DEP/DUA/1/30/16 (Transcript version)

Arabella Wallis

1782

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Novr 11^th. 1782.

Arabella Wallis at 10. of a pale & yellowish countenance, dark coloured hair & eyes, is affected with very frequent & sonorous respiration attended with a short interrupted cough

This symptoms suffers frequent exacerbations & remissions at uncertain periods, but she is never wholy free from it. She expectorates but little & her sputum is not very viscid. She complains of pains in her forehead chin, ears, breast & the region of the umbilicus. She has frequently the sensation of a ball, rising from her stomach to her throat & inducing an asthmatic paroxysm.

But she has never discharged any wind. She has frequent contractions of the fingers & pains in the calves of her legs. she has sometimes cold shiverings succeeded by febrile heats

Her sleep is interrupted during the night.

P.120 rather full but not sharp or hard. Tongue natural, Belly regular appetite indifferent. She is sometimes thirsty. She had the measles about a year ago since which she has been much afflicted with Catarrhal symptoms for which she was admitted a patient at the Dispensary, on the 12^th of September

Her pulse was at that time above 100, she was also troubled with dyspnoea but in a less degree than at present & her respiration was not then remarkably sonorous.

She had two vomits & a blister & was dismissd relievd.

Very soon after her dismission, which is about seven weeks ago, she was suddenly affected with the symptom describd in the case, but with much greater violence than at present.

She had a blister immediately applied to her back without the least relief. The mother ascribes good effects to the Mistura Oleosa which she has been taking now above a month

She has had three vomits without deriving the least advantage from them.

The present affection began without any obvious cause & she finds no alteration in it from change of weather or exposure to different temperatures in respect to heat or cold. She is remarkably acute & sensible for her age, as appears from the answers she gives to the questions put to her.

Novr 16. Rx. Spt. Aether. Vitriol

℥ii. Mucil. G. Arab. ℥ii. Ag.

Font. ℥IV M. cap. ℥P. bis indies.

nec non Rx Calc Zinci. gr iii

Pulv. Valer. Sylv. Ji. M. cap. dos om. m.

23. Has taken the mixture with the Spiritus Aethereus without any inconvenience, but the powders have in general produced sickness at stomach & sometimes vomiting

Her respiration is on the whole rather easier but still much affected.

Janr 11^th At one o’Clock after complaining of a stich in her side & the sense of a ball rising to her throat, she fell into a Syncope which terminated fatally. She had taken the last spoonful of the medicine prescribd for her the night before her death & had no stool for twenty four hours previous to that event. The last thing which she took was a draught of cold water.

Janr 12 one p.m. the body was opened. The Trachea was perfectly sound excepting a small ulcer at the head of the Larynx.

Some water was found in the cavity of the Thorax & about five ounces in the Pericardium. The heart was in a sound state but containd a large polypous concretion in the right auricle & ventricle.

The lungs adhered in several places to the pleura [wall] full of small hard knots & on incision discharged a considerable quantity of purulent matter, but no large ulcer was found in them.

The cavity of the abdomen containd six or seven ounces of water.

All the abdominal viscera were in a sound state, only the kidneys were larger than usual & the Lymphatic glands of the mysentery appeard somewhat enlarged. There were some constrictions in the course of the intestines. The omentum as well as they tata adiposa containd more fat than might be expected considering the long duration of her complaints.

We are informd that for some time before her death she had evening exacerbations of fever, with encreased cough & dyspnoea. She could not lie on bed easily on either side & slept generally in an half erect posture, supportd by pillows. She had no sonorous respiration for some weeks before her death.

Opin formerly deliv of this [patiens] disease that was female of pecul irrit habit.

And although only in very early period of life yet subj to distinct markd Hyst

From this cause inordin action [taken] place even without any obv. circum [excit] it in many diff parts of body.

But more especially apt to affect muscles of Larynx.

Probab. effect of some local markd affect there.

Now therfore necess. that from acct of death & dissect. just read, should consid how far reason to believe that this conj. well founded or contrary.

And How far evid of any other affect, of which did not entert susp.

And to what cause death of patient with greatest probab. to be attributed.

Here must acknowledge that event of disease has been diff from what expected.

And that has taken place also in diff. mannr.

Did not imagine that would have termin fatally.

