DEP/DUA/1/38/41 (Transcript version)

Margaret Hislop

(1785-1786)

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Margt Hislop.

Respect disease of this patient must own that a good deal at a loss.

Circum which led her to apply for our assist was haemor. from nose.

But though this to her most alarm. yet to be doubted whether most imp. part of affect.

For long prior to any app of Epista had been subj to a pulm affect.

And that we may venture to assert if not of alarm, at least of distr. nature.

But before saying any thing of this part of affect. may be prop to give opin of former.

And here first quest. that pres [itself] is whether Haemorr. of active or pass kind.

For in these cases treatm very differ.

First in gener. requir evac, latter astring & tonics.

Here sever circum which would argue its being of former nature.

Patient indeed not at period of life when haem most comm.

This may be placed from 15 to 25 y.

But active haem by no means [entirl] conf. to that period.

And when consider that only at 35 year cannot look upon her as passed prime of life.

But besides this to be remarked that complex. rather florid than other

And that with pulse quicker than natural stand also obs. harder.

In these partic have what com. consid as marks of praedisp. to haem

And this at least somewhat in fav. of being of active kind.

But other partic against suppos

Bleeding takes place only in conseq. of such viol exert. as may be supp to prod rupture.

For has occured merely during course of cough which has attackd her with great severity.

And as thus occurring only to small quant at a time.

A circum afford evid proof that is not affect of encr. impet. but of rupt.

May however be obs that even most viol cough, will not in ordin cases, give rise to haemorrh from nose.

Hence then may inferr that prod this affect only, in conseq. of praedisp to haemor. here exist.

Upon whole then, would view haem as being affect of certain plethor state of habit.

But as immed depend, not on encr. action, which gives active haemorrh, but on rupt. from viol agitat.

In this view of it, though that part of compl. most alarm to pat. yet neither disp. to consider it, as most import. nor what shall find most obstin

In both these respects her pector. compl. more an obj of attent.

These not only of longer standing but in nature even more alarm.

For here also some room to doubt whethr catarrhal or Phthis.

While however in case last treated was inclind to opin of Phthis, here again, am disp to look upon affect as merely catarhal.

In this case indeed sympt descr. not dissim to those of hectic fever.

Shiv fits succeeded by heat, sweating & headach.

And with these, consid perman quickness of pulse.

But here, these febrile attacks, not of that regul kind, which commonly marks hectic fever.

While at same time, long contin of the disease, as well as winter exacerb & cause by which induced all fav idea of being merely catarhal.

And may also be added that pat rather past consumpt period.

For at least most gener. from 15 to before 25.

Here however must add, that in all these circum no secur.

Phthis, a very [insid] disease, often making consid progr. before known.

Pres compl, though not yet Phthis may in no long time, degen into that state.

And should not be surp to find, that she yet falls victim to catarhal Phth if be not already subj to that disease

But upon whole as disp. to view Pect affect. as being origin catarrhal & still cont. merely in that state, & as consider haemm. to be as it were accid, prognos. may be more fav.

Even suppos. severity of cough to contin, hope that latter by remov. of dispos to haemorh, may cease.

And this the rathr to be expected, if can do any thing to remov of cough.

And In this way many attempts may be made.

But am I own very doubtful how far in pres. circum can do much in this way with adv or success.

For to be obs. that sever. partic much against patient.

Especially season of year, for well known that in conseq of cold, disease has as it were winter exacerb.

But empl. during winter no less against her than state of weather.

For occupat by which supports herself, is that of carrying water.

So that is at same time exp. to action, both of cold, & wet.

Very doubtful therefore, whethr this will not have more influ, in supp. cough than any thing we can do to in remove it.

This howevr no obj against trial

And may at least perhaps be able to free her, from circum [most] alarm to her, haemorrh from nose.

This indeed, if conj as to cause well founded, very much depends on viol of cough.

And therefore to be obviated, by means empl. for mitig catarrh.

But have supposed it in some degree also to depend on Haem. tend.

Hence, in conseq of remov of this, less chance of return.

Espec if at same time impet. of circul. through head dimin.

Was with these intent then, that had recourse to pract, first directed for this patient.

Begun, pract you will obs, by direct for her the Crem of Tart to exten of tea spoonf. about ℥i twice a day.

This in remov. of dispos to haem, have often found highly service.

And may I think consider it as operat both from action as refrig, & evac.

For can be no doubt that immed affect of action on stom, is of former kind.

That excites there, a sense of coldness, extended over whole system.

And that, if does not always dimin celerity of impulse, has at least very generally affect of dimin imp. of circul.

With these conseq, at same time oper as evac, in diff. ways.

First & most obv operat, is that of excit disch by stool.

