DEP/DUA/1/44/23 (Transcript version)

Betty Johnston

(1788)

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N^o2. Betty Johnston at 40.

In case of this patient as formerly obs. distinct markd inst of Cynanche.

For here all great charact of the disease, pain of throat, diffic of deglut & of respir.

Under this genus however, both nosol & pract writers have compr. sever diff spec

And some of these not in my opin with strict prop. refer. to this genus.

Such for ex as Cynan. malign an affect. always aris from pecul cont.

And which I think ought by itself to constit separ & dist. genus.

But without saying any thing of other spec. may remark that species to which our pat subj suff. manif.

For from upon inspect. of tonsils & [uvul] such a degree of manif swelling that could have no doubt in pron. a case of Cynanche tonsillaris.

Or as named by others of Angina [Inf].

And in sympt with which here attend nothing pecul.

For is if not univ at least very gener case that this affect involvd & accomp with brisk febrile access.

Patient also as will obs. from hist had before been subj. to repeated attack of this affect.

And is unquest one of those diseases to which there exists with some people uncomm disp.

In so much that never fails to be ind by every imprud expos to cold.

And sometimes even as occurd in pres. inst. occurs takes place without any man. cause.

These prob. tend. to encreased action such that induced by causes entirely escap. obs.

And in after treatm of affect this condit may natur. be supp. to claim some attent.

While however inflam subs. [must] have diff. obj. in view.

Here first obj. natur. pres. itself is to obt. resolut of inflam & to stop [prog]

For on some occas. gives not merely diffic of deglut. but such diffic of respir, that an open into trachea [below] becomes necess.

And is chiefly as a remed in this affect that operat of Bronchol, prop & practised.

That oper howver at least if dis [illegible] treated very seld. I believe necess.

In so much that have not only never had occas to direct it in my own pract. but have never even heard of an inst, in which perf. in this City for 20 years past.

And I believe equally uncomm to other parts.

For very gener. before such diffic deglut respirat as to render this operat necess termin in supp.

This however when it can be done a termin also to be avoided.

For before takes place, patient subj to great degree of pain, & when occurrs, troublesome & inconven.

Hence then endeav natur. directd to obt termin by resolut.

Omiss of blood letting either gener or topic.

+ At Ednr. volat. Linim by add of Alkaline water, to Camph. oil.

Camph. some benef in Rheum cases.

But none here where intendd to operate as strong rubef. app. to blister

And was chiefly with this intent that the various pract. here directd were recomm.

>+

Directed you will obs. the applic of Volat Linim to the fauces extern.

Of this artic need hardly obs. that active basis is volatile Alk or Amm

And hence by Lond Col. now more prop stilld Linim Ammon.

Indeed in their Pharm two diff kinds are introd.

Liniment Ammoniae simply so called & Lin. Amm. Tortius.

Formr made with one part of Spt of Hartshorn, or Aqua Ammoniae in aerated state to three of oil.

While latter not only with larger prop but also with Caustic Vol Alk or Aqua Ammon. purae.

>+

In either condit however operates as very active & immed rubefac.

And where skin tender, excites even very consid vesic.

Is chiefly on these prin I appreh. that to explain benef. derivd from it in this disease.

For by augm of circul. on surface balance between that & intern parts soon changed.

And thus impet at affected part diminishd.

These even immed & readily obt without having recourse to [stronger].

And of some conseq. to avoid even that degree of pain, which actual vesic prod.

This indeed chief reason for pref. volat. linim to prop blist.

Though at same time has also an advant. from sudden of operat.

But whatever prin of operat can be no doubt that often advant empl. in bringing about resolut of inflam in inflam Angina or Cynan. Tonsil.

And since recomm of late Sir Jo. Pringle, who as inf. us in Army dis. was first led to use on author. of Dr Young of this place has been very comm. pract.

But while empl. this outwardly had recourse to an intern applic of a diff kind.

A gargle viz consist of equal parts of Infus. Rosar & Mucil. G. Arab.

The latter intend merely to give form & viscid to the med, so as to lead to more read. [attach].

While former, which to be consid as active basis of this med, possess to consid degree both astring & refrig. power.

And although derives name from roses yet as prep. both by London & Ednr, activ prin dep. on vitriol acid which cont.

This acid in concent. state a powerful means of induc inflam.

But when prop diluted, from astring powr serves to dimin encr. action in parts to which app.

And few affect against which more freq. used under form of Infus or Tinct Rosar than angina.

But in conj. with these two here directed also a third pract.

The use viz of brisk refrig cathart

And as such, though it must be allowed not one of cheapest most agreeab, yet as one of most certain & cheapest [directd] Glaub Salt or Soda Vitriolata.

By this hoped to facilit & encr. infl. of other med from giving determ to intest canal.

And at same time to obv. costiv to which subj.

From all these med. however could not obt. end in view.

For although had obv. operat wishd for, yet this did not prev. inflam of throat from termin in state of Suppur

And Accord a few days afterw. from rupt of abscess formd consid disch of purul. matter took place.

And as happens in ordin phlegm soon restor of parts to sound state.

Whether from med here empl. inflam moder. & suppur of course less consid will not pretend to say.

But at least for a case termin in suppurat. that termin as fav & as exped as could be lookd for.

And with this disease for pres at least consid as termin.

Have however already remarked that with this patient, there was as it were constit disp to this affect.

And where that the case, is unquest an obj of import. to comb it.

Partic with these, who from situat in life, cannot be supp. capab, of avoiding expos to occas causes.

Of these none as have already hinted more comm than expos. to cold.

And on this account always prop. to enjoin defence against applic part to neck.

Is prob. on this footing that to acct for a nostrum if it may so be calld, recomm. by that celeb. pract late Dr Ward.

At least if had in reality [those] good effects which some alledge.

To those habit liab. to Cynanche Dr Ward recomm. the wearing a bit of black crape round neck below shirt & next to skin.

If this any effect can hardly sup any other than that of giving addit heat & supp free perspir.

But whether operates on this or any othr prin am acq. with some people who place very great confid in this mode of prev.

Who assure me that though before very liab to sore throats, since have had recourse to this have had no return.

That this however may have proceeded from other causes do not doubt But at same time the pract as being both [easey] & [illegible] may perhaps be consid as not [unworthy] of trial.

Must however own that should be disp to place equal confid in any thing else afford equal def. against cold.

And besides this gener recomm. adv also to pres patient anoth pract.

Use viz of gargle constit of cold watery infus of bark acid by vitriol acid.

This directed with view to its Tonic & astring power.

And can be no doubt that from thus dimin irritab of musc. fibre, tend to encr action dimin.

Accord in some cases have I think directed it with manif adv.

But how far pres patient will give it fair trial very doubtful.

And if even does in all prob. we shall not know event of it.