And little expected, that if such event had been to take place, would have occurd in manner that did.

If as formerly supposed, patients princip disease of hyster. kind, not to be consid, as in its nature very danger

And little reason I think to supp. that from this cause death has ensued.

This however gives no ground for conclud. that patient was not realy subj to hyster.

For certain that hyster may be compl. or occur at same time with most danger. diseases

Thus as in case before us not unfreq. the concom of Phthis.

Within these few years have lost two patients sisters of same family both of whom died of Phth. distinct [markd]

And in both, for years before Phthis began as well as during course of that affect. Hyster fits & other sympt. to very great degree.

That from dissection, [no] proof of hyster afforded, cannot seem surp.

For well known to be a disease where in very rare inst only that any local affect to be detected.

And when such are found, much more freq. conseq. than causes of the disease.

Hence then dissect affords at least no object to former suppos of hyster.

While many of sympt partic glob. hyster. which attended disease through whole course gave strong evid of it.

Next to Hyster. sympt what at one time at least the most alarm. was affect of Respirat.

This I formerly endeav to shew probab. princip proceeded from spas. affect of muscles of Larynx.

And that thus connected also with hyster.

But from const. of affect, as well as length of time for which had subsisted, concljected that must be supported by some local affect.

And after dissect. must own am now at loss to say whethr app. [illegible] corrob. this suppos or not.

Not long after last lect. on subj must own was inclind to desert supp. of local affect.

For suddenly & indeed unexpectedly entirely ceased.

And that too without any obv. change such for example, as disch of purul. matter, uncommon expect or like, which could give reason to believe the remov. of any local affect.

For this therfore was I own led to concl. that former idea a mist one.

Yet upon exam of Larynx on [dissec] an evid local affect was discov.

An ulcerat viz in Larynx at head of Trachea.

From this app. however no point conclus. can I think be drawn.

Suppos. to have taken place while pecul affect of respirat existed, are yet uncert. how far a cause adeq. to effect.

But besides this to be remarkd that this sympt had been totaly absent sever weeks before death.

And that whole app. here found may have occurd after had entirely ceased.

On the other hand however may have been conject, that what now found, merely remains of larger affect of same kind

And that when sympt subsisted if not dependen on more extens affect of same kind, at least connected with it.

Thus then would inferr that from app. found, no certain conclus. can be drawn.

At same time, think it more prob. that this local affect had some share in induc pecul noise in respirat; than that had none.

But must also acknowledge that was not of that kind which formerly [suspectd]

For appreh some uncom. tumour schirros or the like

And of these no vestiges or indic

Polyp. concr. in ventric & aurum hardly to be rankd among morb. ap.

For almost no case in which wanting.

And merely effect of [congt] of blood after death.

But whether this local affect any concern in disord respirat or not, dis [illegible] other morbid app. with which no doubt that death of this pat. more imm connected.

That is affect in cavity of Thorax. Exam of this cavity discov. two causes well known to prod. powerful danger. & even in general fatal effects.

These were a dropsic affect & a purul. state.

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In cavity of Thorax, partic in right side a very consid quant of water was found.

And in pericard collected to extent of five or six ounces.

From this cause am now inclind to think that sever circum occurring in case were to be expl.

Had prob. very consid share in inducing & support both cough & dysp.

But still more now suspect it to have operatd as cause of deliq. anim

For undoubted that whethr from [comp] of blood vessels or any other cause, with water in pericard. fainting fits often connectd.

Must however own that during life of patient suspectd these to be entirely hyster. faints.

And this suppos. I thought, if not proved, rend at least very probab. from their being preceded by Glob. Hys.

When however considr that one of these faintings had fatal termin. prob. that arose from more serious cause.

And presumpt even that water in the pericard. immed connected with death of patient.

But although this the case, deserves to be remarkd, that affect during life not attended with those sympt commonly consid as indic. Hydroth & Hydr. Pericard.

But besides this dissect shewd us another import. morbid affect.

Purul. matter to consid extent in almost every cell of the lungs.

Upon cutting lobes both on right & left side could be squeezed out by gentle press. from almost every [vess]

And that realy purul. might be inferrd not only from app. but also from sinking compl. & entirely to bottom of water.

