DEP/DUA/1/37/44 (Transcript version)

Mally Newall

1785

---

Molly Newall April 9. 85

Respecting disease of this patien in sever. partic little room for doubt

And even diff. names which might with prop. be affixd to it.

Sympt in her case the most alarm distress were diff. of respir & diff of deglut

And these in some inst arose even to a distress. degree.

Affect of first consit a genus which among nosol & pract writers known by name of dyspn.

While last again diffic viz of deglut. is the great charact of dyspn.

To both these disease then migh consider this pat. as here subj.

And although each may arise from variety of causes yet here no doubt that both to be attrib to same cause.

And that cause too a manif one.

For on inspect of fauces tonsils app so much encr. in size as almost totally to obst pass. downward.

To this enlargem then could have no doubt in attrib these sympt.

Such sympt every day conseq. of affect of same parts in Cynanche or Angina.

There however both progr & symp very differ.

From state of active inflam. is attend with high degree of acute & pung. pain.

And as in other cases where that state takes place in very short time termin either by resolut or suppurat.

While during its contin very generally attended with fever.

In pres case however not only free from pain but also of much longer contin.

Had commenc accord to acct given us, no less than twelve weeks, bef came under our care.

During that period had grad encr. & as far as could learn at least in whole of that time, no sympt of fever.

Is indeed true that commen of disease, said to have been attended with a febrile affect.

And that too accomp with erupt. which from app. supposed to be measles

But whether this really the case or not very uncert.

At any rate, febrile affect may be consid as having preceded that of throat.

And disease evid very diff from ordin cases of Cynanche.

Here when consider conj of erupt & of swelling of throat, may perhap be stated, as no improb. suppos. that pres affect to be consid as sequl of Scarlatina.

For while in that disease [redn] often simil to meas. so also affect of throat very gener. concom.

And while internally affected in diff ways, often extern tum, such as occurrd in pres case, remaining for great length of time.

Hence then in app. at least nothing giving diffic to this supp.

During pres course have already had occas to treat of anoth pat. whose disease had also app. of being sequel of [Scarat].

Case viz of J. McGregor, which there occurrd, very compl [illegible] of cutic with drop sympt.

There however stated as obj to idea of Scarlat, that disease did not then prev as epidem.

Or at least that had neither met with it in my own pract in Ednr at this time, nor heard of its occur to others.

And have not, in formr pract, met with what could be calld spor. inst of that disease.

In pres case then, same obj also occurrs.

But whether swelling conseq of scarlat, or of any othr cause here evid that was immed cause, both of diff of respirat & deglut.

And these were at least most distress, & alarm sympt in this case.

Here however cannot I think cons this swelling as cause of all sympt

For besides affect. already descr. for space of sever years, lab. under pain of side.

Had at times been affected with headach, at times with viol cramps in her upper extrem.

And at times also had disch worm

All these affect. as evid app. from commen & other circum. unconnected with disease of throat.

And most of them was disp to consider as of little conseq.

For some, as for example worms, had not in any degree been obs, for some years.

Others as cramps of extrem. seldom to such height as to be consid in light of a disease although a destr. sym

While headach here, seemd to be merely transit & sympt. affect.

And pain of side now not worse than had been for years before.

Consid therefore first affect. as being here alone subj of pract.

And of this only therefore, reckon it necess to speak with regard to Progn.

Here however in speaking of prognos. cannot have recourse to what have myself seen in former pract.

For must here observe, that in pres inst, the greatest enlarg. takes place that have ever met with.

At least, of a nature in any degree perman.

For when affect of accid inflam as in cynanche is for most part very tempor.

And very soon termin either by resolut or suppur.

Here however, from long contin, such an event not to be expected.

And after grad encr. for such lengh of time, hard to say to what height may [arriv]

Inst. describd by authors, where said to be prod of most alarm sym.

Accord, operat in their nature even danger. prop for remov. or ob. conseq.

Thus while some have advis [extr], others have recomm bronchot, with view of prev. suffoc.

How far cases may occurr, where these necess. will not pretend to say.

Would only obs. that am inclind to think, that neither will be requis in pres. inst.

And hope, that soon affect so much removed, that no farther assist will be necess.

Of this I think ground to entert hope, from fav change which has already occured.

At same time, I do not from this imag. that disease will soon be entirely removed.

For as affect slow in encrease, so have also reason to believe, that will be in decline.

And may even happen that never compl. removed.

For many inst, where such swelling once induced always contin.

This however may happen, without any inconv. whatever.

And accord, even most superf obs. must shew, that tonsils not of any fixd size.

But that with diff indiv, consid variety being sometimes larger, sometimes smaller.

Even on suppos however that formerly small, & that were now to remain of largest size, yet if no lesion of Rep. or deglut hardly to be consid as remain disease

When however applied for assist here, size such that both affected to very consid degree.

Became therefore an obj of great import. to dimin them.

After these ceased, yet still desirable that should be reduced to ordin & moder. size.

For while contin enlarged from every accid cause, augm size, were exposed to danger of recurr of sympt.

Was with intent then, of prod such dimin, that had recourse to pract. at first empl in this case.

Began you will obs, by directing for patient, the use of a refrig. cathar elect. consist of Cream of Tart, with small prop of Jallap, as adjuv & of Cassia as corrigens.

By this hoped to dimin inflam tend, & give determ to intest canal.

From this imagind, that would have some tend, to reduce swelling

Or at least that would aid operat of other med, used with that intent.

But at same time, had recourse you will observe, to an astring [gargle].

And on this, as immed dimin swelling, put much greater confid.

For here, seemd evid to be of soft & spungy kind, depen on relaxat.

As an astring had here recourse to the infus rosar.

An artic which though deriv its name from roses has in reality its effic from vitriol acid.

Here however imagind, that as prepared to by stated formul of Pharm. would not be suff. strong of acid.

Directed therfore an addit. propor. by which rend as astring as could easily bear.

And this addit the rather necess. as to give some degree of viscid, comb. with Infus Rosar, an equal quant of mucil of G. Arab.

Under these med, swelling soon somewhat dimin.

And very consid relief, both in respirat & deglut.

Since began use, however, dimin has not contin uniform.

For about end of last month, had again some return.

And at same time also, obs to disch some ascarid.

Conclud however, that swelling would soon again subside & thought it suff to persist in use of gargle.

And for ascarid had recourse to inject of Lime water.

Which as prod expuls. of these worms from alim canal, consider as safest & most affect pract [with] which am acquainted

Of effic in this way already example during this course

From these inject, a consid num of ascarid were disch.

And since that no more have been seen.

Reckond farther contin therefore, unnecess.

Under use of gargle, swelling of tonsils, also, somewhat dimin.

And at last report both respir & deglut pass free & easy.

Am in hopes, therefore, that from short contin of use, patient may be in condit to be dismissd.

If in this howevr disapp. may have recourse to othr gargles of [illegible] or bracing kind.

Partic to alum, or Peruv bark

And latter may be used under form of spirit tinct at least in diluted state.

For by spirits, parts encr. in size from such relaxd condit, sometimes brought to natur state.

With these pract also, as an addn means of encr. power, scarif, may be conj.

And trust that under use of some of them, affect may be removed

Am however inclind to hope that none of them will be necess.

And that from article at pres. used disease may soon be overcome