DEP/DUA/1/30/14 (Transcript version)

Arabella Wallis

(1782-1783)

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Arabella Wallis.

With regard to this case have very great diffic both as to name & nature.

And not altog. without susp. that this diffic somewhat encreased by pat. herself.

Have some susp. that if be not cap. of altog induc. can at least aggrav. most consid & obv. part of affect.

Affect viz of respirat, partic as attended with pecul. noise.

If this realy the case, hard to say what can be motive for it.

Here no advant from it.

Perhaps even no other than by shewing it in worst state the more readily to obt. most effect aid.

But whatever be in it, some ground at least for suspic.

Partic from its having been repeatedly observd that affect. much less consid when sits in waiting [rooom] than when calld in for report.

But whether affect real or fictit is in sever. respects such a one as have not before met with in pract.

And for my own part although [inclin] to susp. that app. somewhat aggrav. yet look upon it as being prin a real disease.

To this opin the rather induced from diffic which conceive, there would be, in entirely feigning it.

At least for my own part find, that cannot by any volunt effort, emit such sound in respirat. as here takes place.

At same time, where from diseased state of parts, such sound in some degree emitted, can easily conceive, that by volunt effort, may be augm.

Taking this view of case then, if not princip, at least most remark [symp] of disease consists in pecul. sonor. respiration.

This of such a nature that cannot pretend to convey any idea of it by words.

May only obs. to those who have every had opport. of seeing pat. lab. under that disease, which in this [country] comm. known by name of Croup, that appr. more nearly, to noise then emitted by respirat, than anything else with which I am acquainted.

This pecul. noise which as occur. in Croup has by some been comp. to crowing of cock, though resemb. by no means accur. is by many consid as a cert. pathogn of that disease.

That is as a sympt. always pres. in croup never occurring in any other affect.

In that view then, would be disp to give to pres. disease the name of croup.

But if has this one mark of that affect, wants almost every other.

And still more diff from that affec in progr.

For while Croup so rapid in progr. as to prove fatal, sometimes in space of few hours, seld. cont. for many days, pres, from contin which has already had, may pron. to be in some degree even a chron. affect.

Probab. diff from it not less in degree of danger.

For Croup a most alarm affect, unlss speedily termin by prop interp of art.

Here however must obs. that with regard to nature of this disease, pract. by no means agreed.

And hardly two who have written with regard to it, entert same sentim as to immed cause of prin & charact. sympt. viz pecul. sonor. & diff [respir]

Croup a disease known only in few places of Brit.

Or at least, if has there in others sometim taken place, conf. with other different affect.

Hence nothing said with regard to it, by any of older pract of emmin

First public on subj. with which I am acquainted, an inaug. dissert. pub. by Dr Jas. Simson of St Andw, in the year 1762 entit De Asthm. Infant Spasmod, cum ranca voce & respiratione sibilio.

In that, as you will indeed inferr from title, consid disease as being entirely of spasm. kind.

And looks upon affect of respirat, as well as pecul noise with which attended, as proceed totally from strict taking place in muscles of Larynx.

Not long after this, viz in the year 1765, Dr Home pub. at this place his inquir into nature, cause, & cure of the Croup.

In that, gives very diff view of prin. affect.

Ascribes both diff of respirat, & pecul. sound in breathing, to a memb. formd in the inside of Trachea.

A few years after Dr H. public, an inaug. dissert. app. at this place by Dr Crawf De Cynanche Stridula.

In that dissert. great part of which taken from lect of late Dr Greg. the auth. contends that the disease entirely an inflam affect.

And ascribes both diff. of breathing & pecul noise, to inflam of Trachea.

In this, adopt. also the sentim of Dr Cullen who has stiled the Disease Cynanche Trachealis.

Besides these, sever. other authors have since written upon this subj.

Partic. Millar. Rush, [Mease], [Miha] &e.

But have adopted one or other of opin already ment. those viz of Spasm, Inflam, or Membr.

Into this controv. cannot here prop to enter.

And the rather as have never in my own pract. seen many inst of these affect.

But from all that have seen, am most inclind to sentim of those who hold it to be prin a spasm. disease.

Would not indeed pretend to deny that white memb. is not freq. formd on inside of Trachea.

This however consid. not to be most cause but merely conseq. of disease

And from all that I have seen am inclind to consid it as nothing else but viscid mucus.

And as when does take place can only be late in the disease, while in some cases entirely wanting, althoug may undoubt. augm diff of breathing yet can neithr look upon it as prin. cause of this sympt. nor of pecul. noise in Respir.