From this then app. that to affect formerly mentiond in lect. must not only superad hydroth. but also Phth. Pulm.

And that this the source of many of sympt cannot now be doubted.

Besides influ as induc. encr. & support cough & dyspn. are to this probab to referr constant quickness of pulse, as well as diarrh. with which [illegible] [close] of disease, very much affected.

When this latter sympt occur in general supp. that in Phthis. death not far distant.

And not impossib. that by compress of lungs from water without & purul within that event not a little [hastnd].

Perhaps had even more influ than water in pericard. affect. heart & large vessels.

Here however to be obs. that though patient much reduced in point of strength was yet not in situat in which [those] dying of Phthis. comm. are.

Had not operated so far in [exhaust] the syst.

For still consid collect of fat both in Tela adiposa on surface of body & also in cells of Omentum.

If therefore do consid her as dying of Phthis was not cut off in ordinary manner.

And while death, did not happen as affect of exhaust. so could not consid it, as proceeding either from hectic fever, or suffoc on fruitless attempts to expul. of purul. matter.

But whatever may have been here cause of death, dissect. shewed two diseases, of which I own during pres. illness had but little suspic.

viz Phthisis Pulm. & Hydroth.

Of former indeed when now again examine case see sever. circum [which] might have given susp.

Partic cough, dysp. & quickness of pulse.

Still more the origin to which her affect was attrib. viz. Measles.

And indeed when first admitted a patient at the Dispen in Sept last her affect cheifly app. under form of Catarrhal sympt. threat. Phthisis

But was at that time very much against suspic of Phthisis, that these soon yielded to remed then employd.

Partic an Emet a blister & the use of Mist Oleos as demulc.

On readmiss, though some of catarrh sympt still remaind, yet other app. so much more distress. that these alm entirely overlookd.

And attent solely engagd with pecul noise in respirat, glob. hyster. flying pains, contract of fingers & the like.

While at the same time but very natural to suppose that cough & quickness of pulse proceeded from same cause with other affect.

And well known that both of them very freq. hysteric sympt.

This case therfore as well as many others which have before occurd to me in pract. demonst. insid nature of Phthisis.

And shews to what advanced [period] will often arise where yet no cert evid. or even strong susp of exist.

If this however the case with regard to Phthis not less so with respect to Hydrothor.

Of this affect I own had never any suspic.

Nor indeed did there here occur almost any of those marks by which in gener. thought to be charact.

Confirms therefore the truth of an observat made in practic course that hydrothor. often exists when all sympt. by which has been defind by nosol. entirely abs

Had we been able during life of patient to discov. real nature & full extent of disease, would not I own have followed that mode of treat. here adop.

Should have been less anxious then about counteract. some of most urgen sympt. partic those of hyst. kind.

Would not prob have had recourse to Zinc or Valer. although from these no bad effect on either comp to be appreh.

Still less should I have employd the Aether & Tinct. Fulig.

For action on stomach that viz of stimulus augm impet of circulat. unquest unfav to Phthis.

These however which were [illegible] to counteract alarm sympt at the time, contin only for short period & never given to any great extent.

Can hardly therefore suppose that were prod of any bad effect.

And such at least we may vent to say did not obv. occurr.

While had so far the effect of prod temporary mitig of sympt.

For obt. which even where Phthis or Hydrothor. known to be pres. often necess to have recourse to pract. adverse to the disea

Although therfore if had known real state of matters, would not [perha] have vent to have empl. them am yet inclind to think that did here more good than harm.

With regard to other pract empl. partic Emet & Blist. are the remed which would have cheifly depended on if had known nature of disease.

Know no remed from which both in Phthisis & Hydrothor. more to be expec or more obt.

And same also may be said both with regard to Elect Japon & Theb. Tinct. where colliq. diarrh. occurs.

Hence therefore more from accid than intent, patient had here that chance of recov, which most active med, that in my opin, could have been with prop. tried, could have given her.

[Many] other active remed indeed used both in Hydroth & Phthis.

Thus strong cathart & diuret [often] success. used in formr, blood letting in latter

But while first [illegible] in Phth last still more so in Hydroth.

Hence then had we been even fully acquainted with diff affection to which patient subj. do not think that remed prom greater success could have been empl.

And indeed thorough knowledge of disease would have precluded all hopes of recovery.