DEP/DUA/1/45/28 (Transcript version)

Isabel Middleton

(1788)

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Isabel Middleton N^o22.

When formerly spoke of case of this patient expressd doubts with regard to it.

And was not decided in opin, whethr pulmon sympt. at that time prin part of affect, were Phthis, or Catarhal. Of two however rather inclind to latter opin.

And on that ground disp to give fav prognos.

Cannot however say that in this partic expect yet fulfilld.

At same time conject as to affect being catarhal more [confused].

And even reason to imag. that has had more connex with preced interm than was then incl to imag think.

Formerly suggested that not impossib catarrh affect merely to be consid as sequel of that disease.

But has since app. that rather to be consid, as concom, & perhaps even sympt of it.

For since came under our care, interm has app. under diff. forms

And [to] this, no inconsid part of treatm directed.

Pract however, it must be allowed, at first begun on diff footing.

Began by direct for patient the use of an Emet.

This on idea eithr of Catarh or Phthis, might be [attend] with some benf. & nothing to be dreaded

But before empl. menst flux which had been obs. for some time spont. app

And upon this our patient though it inadvis to empl. the emet.

By this means delayd for few days.

Finding her then howev in same situat. consid it as equally indic as before.

And at same time as farther [means] of mitig cough, directed a mucil mixt, with prop of Theb. Tinct.

To this added a prop of Spt. Vitr. [ten]. Of effects of which, as comb. with opm have already oftener than once had occas to state opin.

After use of Emet & empl of mixt for some time cough consid relieved.

But from neither one nor othr, of these med was any remark benef [obs] in way mitig cough.

And in other respects sever sympt with app. even more unfav. than before

Partic obs. to be subj to profuse sweatings.

A circum always unfav where any reason to be appreh of Phthis.

For colliq sweats one of those evac. by which more than any other Phth patients reduced.

Here however some ground for hope, from its occuring with a pat, before subj to an interm.

And from its being now attended with freq. shiv fits.

These also it is true common symp of the Hectic fever.

But still more freq. occur as sympt of an interm.

In this state of doubt however seemd not improp. to empl med [count] it in both views.

And to this the rather led as these in no degree uncomp. with [each] other.

Accord on supp. that might be colliq. sweat of Phthis, augm prop of Vitr. acid in mixt.

And on suppos of Interm had recourse to Peruv. Bark.

After both however cont for space of a week, yet sympt nothing allev.

And during that period, had been much affected with looseness.

This she herself was disp to attrib to bark.

And this the rather prob. as in some inst such an effect known to arise from bark.

While at same time patient [nothin] affected with it prior to use of that med.

On this account then thought it [prop.] to interm Bark & cont. mixt alon

And prob. of looseness proceeding from bark, strength from its now [ceas]

Cough also & expect [much] [dimn]

But now subj to return of [fev] access in more regul manner & more strongly indic exist of interm.

On this acct seemd again advis to have recourse to bark.

And although formerly looseness from use yet did not follow that would now occur.

For very much depends on state of alim canal at time

Now however mixt seemd less necess than before.

For cough very much abated.

And sometimes happens that bark disagrees when given in conj with other med, but prod of no inconv if empl by itself.

Hence then that might give trial to bark alone orderd mixt to be interm.

On this occas no inconv from bark.

And while less affected with febrile fits cough also contin to be still more dimin than before.

From this therefore led to hope that by contin compl. recov might be obt.

But although for some time app. contin fav, yet again as it were subj to relapse not indeed of all compl. but at least of sympt of Interm.

For even during contin of bark & without any manif. cause, becam subj. to regul febrile attacks recurring even daily.

And as happens in most [distinct] interm each termin by prof sweat.

In this situat in place of [persis] in bark & augm quant. thought it more advis to interm use for some time.

And in interv directed a mixt with remed empl in last case min [Solu].

If success. will at once be proof of opin respect disease & of effic of the med.

But if not, which in quant here empl, have rathr reason to susp. shall prob. again have recourse to Bark.