DEP/DUA/1/44/39 (Transcript version)

Ann Ross

(1788)

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Ann Ross at 61. N^o10.

Formerly remarkd that consid disease of this patient as somewhat compl.

But that princip part of affect, was dist. markd inst of catarh of chron. kind.

And during contin of patient under our care have had no reason to alter opin.

In treatment endeav almost solely directed to catarh.

And have I think had at least some influ in allev it.

Began pract by directing for this patient the use of an Emet.

These in inst of catarrh partic when degen to chron state often useful on diff. grounds.

Are first & perhaps even prin useful as tend to unload breast.

For can be no doubt that operate both as most powerful & most immed exp.

And as little that all most distress sympt of this disease conseq of encr. secret of mucus at lungs.

And especially of accumul in air vesicles & branches of Bronchia.

This mucus however the action of vomiting tends very effect to expell.

And thus gives very immed relief both of dysp. & cough.

Indeed few pract. better effect in giving good night.

But besides prom expect, emet useful also on other footings.

Partic as giving determin to surface.

By this means some chance that balance of circulat restored.

And from dimin determin to lungs some prosp. that of dimin of secret of mucus.

These ends, in some degree accompl., by every med operat as an emet.

But consider Ipecac as pref. to all others.

For by means of this, can most readily obtain full vomiting.

And at same time, without either too great severity, or distress nausea, which is conseq of some emet.

While however emet in gener, & Ipecac in partic thus useful, are by no means altog free from obj.

Not indeed from single empl, but from freq repetit.

For can by no doubt, that by this, tone of stomach very much weakened.

Are therefore partic to be empl. with caution, in such inst as pres, where with catarh, some degree at least of dyspept. affect.

And that here indic by nausea & pyrosis, with which at times affected.

Of these sympt indeed as well as [catarrh], emet often afford immed relief.

But when so employd as to weaken tone of stom, after affect to encr. them.

Hence then tempor. benef should not lead us, to overlook future conseq.

But though these evils from freq repet of severe emet. yet from single emet. or even repet at prop interv, best effects may be expected.

Accord in obt. these, not disapp in pres. inst.

For at succeeding report both cough & dysp. easier.

This however could not entirely ascr. to Emet.

For at same time with vomit, another med also prescr for patient.

Use viz of Squill pills.

These also need hardly remark, a remedy in daily use in this affect.

In so much indeed that often become as it were a habit med, with those subj to this compl.

And perhaps as often prescr. by patien themselves of as by pract.

Hence Ednr. Coll. who rejected them from Pharm of 1774, have again been obliged to rest them to 83.

When formerly rejected, was not done either from suppos. of inactiv on one hand, or dangr on other.

But from idea, that was better to have no fixd formula.

For by this imagind that [quant] of squills more readily varied at pleas & prop. to circum of case.

And that such corrigen also might be occas added & as pecul state of patients stom, seemd to require.

That these varieties, in partic inst, attended with adv. not to be denied.

But from these are by no means precluded by having fixd formul, under name of squill pills.

And after many patients much in habit of ordering them for themselves, become even necess.

Accord as have already obs. to pres edit of Pharm, has been [restored].

Now however in some respects alterd from what formerly was.

Then app. a much larger propor of squills than in pres.

But at that time directed to be prep with recent squills.

A subst., which to same weight, much less active than dry, as great part of weight, from water.

And accord as water more or less exhausted activ various.

But besides this uncert, anoth disadv from recent Squills.

When formd into pills, very apt to corrupt & mould.

And thus activ totally destr & alter.

For avoiding these inconv, now directed to be formd with dried squills.

And thus obt. an artic both more certain activ & easily preservd without injury.

Into each pill of grV Squills [enter] to extent only of gr p.

And in this state of activ such divis necess.

For in quantit of one or two grains with some stom, apt to excite sickness & vomiting.

And thus disapp. of effects as acting upon the syst.

Though other artic entr pills, yet both now & formerly, have derived name from Squills.

And on these activ may be consid as justly depending.

Not indeed that other artic, entering compos. to be consid as inactive.

For now as well as formerly, are comp. with G. Ammon & Card. seeds.

But these are artic, which for prod much effect, require to be given in consid doses

And in quantit to which here empl. can be consid as having no other effect than to give form.

In formr however, have a med in some degree supp. to coincide with power of squills.

And from operat in prom expect, to act as an adjuv.

While in latter, a warm aromt operat as a corrigent.

Besides these in former Pharmac. there entered also a proport of Bals. Copaib.

But from this no other effect than that of excit nausea, with a med, where nausea partic to be avoided.

Hence with much greater prop, mass now directed to be formed with simple Syr.

And upon whole, in Squill pill, as now enters pharmac. have elegant & [cons] formula for exhib of that artic in most activ state

Here given to extent of five gr. m & ve.

That is to extent of gr only of squills in course of day.

From this quant. had little to fear from action on stom.

And accord better chance of entering system.

For where either vomiting or looseness induced from use, disapp. in this effect.

Of influ as entering system, differ. opin enter.

Now however very gener. consid as having no effect, in common mass of blood.

And chief diff in opin, as to collect at excret. partic those of breast.

Accord while some support, others as stren deny expect powers.

Very gener. agreed however, that has effect as encr. secret by kidney.

Or at least, although no med [const] & unif diuret, squills so freq. so as justly to be rankd among most powerfu diuret.

And for my own part as little doubt that act also upon lungs.

Nothing certainly more extraord. in suppos. that should act upon one, than other.

And for my own part, from what I have seen, entert no doubt that by encr. tend to excret. prom expect.

And thus from prev stagn, have app. effect, of rend mucus more fluid.

Or as has comm by been calld of [cuttin] phlegm.

A prop. which can in no degree suppose them in reality to prod.

But without prod any alterat on mucus, which has already acquired viscid, consid them as useful in Catarr both as expect & diuret.

And in these ways have often before seen benef from them, in other inst of this affect.

Of this had I think manif ex in pres case.

For from commen of use had obvious effect of encr. diures.

And expet though copious yet free.

Relief indeed thus obt. did not contin uniform.

But although affected by changes of weathers yet so far relievd that reckond farther attend unnecess.

To this the rather led as unwilling to renderr Squills an habit med with her.

As imag. that even more adv. from return to use, after some interm.

Am far indeed from consid disease as what may be calld cured.

Have no doubt that on expos to cold will again to subj to severe returns of it.

But have at least here good effects of Emet & Squills as allev chron catarh.

And in prev of return more to be expected from avoiding cold, than from any thing in way of med which we can direct.

Hence patient as much benef from keeping house as from attend here in this weather