DEP/DUA/1/33/06 (Transcript version)

Betty Murray

1783

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Betty Murray 1783 Novr 22

Case of this patient appear of complic nature

Here evid morbid condit affection of glands about neck & that too of very consid. standing

But besides this a more distress compl in cough to which also subj for consid length of time.

These in nature may at first sight app. very diff affect.

And no doubt that often take place without least connex with each other.

Here however am inclind to think that both from same cause.

And that are to view whole as being a scroph affect.

This the suppos. which would naturally be led to adopt with respect to tumours in neck.

Both from situat, from gland nature, & from obstin, might reason concl. that were of scroph. nature.

But much more room for doubt with respect to cough.

For at least much more freq from other causes than from any scroph.

Well known that may be effect of any cause either operat as irrit lungs or encreas. irritab.

By former these convuls agitat in which coughing consists immed induced.

While by latter, brought to such state than even ordin stimul of mucus a cause of uncomm irrit.

Both one & other of these effects however, conseq of scroph affect, of glands of lungs.

For by tumours themselves a [const.] cause of irrit is afforded.

While again, when by any [accid], subjected to inflamm, irritab. [ens.]

And when these tumours formd inflammat excited by very slight causes.

Thus readily conseq of any accident cold.

To such a state, of such tumours in lungs then, was I own disp. to attribute this part of pat. compl.

For that here something more than simple catarrh might be inferrd from many circum.

Among others may mention the long contin of cough, & the state of expectorat.

For although subj to it for sev. weeks showd no tendency to degen. into state of chron catarrh.

On contrary expectorat in small quantity, & of fluid & saltish tasted matter.

This however well known to be state of expect. in general attend scroph tumours & indeed ushering in turberc. consumpt.

Scroph nature of cough also rendered probab. from state of pulse

Not only weak but also remark quick at rate viz of 130 in min.

Rend probab. also by pain of right side & affection of respirat.

And lastly by foetid breath.

For from this circum reason even to conject that some partial [suppur] may have taken place.

Upon whole then, while viewd cough as most alarm part of disease was disp. to consider it as depend on scroph affect of lungs as disease evid in anoth part

From this view of nature of affect necess led to very unfav. progn.

For if idea well founded in reality to be consid as incip state of tuberc Phithis.

A disease if not always at least in greatest numb of inst certainly fatal

To this opin however pres state of patient may occur as object.

For since treatm begun most alarm sympt. cough has almost entirely left her.

A circum but rarely occurring when arises from tubercle.

This however though some object to suppos. by no means [suffict] to to invalid what already urged in support of it.

For tuberculous Phithis to be obs. only takes place, when scroph tumour termin in state of suppurat.

These however when occurring in lungs as well as other parts do not necess. termin in that state.

And that too even when subj to consid inflam.

Often obs. that those under chin or in other parts suddenly encr. in size & very painful, but again subj if not to complete [resul] & least to very consid dimin.

Same also may happen when seated in lungs.

And this I suppose to have been case in pres inst.

As however in other parts are in end very liab to termin in suppur. same may also occurr with resp. to lungs.

And must own that although at pres. should obt. compl. recover. yet very [appreh] that at last this patient will fall victim to be tubercul. Phth.

For on every expos to cold, will be subj to success. inflam, & in end probab. suppurat of these tumours

This however an event which may not take place, for some years to come

And indeed more likely to happen at what stild consumpt. period, than any [other] viz betw 15 & 25

A period from which our pat yet at consid dist.

But although this, encreas pres. chance of recov. is no security.

For unquest that patients die of prop. tuberc Phthis even at very early period of life.

Have myself witnessed, more than one dissect, where this fate of a child not three years of age.

And have met with several other cases as early, where although no dissect yet equally little doubt as to nature of disease.

Hence then would not at all surp. me here if recurr of sympt should have termin in fatal Phthis.

At same time from relief already obt. reckon it more prob. that event for pres at least will be otherwise.

And that may have satisf of dismissing patient, if not completely cured, at least with very consid allev of affect.

