DEP/DUA/1/31/24 (Transcript version)

Ann Breakenrig

(1782-1783)

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Ann Breakenrig.

In case of this patient no circum which can be consid as any great singular.

And although sympt numer yet prob. that whole to be consid as connected.

Nay as depend on some common cause

Most alarm part of affect. pect. compl.

And here some room for doubt whether these to be consid as Catarrh or Phthis.

But besides these in this case still a third suppos.

This viz of Pertussis.

Of this affect however although her mother at first inclind to that suppos. in my opin from begining very little probab.

Founded almost solely on two circum severity of fits & pat. having not had that dis

On neither however could any stress be laid.

And two others by which these more than counterbalanced.

Want viz. of Contag. & want of [hooping] or back draught.

Pertussis well known to dep on specif contag.

And on this acct. in gener. obs. to occurr as an epidem.

In pres. case however no contag to which could be traced

And though fits of coughing severe, yet almost if not altog without that pecul. noise occurring at concl. of fits which seldom wanting after disease of any contin.

And which has justly been consid as almost if not altog. pecul to Pertussis.

Besides this nothing of vomiting or indeed of any other of these sympt by which Pertussis disting from other coughs.

Here then little diffic in reject this suppos.

And of two others have been all along I own most inclind to suppos of catarrh.

To this chiefly led from absence of hectic fever.

For although pulse quick & skin hotter than natural yet neither manif shivering fits nor febrile xacerb.

Besides this no reason to imagine from what had opport of obs. with resp to expect. that containd purul.

No presumpt of this from state of tongue, which with purul. expector in gener. obt. partic cleaness.

And in [swalling] expector. matter no more than happens to almost every infant at age of our patient.

While again quantity of matter raised from breast much more in fav of Catarrh than of Phthisis.

This opin that pector affect merely catarrhal now still farther corrob by mitig of cough

An event which could hardly have expected to take place if

But although from these circum inclind to suppos of Catarrh, yet not without strong appreh that will at length termin in Phthis.

And this the rather to be appreh if idea respect pres catarrh well founded.

For hold that here dispos to encreased secret by the lungs connected with Scroph habit.

Of this habit in mother have evid by large glandul swellings about neck.

And although not thus charact with our patient, yet here I appreh other marks of it.

For in pains of belly, especially as accomp. with swelling & tension, have grounds for susp. such an affect in mysenter. glands.

To Scroph then am I own inclind ultim to referr both pector & abdom affect.

And this I think the rather prob. from attending to origin & progr of affect.

Partic from bad health even from [illegible] periods of life & from consid aggrav since lab. under the meas.

A cause from which well known that scrophula in the habit partic as affect intern parts often very much aggrav.

With this view of disease progn cannot be favour.

From app. indeed do not consid patient as in any immed. danger.

And should not be surprized to find even consid tempor. relief.

At same time appreh is that from scroph affect intern glands, patient will at length fall victim either to Phthis Pulmon or to Tab. Mysentr.

But still more immed than either of these have I think reason to dread the occurr of rachitis.

This an affect not unfreq. in som degree complic with Scroph.

And tend to it in pres case evid indic by general weakness, by dullness, inability to walk & pains in joints.

From occur of this therfore, not improb. that patient may have in consid inconven.

At same time reason to think that conseq. will more immed [inconv] than danger.

And is chiefly from one or other of affect already mentiond that reason to dread fatal conclus.

Am however hopeful that neithr of these have as yet taken place.

But with such tend in habit to that affect as here suppose to exist expect. from use of remed cannot be very sanguine.

In pract here somewhat restrained from circum of pectoral & abdom affect conjoind.

And by catarrh affection partic prev. from free use of remed, in which [otherwise] should be disp. to place here greatest confid.

Such for ex as cold bathing & Peruv Bark.

From former reason to appreh. bad affects from encr. determ to breast.

And from latter as restraining free expectorat.

Hence then in counteract Scroph. tendency was natur led to think of [other] [med]

And was with view to this that had recourse to Cicuta

Of effects in Scroph causes have already oftener than once had occas to speak

Am very far indeed from consid it as adequate to cure in every or in most inst.

Yet inclind to think that not without good effects.

And that too both in resolv. Scroph tumours & in giving ulcers disp. to heal

Am even inclind to think that does more in Scroph than in any other affect.

On these grounds then inclind to hope that might be of some service where here susp. incip affect both of mysenter. glands & of those of breast.

But besides this in use of Cicuta had anoth intent in view.

Among other affect of late much employd for allaying obstin coughs.

Need hardly observe how highly has been extolld as cure for Chin cough by Dr Butter of London.

And although acct which he gives of virtues certainly much exagger. yet these not without some advant.

Partic as mitig sever. & dimin freq. of fits of coughing.

Use in this disease has led to employ. in other coughs.

And in these also often found attended with benef.

Effect in such cases in gene. expl. from narcot. power.

And thought that by dimin of irrit less tenden. to inordin action though stimul from mucus contin.

Hoped therefore that besides [counter] scroph tenden. might also mitig cough.

And was with that intent that here gave it rather as diff in mucilag mixt. than in form of powdr.

As thus hoped that influence in allaying tickling cough might be somewhat augm.

While this remedy chiefly directed against pector. compl. had recourse to anoth, prin intended with view to affect of alim canal.

A mixt. viz of Magnes. & Rhubarb.

Where To this remedy in affect of alim canal occurring during infan have often recourse.

And where wish to conjoin with effect of opening the belly that of strength tone of intest few better fitted for the purpose.

But to this med still farther led in pres case from anoth consid.

Effects viz formerly observd to result from it.

Before given when subj to simil compl.

And then found prod of good effect.

Here therefore suggested by attent to juvantia.

And was in hopes that might again be prod of same good effects as formerly.

These then reason for putting pat. on course with which here began.

From commen of use cough somewhat mitig.

An affect which am I own inclind to attrib to the Cicuta.

But did not app. that derivd any other advant from it.

And therfore after contin for space of more than month when cough had altogeth ceased, directed use to be omitted.

To this the rather led as wishd to substit to it the use of Per. Bark.

As from remov of cough & expect now no farther obj to it.

And seemd still more indicated by great weakness with which patiens app. affected.

But before begining use wishd that cicuta should be intermitted for some little time

As by this best able to judge when cough for pres. at least entirely gone

But during this intermiss contin of Magn. & Rhub. seemd as necess as before.

And to this from app. there was of pain in joints anoth. prescript was added.

Camph oil viz to be employd in way of extern friction.

With these med if circum of case contin as they were is intent soon to conj. course of Peruv. Bark.

And if this duly taken perhaps no artic from which can reason. hope for better effect.

At same time must be allowd that case a very hazard one.

And if even taken to fullest extent will prob. be found inadeq. to cure

But that will be duly taken not very probab.

For well known that every endeav to cover taste with infants often ineff.

As best means of doing this howev is intent to order it as diff in solut of Succ. Glycyrrh.

And if as thus taken shall prove means of restor. health to patient will I think be a strong fact in its fav.

At same time this I own more than I expect.

And if does fail much at loss what can afterwards empl. with any prospect of success.

May however if circum contin much the same make trial of [illegible] or when season will permit of it recomm. cold bath.

At same time future meas. must be very much regul. by future circum.