DEP/DUA/1/38/71 (Transcript version)

Isabel Renton

1786

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Isabel Renton Janr 29^th 86

Of case of this patient very little to be said.

For since formerly spoke of her have seen nothing more of her in this place.

Then obs. that consid her disease as a distinct markd inst of Catarrh.

And in that condit which may I think with greatest prop. be termd chron state.

For though this patient at 46 year, could not even in her case with any degree of prop. be stilld Cat. Senil.

Here indeed in cough, dysp & pain of breast, have, as have often alr. had occas to remark, sympt of Phth as well as of catarh.

And must be allowed that in diagn in some inst great diffic

Must candid acknowl. often this respect fall into mist.

Sometimes on one hand consid as incip Phthis. what have [alter] reason to belive merely catarrh.

And on other viewing as merely catarrh what in short time land in distinct markd Phthis.

But in pres. inst there is I think very little room for doubt.

Here no sympt occur [marking] in any degree hectic fever.

Copious expect such as is the common attend of catarrh.

Is consid past that period of life, when Phthis chiefly occurs.

And at least verges towards period when catarrh a very comm. disease.

But above all affect markd to be catarrhal by long contin & exacerb. during winter.

For at least a very rare case, that any one can be said to be subj to Phthisis for space of three years.

And seldom happens that after commen. any consid remiss & exacerb. for any length of time.

With catarrh howevr nothing more common.

Many with whom when begining even at earlier period of life than that to which our pat. arrived will contin for numb. of years.

And during all that time regul subj to it during summr & regul exacerb. in winter.

From these consid then concl. with some degree of confid, that this pat. case catarrhal.

At same time as already obs. do not pretend to say that is altog. without doubt.

Yet if in this case Phthisis should be termin would I own rather be disp to consider it as superv. affect than as having been prim disease.

But with respect to termin, as shall prob. see nothing more of pat, unnecess. to make farthr remarks.

May only obs. that on idea of affect being entirely catarrhal became [first] here obj to unload lungs.

And with this view directed an Emet.

For although do not agree with those, who look upon Emet as being only expect. yet consider them as both most immed & most powerful.

Accord where large quant. of viscid mucus collected in lungs, prod of [greates] relief.

And in such cases from repeated employ pat often very great benef.

To such repetit then had pat. contin attend should prob. have found it necess to have recourse.

But from very freq. repet. bad affects arise from action on stom.

For can be no doubt, that by overexert if may be allowed to call it so, which takes place in vomit, tone of stom weakned.

Hence then urgent sympt alone which should lead even to freq. repet.

And although Emet most imm. yet in catarrh. cases more perman. relief by other means.

Partic by those which dimin determ to breast.

In this way nothing more effect than warm temper. as giving determ to surface.

And perhaps no disease where change to warm clim & thus avoid winter of more use.

But with pat in such rank as ours, this a pract not to be thought of.

And can be supplied only by warm cloath or keeping house.

Benef. however also obt. by determ either to intest canal or kidney.

And thus advant both [from] gentle laxat & diuret.

Partic latter which less effect in debilit.

As such had here recourse to what in some resp. may be consid as a nerv diuret.

Vin Nicot. – Hoped here for opport of trial.

But from dissert of pat. has not been afforded.

Shall only concl. then with remark that have of late tried remed with some other patiens simil [affected] & I think with manif adv