With respect to pract in this case on idea given of affect great objec to be aimed at is to prevent inflam & obt resolut of scroph tumours

And is with this view that pract already empl. have been directed

With a view to topical action on affected glands on side of neck had recourse to frict with Camph oil.

Camph I need hardly observe a subst of very pecul [pungen] & activ.

And in whatever manner may oper. that has often very consid effect in prod resolut of swellings unden.

Prob. I think conseq of renewing circul & prom. absorpt.

But in whatever manner obt was with a view to this effect that here directed it.

And although cannot say that have yet derived much evid benef from it tumours since began use nothing encreased.

Am inclind to entert hopes that by due contin fav resolut. may be obtaind

While used this topic applic with view to glands of neck had recourse to anoth remedy chiefly at least intend with view to pectoral affect.

This consisted in mixt of powder of Peruv. Bark & Cicuta. in such prop. that ever ℥p of former cont nerl near four gr of latter.

This dose twice a day with girl of age of our patient thought suffic at least for comm of Cicuta.

And on this part of compos. I own chief confid here put.

Need hardly obs. that [intern] use of this remed, first introd into pract about 20 years ago by Dr Stor. of Vien as remed in cases of Cancer.

Though in that disease has by no means answ. expect which his acct led pract to entertain yet free use extended to other affect

And among these none in [which] more freq. & in my opin more advan empl. than Scroph.

Where scroph in state of open ulcer has often effect of changing & meliorat. disch.

Where in state of tumours often consid influence in prom resolut.

And where in state of giving very violent pain, often attended with effect of giving producing very consid mitig.

Here then on suppos. that severe fits of coughing from scroph [tumr] hoped that might have influ in removing cause.

But besides this expected some benef from it as immed allaying cough.

For among other affect also introd against this.

Not long since prop as a remedy for Chin cough by Dr Butter of Londn

And although exper of other pract. has by no means conf. his accts, yet has since been freq. used again differ. kinds of cough

And where before very urgent has unquest. had consid influ in dimin freq. of attacks.

On this also therfore as well as former ground, hoped that might be useful to pat.

These effects, might in some degree have expected from it, even if exhib alone.

But imagind that influ in both ways, might be encreasd, from Peruv. Bark.

The use of bark indeed very doubtful, or rather gener. consid as hurtful in cases of Phthisis.

And partic where in order to pres. freedom easy of respirat, free expector must be supported.

In case before us however no such object occurrd to use.

And here expected benef from it both as combat scroph affect & cough

For with other means of [counterat] former is unquest useful, at same time to strength syst.

And with encrease of tone given by the bark, can be no doubt can be no doubt, that consid effect prod as dimin irritab, on which freq of cough often depends.

Accordingly in former pract have often used this combin. both as in cases of Scroph & against cough.

And I think with better effect than when either article empl. separ.

Consid it therefore as well meriting trial in pres case.

Soon after began use a very consid mitig of affect was obt.

And this I own was disposed to attrib in very consid degree to the med empl.

At same time would be very far from denying that other concom circ [with] which we are unacq, may also have operated.

And far from being confid, that relief obt, whether effect of med emp or not will be perman.

Suppos conject well founded, can as little imagine, that compl. remov of affect in lungs has taken place, as of glands about neck.

May therfore look for return of affect from expos to cold, or any other triffling cause, either renewing inflam or encreas. irritab.

At same time here not less probab. that benef will be more perman.

And if remed has realy had as much effect, as am willing to suppo, by contin return of affect may be prev.

While at same time meas. empl. may also be prod. of consid [dimn] of obvious gland swellings.

If however shall contin remain for some weeks free from return of cough though these not entirely removed shall not reckon it necess either that she should persist in use of med or cont. attend.

And shall be much satisf if have it in my powr to dismiss her without having recourse to any other pract.

If on other hand compl shall return hard to say what pract may yet think necess.

Prob. however may have [recour] to opiates & blisters

At least these the meas which had formerly in view, if trial then made, had not been prod of relief.

But after change which has already taken place, meas. hereafter to be directed, must be accom to state in which shall hereafter then find patient.