DEP/DUA/1/32/05 (Transcript version)

Ann Mason

(1783)

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Ann Mason. May 27

This patient can have little doubt in consid as subj to one of most comm disease which have occas to treat in this country.

Catarrh viz which has degener. into what may be calld Chron. state

For although already at 40^th year of age yet even with her, yet even with her may with much greater prop get name of Chron. Catarrh than of Catarrh. senilis

Sever of sympt indeed which here occurr, are it must be allowed the charact of a much more dang. affect. viz Phthisis Pul.

For in that disease as with pres patient cough dysp & diff. expect.

Must also be admitted that Phthis a very insid disease.

In so much that in many cases has made remark progr before discov

This however princip the case when little or no cough to give alarm.

And when Phthis rather feigns app of other diseases than of catarrh.

That here catarrh sympt not Phthis may be inferrd from many diff circum.

Strong obj to that suppos in state of pulse

Here of natural stand while in almost every inst of Phthis greatly accen

Same observ. may be made of heat.

Although not perman. augm yet almos no inst of Phthisis in which this does not occurr at least in temp. way.

And in most inst takes place in partial manner.

Not only local flushings as in [face] but also partial heats at partic [parts]

And espec. obs. that at times sense of burning heat as in palms of hands soles of feet & the like

Object also afforded by state of tongue.

While in fever white & dry in Phthis notwith sympt fever pecul moist & clean.

This partic the case after expect of purul matter.

And if Phthis. here existed should be of that kind attend with purul. expect for in copious disch of expect. matter have cause adeq. to prod both of cough & dysp.

To these circum as farther obj. to Phth might ment absence of pain of breast natural state of appetite, thirst &e.

But above all contin of the affec age of pat & progr of disease.

And when attend to these partic affect of chron catarh very distinctly markd.

Patient already at 40 year. A period of life at which Phthis very rare chron catarrh very comm.

Has now subs. for several years.

A term by no means uncom for chron catarrh but very rarely so for Ph.

During that period has partic occurd in winter months & been abs. during summ, disapp in spring.

Such remiss however never obs in Phthis. which of all seems most severe & most freq. fatal in spring.

In chron. catarh again this almost const course.

In so much that perhaps no disease where change from cold & variab & steady & warm clim of more service to pat.

And in which where this cannot be obt. more advant. from keeping house as def. against cold.

Upon whole then with regard to affect to which this patient subj. no room for doubt.

Without any susp. of purul. can have no hesit then consid affect as depend. merely on encreased mucus secretion

From quantity giving dyspn

From irritation giving cough

And from viscid giving difficult of disch.

To this affect in my opin name of chronic catarrh may be given with greatest prop.

Has indeed in diff pract. syst. obt. diff denomin.

And in partic in Nosol of Dr Cul. arranged under genus of Dysp. being disting by specif. name of Dysp. Catarh.

This appellat howevr to me app. a very improp. one.

First in first place draws name of the disease from a sympt merely accid.

This I appreh. no one can deny to be the case with the Dsyp.

When indeed affect long contin & has arisen to great height is it must be allowed often a very distress sympt.

But then only that takes place to any consid degree.

And even then not a constant symp.

For on free expect. will be entirely [remov]

In cough & copious muc. disch again have sympt. attend the affect. through whole course.

And cough, which is immed conseq. of mucus to be expect, is at all times most distress. sympt.

In so much that very common as is indeed case with pres patient for sever of fits to excite prof. sweat.

But besides this from referring pres. affect to genus of Dysp. is [illegible] with a set of affect of very diff. nature.

Thus in Aquosa in affect belonging to the drop.

And in pingued a sympt of corpulence

And indeed may here by way obs. that the genus altog. an unnatural one.

For even as simpl. in syst of Dr Cullen still cont. eight diff diseases which have no othr connec with each other but in single circum of dysp.

And which with much greater prop consid as sympt of other diseas.

This examp. not only in Dysp. catarrh but also in two other just ment.

Thus dysp. Aquosa merly sympt of dropsy of breast.

Partic of Anasarc. of lungs.

While again Dysp. pingued. is a sympt. merely of the Polysarc. or gener encr of fatness.

Of a nature equally dissim from each other are Dysp. extrinseca thoracic terrea [areae] & other species

Upon whole then can have no doubt in looking upon this genus of Dysp. as cont. a very unnat assemb. of affect

And in consid term of Dysp. catarrhalis as improp. applied to pres. such cases as pres.

While again with strictest prop. referrd to genus of catarrh.

For essent & leading morbid affect is encrease of mucus disch.

And in by much greatest numb. of inst. degener. to this state, from that of catarrh under acute or febr. form.

From this circum then as well as long contin. may very justly obt name of chronic catarrh.

This then idea as to name & nature of affect of pres. pat.

With regard to progn. may obs. that is a disease in the end often fatal.

Partic in this country.

From repeated severe attacks espec during hard winters patient exhaust. at length incap of raising mucus & necess. falls victim to affect.

That this may yet be case with pres pat. would not deny.

But in most inst unless from accident. occurr. happ. only at late period of life

And indeed by much greatest part of those subj. to it fall victims to other affect.

In pres case no appear of an alarm nature.

[Since] patient came under our care severity of compl. even consid mitig

And from this circum [joind] to seas of year, appr. viz of warm weathr have now reason to hope for speedy remov. of affect.

Not indeed that may not be liable to return during anoth winter

But have at least reason to hope that attend here will not be much longer requis in pres. affect.

And this event. have reason to think may in some degree forward by treatm here.

In treatm of this affect in general two obj. pres. themselves as princip claiming attent.

When breast much loaded with mucus is first obj. to disch what already accumul.

But after this effected is of still more conseq. to prev. fresh acccum.

An end to be accompl. either by promot more free expect.

Or by dimin morbid secret.

In certain circum especially where sympt very urgent pract may be requis with all these intent.

But in pres case use of many med did not seem requis.

In this affect many remed empl.

Partic those supposed to operate as promot expectat.

For by this means accumul in the air vesicles of lungs prev.

Those in my own pract. partic squills often empl. with this intent

And I think with best effect.

But of all remed none to which hav more freq. recourse the Emet. Blister Diuret & gentle cathart.

Two first most immed means of obv. urgent sympt. either in way of cough or dysp.

Two last as giving most perman relief & prev. recurr of affect after mitig once obt.

After these observ. need hardly add any thing as to partic practice in pres. case.

Began by direct. an emet with view of unload breast from [muc] already accumul.

And in this not disapp.

For while operated briskly, conseq. was that cough & dyspn. consid [reliev]

At same time that ordered emet directed also laxat elect of equal part of Cream of Tart & Sulph.

This need hardly obs. one of most gentle refrig cathart which we possss.

Accord. in freq. use in cases where such necess such for ex as haemorh [affec].

But no affect in which have seen more good effects from it than pres.

And here prob. partic useful from oper. also as encr. urine.

Under this med while obv operat what wishd, compl. have also been consid dimin.

And hope that by contin may be able to effect at least tempor cure.

Is intent therefore unless some circum shall require alter to per. in use.

And if from pres. cold weather, or other accid circum, affect should be aggrav. only addit remed which shall prob. empl. will be repet of Emet.

And under this treatm am hopeful that in no long time patien may be dismissd from any farther attend. here.

If however disease shall take any unexpected turn, meas. must be accomod to circum which shall then take place.