taken place.

During course of attend, pract almost solely directed with view of mitig urgent sympt.

When came undr care her most urgen sympt the severe cough.

Was with view of mitig to this that had recourse to mucil. mixt.

And no doubt, that from effect of lubric fauces, has often in this way very consid influ.

But here empl. with addit of consid prop of Liq. Laud.

To extent viz of dram to six ounces

That is between 10 & 15 drops to ℥.

From this had in view also the mitig of cough.

For unquest that from dimin sensat has very powerful influ in restr. tend inord action.

And accord. where cough necess for expuls of matter from breast, bad affect.

This so much the case, in pres. inst, that should have been very doubt. as to empl. had it not been for two other circum.

Pain of belly viz, & looseness.

Exp. that from grad introd in mannr here prop. would be useful against both

And that in such affect often serviceable is subject of daily observa

Even when cause such, that cannot be expected to cure, yet in gener. prod of tempor relief.

Cannot however say that found this to be case in pres. inst.

From empl. at first indeed, cough whethr from veget mucil. opium, or any other accid circum, consid dimin.

But looseness still cont. nearly in former state.

And in every other respect, no mitig of affection.

Pulse in partic still so freq as 120 in [mint]

Now however nothing at least more urgent than before.

And imagind that by contin of med formerly ordered, advant. then exp might be obt.

Directed therefore that should persist in use as formerly.

But during this in place of farthr mitig, cough very consid aggrav

And looseness so far augm. that had in gener. 4 or 5 mot. during course of every night.

Neither of these effects however could in any degree be attrib to the med.

On contrary cause from which arose obvious

And could have no hesit in attrib them, as she herself did, to expos. to cold during night.

For from looseness then freq. obligd to rise & that too even when sweating.

This of itself suff. to induc both cough & looseness.

Still more to aggrav these when already existing.

Now therefore became requis. to do something farther to counteract them.

And at same time to preven. future influence of this cause of aggrav.

For these purposes however nothing seemd better suited than pushing the opiate to a greater extent.

Hence then with contin of Liq. Laud as formerly ordered opium to be taken in form of pill to extent of gr. every night at bed time.

Under this med, cough app. to be at first somewhat easier.

But had no affect in dimin freq. of stools.

Now concl. therfore, that not to be restr. by quiet dispos. to action, in intest. canal.

But that necess to employ astring to prevent depos. of serous fluid in intest.

Or at least expected more advant from conj of astring with opiates, than from employm of latter alone.

To mucil mixt therefore, substit infus. Japon.

Which formd by solut of Succus Japon to extent of ℥i, in ℥VIII. [Ag.] [Ca.]

In this mode of preparat when succus Japon not very pure, get rid of impurities.

For clear liquor pound or straind off from sedim cont. all earthy matters.

Is therefore one of best forms for exhib Succus Japon in most [pure] [state]

To this infus. superaded the Laud.

And to save the having recourse to diff med. encr. prop. of Laud & augm dose at bed time.

From use of this med, were [inform] at succeeding report, that looseness somewhat abated.

But cough & othr sympt still cont. as before.

And now strength had so far faild that unable to attend.

As med however prod of relief directed contin.

And at succeeding report were informd afterwards learnt that both cough & looseness cont. still somewhat dimin.

Could not howevr consider her as upon whole benefited.

For weakness & faintness so great that little able to be out of bed.

Since that have heard nothing farthr of pat. for space of some weeks.

And must own that am inclind to suspect, that if still alive, is not in more fav situat, than when last heard of her.