DEP/DUA/1/35/10 (Transcript version)

Mary McIntosh

(1784)

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Mary McIntosh. May 30

Disease of this patient manif consist princip in an affect of voice.

And this indeed may say is almost only compl to which she is subj.

Besides affect of voice indeed, compl of some pain, immed above the clavic.

When however consider that this referrd to windpipe, in all probab. immed connected with cause prod affect of voice.

In that case indeed as referable to a fixd cause, might be expected that should be const. & uniform.

On contrary however are informed that aggrav by cough, & by swallowing food.

This however can readily conceive to happen even although fixd cause.

For parts in diseasd state not otherwise giving pain, may readily be prod of such sensat. when exposed either to slight [illegible] or exert.

Such however must happen, both on coughing, & even on exert to swallow.

But besides pain refered to windpipe is affected with more consid pain under sternum.

And this too attacking without any manif cause.

But notwith this circum, am inclind to look upon it, as being also connected, with the affect of voice.

Or at least, diseased state giving that sympt, may be propag. downwards though windpipe.

And thus on any slight irrit, as for example from hardned mucus, spasm affection affect may be induced, by which pain of longr or shortr durat as well as dysp. may be induced occasiond.

Thus then consider all the sympt which occur here, as either depend on same cause prod affect of speech or as being immed conn. with it.

From this then to give name to affect.

May obs. that by nosol. writers sever gener. formd, princip part of which, consists in affect of voice.

Partic Aphon. [Mutit] [Paraphonia] & Psellismus.

All these genera will find in the Nosol of Dr Cullen.

And whether really to be consid as prop distinct gener or not unquest found for each.

Of these diff gener. can have no hesit in referring this case to that of Paraphon.

And of all the species best entit to appellat of Paraph. rauca.

From this view of the disease will be led to form more fav opin. than if refer. to any other cause.

For most of these at least, more depend on a fixd cause.

While again the paraph. rauca chiefly from state of secret. in windpipe.

But though this often, yet by no means always the case.

For even from cold, local affect partic at the larynx, not unfreq. induced, which give hoarseness of voice, during whole remaind of life.

Will not therefore be surprized if this shall turn out to be the case in pres inst.

And the rather to be [feard], both from degree to which has taken place, & from pains with which attended.

But on other hand circum in case which would lead us to more fav opin.

Age of patient much in fav.

For, at so early a period of life, that syst. yet subj to many changes

And from these where all [artif] means fail, known that cure will often occurr even in most obst. diseas.

But what of still more conseq, is but of short duration.

For at utmost only of six months contin, which with this affect, cannt be consid as of long standing.

And during that period fav circum have taken place.

For through whole of that time, this disease has by no means cont. to an equal degree.

At times even perfectly free from it.

And was only within space of a forthnight, of time that applied for our assist, that had any return of it.

When prob was affect of some accid expos to cold.

And is also a circum somewhat in fav of patient that to this cause was origin attrib.

For affect you will obs. dated, from wadding in a pond of water, by which infer extrem much chilld.

And though this a cause which might give rise to a local affect, yet most prob, that such only as may soon be removed.

Or that prod affect of voice merely from alter in secret of mucus.

And this notwithst pain referrd both to trachea & breast, may still be at least princip cause of lead sympt.

Upon whole then case not unfav.

At same time recov. more to be looked for from operat of nature than from medical aid.

Yet may have recourse to diff pract, with view of acceler. & prom it.

As such, have with this pat., had recourse to use of an oily mixt.

This indeed, can hardly suppose to act in any other way, than as a demulcent.

And that merely from lubric fauces & head of Larynx.

This affect however vegetab oil even as diff in water, well known to prod to a very consid degree.

And although affect may be extended through whole trachea, yet is princip from larynx & neigh parts, that alterat in voice prod.

Hence then even from this med, might look for some advans.

And accordingly in inst of Paraphon., [Raucid], &e. often attended with good effect.

On this med then is intent to contin patient for some time.

And am in hopes that during use, either from influ of med or operat of syst itself, shall be able to witness progr to recov.

If this however not the case only other meas from which probab. chance of recov. are those [acting] immed on seat of disease

With this view nothing would occurr as more readily meriting trial, than vap or steam.

And as such may introd mere watery vap. By Mr [Mudge] inhaler, or any simil contr.

May introd vapour of more penetr nature, as for example steams of Aether or of Vineg.

But in pref to any of these have thoughts of trying another & no less powerful agent.

The drawing viz electric sparks from fauces, & trachea.

For by this, I think hopes that state of secret at least may be corrected & altered.

But with regard to this as well as other meas. must be regul. by state in which shall find pat after trial already begun.