My sentim with respect to inflam nearly the same.

Have no doubt that inflam of [Trachea] often exists in Croup.

When exists will undoubtedly produc. some affect of respirat in diff ways.

At same time reason to believe, that in many common catarrhs, & in other species of Cynanche, such inflam takes place without any of charact. sympt of Croup.

And certainly no reason to believe, that such inflam conf. to that early period of life during which alone Croup can be said to occur as a disease

Infants however well known to be subj to spasm. affect. from very slight causes, which afterwards would have no influ.

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Where inflam of Trachea takes place in tender & irrit habits, spasm affect of Larynx will much more readily be induced, than in any other circum.

Thus I appreh croup often superv. to inflam, or rather compl. with it

Thus by removal of inflam, croup also removed.

But appreh. that without spasm of Larynx can neithr give diffic of breathing, nor pecul. sound.

That from such spasm alone, croup often arises corrob. by many circ

But partic proved from manner in which disease makes attack.

For in many cases with those [before] in perfect health, arises suddenly to greatest height at once.

Proved From manner in which often disapp

For in some inst. as instant attack so also instant recov.

And lastly from its being observd in some cases at least, that this affect of respirat altern with spasm affect. taking place in other parts.

To these may also add, that by a volunt, contract of musc at head of Larynx, can prod a sound somewhat simil to that in croup.

May therefore reasonably inferr, that a stronger & involunt contract, most ready cause of prod that mode of respir. which charact. this disease.

May likewise obs. that although most success. pract, not hitherto [perfec.] ascertaind, yet many remed empl. with greatest advant, such as will [counteract] spasm.

For from some late trials, by diff pract. appears, that warm bathing opium, & aether empl. with great advantage.

As remov. & counteract spasm also may acct for good effects of Emet.

And as far as my exper. goes no mode of cure, attended with equal benef. in this affect.

In most urgent circum. where oppress of breathing almost [insup.] have seen from Emet. most remark relief.

And at least much more [concom.] to what we obs. in comm. pract. to suppose that oper. by remov. spasm than by counteract inflamm.

Must here however obs. that for my own part, at least, am disp. to attrib prin benef. from emet. to their operat as expect.

And relieving respirat. by disch. large quant of viscid mucus.

Which however suppose to be [retained] there by spasmod affect of the larynx.

From these consid [then] in place of referring croup to genus of Cynanche my opin is that should be placed undr that of Asthma.

And when considr how much is confined to partic period of life, perhaps best disting by title of Asthma Infantile.

These observ. on Croup seemd rather necess. that might state opin as to nature of pres. affect.

And how far seemd to me to differ from that disease.

Here also as in Croup am inclind to think, that pecul noise in respir. is prin effect of inord. action of [musc] of Larynx.

And this the rathr probab. when consider that here evid sympt of inordin action in other respects.

For among other partic mentiond in case, is often affected with globus hysteric.

And probab. that not only contract in fingers & legs, but flying pains also in head, ears, & breast, sympt of the hysteric kind, & depend on inordin action.

At same time can hardly [illegible] cause of this kind to have const. existed prod such affect of respirat for so great length of time.

Am therefore inclind to think that [here] there must also take place som local morbid affect of Larynx.

And that by this means inordin action or even volunt effort of these muscles, prod sonor. respirat to that remark. degree which with this patient have often had occas to observe

My idea then of disease of pres pat. is that she is a female of pecul irritab. habit.

And although only in very early period of life, yet subj. to distinct markd Hyster

While from this cause inordin action takes place even without any obv. circum exciting it in many diff. [parts] of body is more especially apt to affect muscl. of Larynx.

As prob. these there exist about parts concernd some local morbid affect.

This opin however cannot pretend to offer with any great degree of confid.

And at that you will not be surpr. after what already said as to suspic of app. at least of affect. being intent aggrav.

But even suppos conject to be strictly well founded, still very uncert. as to Progn.

Regarding case which have not before met with in pract. cannot form any opin on ground of former exper.

And as far as can judge from [former] exper. are in little less doubt.

Suppos local affect to exist may yet be of such a nature as to be easy removable.

More probab. however, that if ever, will not be speedily accompl.

With regard to hysteric affect as little reason to look for exped. cure.

Well known to be a disease which when once rooted in constit. very diffic to be overcome.

And here reason to fear will be pecul. obstin from having taken place at so early period of life.

At same time from this circum. some ground for hopes.

As constit. in progress of life soon subj to many changes induc very great alterat.