But perhaps a more gener. & perm affect from it, is that of oper as diur.

And in both ways, must have affect of dimin impet of circul. fluids & of course haemorh. dispos.

Besides which still farther tend to dim dispos to haemorh. by nose, from giving determ to other parts.

And accord, in this way Cream of Tart. & indeed simil cathart & diur, often useful even in catarrh.

For in that disease, encreased quan of mucus disch, very much conn with determ to lungs.

But with view of prev. epistax. from giving determ to other parts, expectd still more from anoth pract.

The applic viz of blister which directed at same time to be put betw. should.

And which advis. should afterw. be kept open by Epispas. ointm.

That the applic of blister, very powr influ, in augm circul. through part unden.

And this necess. followed, by dimin in neighb vessels.

Espes. the case, where not only disch at first, but after by prop. means contin.

Accord an issue, has with great prop been termed by a late elegant writer Dr [Simson] of St. And. quase nova glandula

And in all inst. where situat of part will adm of it & where wish for change of determ, possess few means more effect for accompl. end.

Thus reason to hope that as giving determ to superf vessels of back, might tend both to prev. return of epistax & to allev. catarrh.

How far these remed prod of good conseq. here ment. cannot perhaps very pos. say.

But some, at least, of those conseq, have in reality taken place

For while in obv. operat were attended with effect expected, ever since began use has had no return of Epis.

And at same time, as farthr mark of dimin of determ to head, has also been free from headachs with which before affected.

Has also less florid compl, & less quickness of pulse, two of prin marks of haemorrh. dispos.

Some reason therefore to hope, that while have obt. at least tempor. [relf] less danger of return.

But if from pract. empl this chang prod on dispos to haemorrh. cannot at least say so much with respect to cough catarrhal affect.

For at last report, cough you will obs, still contin with very great severity.

And still attended with cold & hot fits, sweating & other circum giving some susp of hectic fever.

With view however, of still counterac it, both Cream of Tart & Issue might have been contin with adv.

But from finding issue inconv. to her, had allowed it to heal

And, so far skind over, that disch could not be renewed without fresh app of blister.

This however was desirous at least of delaying for a little.

And therefore with contin of Cream of Tart directed use of Theb. Pills.

This pract, I must acknowl, I reckon a doubtful one.

And considr it as nearly equal [chance] whethr be followed with good, or bad affect.

Have not unfreq. used it in former cases, sometimes with adv, sometime with the contr.

Here need hardly obs. that intent in view, is to dimin freq of cough, by taking off affects of irritat.

And little doubt that from this freq. irritat cause rend less more consid.

For by freq agitat in coughing secret prom.

But on other hand if secret contin without cough, still [more] conseq may be expected.

For then accumul. in lungs induc distress dyspn. must necess. occurr.

Accord. obs. by many of those long subj to such affect, that never in worse health than when cough wanting

For in that case, habit secret & depos into lungs still cont, withou howevr being disch.

But if, with dimin of cough, at same time corresp. dimin of secret. could not fail to be prod of best conseq.

And this, was in hopes, might be conseq of empl. at same time, the Cream of Tart & Theb. pill.

From doubtful affect of opium however, have here directed it only in small dose.

To quant viz of gr s morn & even.

For to this extent enters each grV of Pil. Theb.

Accord. to affect of this quant. will be regul in future meas.

If has affect of allev. cough without any farther inconv, may cont or encr. it.

And perhaps by persist in use, may do as much for pat as expect.

For during winter season & while able to contins empl. of carrying water can hardly expect that will remain free from return.

Indeed, in this disease, where situat of pat will admit of it, more advant from avoid winter, than from all other remed put togeth.

And this mode of cure naturally indic by period relief in this clim, during summer months.

Where change of clim unattain, [some] same advant. from keeping home during winter.

But where, as with our pat, necess expos to cold, remed given to very great disadvant.

If from this or other reasons, shall seem advis to altr pres course, have thoughts of trying a remed. in which am inclind to think advant of two now used in some degree conj.

The remed. to which now allude is Vin. nicot.

Made by infus ℥i of dried leaves of Tobacco with lb.i. of Wine.

This remed need hardly obs. lately recomm. to attent of pract by Dr Fowl. of Staff. as a cure for drops. affect.

And in cases which he relates has unquest from diuret. power been attended with best conseq.

With power as diuret howevr manif comb. also a narcot qual.

Thus may inferr that in some degree to expect from it advant both of Crem of Tart, & Opium.

On this ground have of late had recourse to it, in sever inst of chron catarrh.

And I think with manif good affect.

But whethr shall have recourse to this, or some othr pract, must depend very much, on situat in which find our patient.