Some of these however such for example as app. of menst. flux often tenden rather to aggrav than dim. hyster

On these grounds then reason I think to fear that affect will be obstin.

Will not be less so, if patient as we susp. has any partic reason for wishing to app. worse than she is.

Upon whole then shall not be surp. if after all efforts, leave her in no better situat than have found her.

Or even with affect. rather aggrav. than dimin.

At same time see no reason to fear that will suddenly or rapidly encrease.

And still less to appreh. that in the end will be attended with fatal conseq.

For hysteria in all its diff [modes] much more alarm than danger.

If therefore does prove fatal, will prob. be by local affect of Larynx disturb. vital funct of Respirat.

This however only to be dreaded from grad encrease by long durat.

And if does take place disease will prob. ere then have put on other appear.

Although therefore in this case have no sanguine hopes of accompl. speedy cure, yet if pat. contin regul. attend. may at least afford opport. for trial of diff. pract.

Here however must own am much at loss to think what can be tried with any great prosp. of success.

Have already without effect had recourse to diff remed.

And these too such as in my own pract. have before found most success. in cases of genuine Croup.

Have tried without any benefite repeated Emet.

And have had recourse with no better success to applic of blisters at diff. times.

From this have since been led to other pract. of which have less exper.

Some of these meant to counteract & remove spasm when had already taken place.

Others to prev. return.

Was with first of these intent that had here recourse to Vitriol Aether.

This artic [well] known to be one of most powerful antisp. with which we are yet acquainted.

And on this the activ of mixt. [first] prescr. entirely depended

For water & mucil with which was combind intended merely to give prop. formula for introd.

While this however empl. with view of allev. affect. had recourse to anoth remedy as means of remov. disp to it.

That was the Calx of Zinc.

For introd of intern use of Zinc as means of remov. spasm. affect. are prin indebted to late celeb. Dr Gaub.

And for first acct of it may referr. to Chap of Advers. where trials of Luna fixata [Luddeman].

For this app. that an Empyr. in Holl. of name of Luddemannus had empl. with great success. a nostrum of his in cure of diff. nerv. affect even of Epil.

From Chemic Analys of this med Dr Gaub. led to concl. that active artic the flowers of Zinc.

This led him to try these in diff. affect.

And having found use attended with remark success, thought it his duty to pub. acct of it.

On his authority tried by many practit.

And am sorry to say that have not all agreed in opin with regard to efficacy.

Some from repeateded disapp. consid them even as of no effect.

And no one I appreh. who has used them much can pretend to say that have never disapp. him.

For my own part have often found them fail, where regul. employd for due length of time & to as great extent as could easily be borne.

This however has in gener. at least happ. in affect which found [incur] by any other means.

And if sometimes have faild, on other occas. have succeeded even where did not expect it.

From this success which have often exper. look upon Zinc to be useful & powerful artic. in diff affect of the spasm. kind.

And my sentim in this respect corrob. by testim of diff pract. now publishd, in Med. Comm & other period works.

With these two med then began treatm of this case after selected as patient for Col. Casuale.

From Aether had at least no incon & at first imag that prod of some benef.

But Calx of Zinc which was given combind with Valer. had effect of in gener. excit vomiting.

This however ascribd more to Valer. than to Zinc itself.

With contin therfore of Vitriol [Aether] as before only encreas. quant. [taken] had recourse to Zinc in anoth form.

That viz of pills.

These though at first excit some sickness have since been found to sit upon stomach without inconv.

A circum augm probab. of opin that former sickness prin effect of Valer.

Although howevr now retaind with ease yet not prod of desird effect.

For disease very little if at all mitig.

And now became subj to anoth sympt. which consid also as Hyster.

viz Frequent deliq Animi.

In this situat changed aether for Spt. Salin. Aromat.

As from combin of Vol. Alk. with essent. oils afford. more warm & grateful stim to the stomach.

Still however have persisted in use of Zinc to which desirous of giving fair trial.

And under these med at last report, sympt upon whole found to be somewhat easier.

In this situat med ordered to be contin.

And while affect. contin allev will prob. persist at least for some time in same course.

If app. changed hard to say to what pract. may have recourse.

But if in pres. form shall find [them] aggrav. trials which have cheifly in view are use of, Electric. Assafoe & Peruv. Bark.

And if farthr reason to suspect that compl in any degree feignd, may [here] have recourse to renewal of the blisters.

But if these pract tried, & if case has termin in our hands [without] success. or otherwise shall prob. again make it the subj of few observ.

At pres. therefore shall say nothing farther with respect to it.