DEP/DUA/1/46/36 (Transcript version)

Janet Sutherland

(1789)

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N^o11^th Janet Sutherland at 34.

Case of this patient, which as will obs from hist read, consisted cheifly in cough, dysp. & viscid expect, consid as ex of chron catarh.

And have since had no reason to alter opin.

Must indeed be allowed that same sympt are also ordin constit of Phth.

And that Phthis in many inst makes consid progr before dist. markd.

But at same time many circum in pres case against that suppos.

Patient partic has already passed consumpt period.

Has none of that quickness of pulse which at least very gener attend of Phth

Nor is she affected with hot or cold fits, which so great charact of hectic fever.

Has nothing also of emaciat, loss of strength colliq sweats or other comm attend of Phthis.

Tongue contin either in natural state or whiter than natur.

An evid proof that matter expect free from mixt of purul.

Nor do we obs. in eyes that pearly app. & want of red vessels so common in Phthis.

Prob an indic of want of due imp. at extreme vessels.

Menses indeed said to be irregul.

And this it must be allowed not unf. occurs with Phthis patients.

But at same time irregul or obst of menses by no means, a common Phthisc sympt.

While also a freq. occurr in many other affect.

And indeed hardly any disease of which may not be sympt.

There is indeed one circum ment in history which may lead to supp. of Phthis injur viz done to breast, and conseq morb affect of lungs.

Severe hurt viz which [receivd] by a fall.

This it may be conceivd prod local inflam termin in vomica or abscess of lungs.

But had this been case [train] of sympt. would have been very diff from what here describd.

Should have expected constant fixd pain referrd to partic spot in breast.

And patient able to sleep only on paind side.

As free respir only when [unaffec] side not compressd.

And finally on bursting of vomica should have expected copious & evid disch of mucus.

Thus then app. that hardly any circum here giving susp of Phthis.

While at same time, every ordin charact of chron catarrh a disease not unfreq even at age of 34.

While however what have seen of case since last spoke of it, tends to confirm former opin of nature, cannot say the same as to Progn.

For then expressd hope that as diseas of no long stand might soon be able to overcome it.

Must however acknowl. that hither have hardly made any progr in cure.

And prob that cold & unsteady weather has done more in support the affect, than remed we have empl in remov. it.

Must be allowed that in this affec nothing of equal conseq. with guarding against influ of cold.

This indeed abund app. from period return of disease here, during winter season, & period relief, in summ month.

Indeed no mode of cure perhaps of equal conseq in this compl with passing winter in warm & steady climate

In my opin is much more in such catarrhs than in Phthis that every does any good.

Indeed am inclind to think that reputat of South of France, & other simil climates in cure of Phthis has entirely arisen from catarrh being mistaken for Phthis.

For cannot be doubt that there tuberc equal tend to suppurat as here.

And that suppurat when induced gives equally acute hectic.

Accord in distinct markd tuberc Phthis as great a prop die who go abroad as who remain at home.

That is very nearly the whole.

In catarrh however where disease solely affect of augm secret at breast very great benef. from that state of [alm] allowing free circul on surface.

And next to change to warm & steady clim, the keeping here withn doors in warm & comf. house.

With [lowerer] class however both one & other of these equally unatt.

And utmost we can do is to endeav to counteract effects of cold by prop cloth.

At same time avoiding much expos. partic to night air.

But while this essent to cure, as tend to counteract & prev [causes], supp & aggrav the affect. sometimes also may be done by aid of med.

And various artic which as answ diff intent, may here be prod of some good effect.

With this patient had in first place you will obs. recourse to an Emet.

And as most certain means of obt full vomit empl Ipecac in powd.

The action of vomit I need hardly obs. is one of best expect we can empl.

Next at least to coughing is unques best means of prod disch from lungs.

And where fruitless cough for great length of time well known that superv vomit facilit expect.

Thus then expected that at least for time would unload breast.

But besides disch mucus already secreted, has also tend to dim future secret.

For no doubt that gives though tempor only, yet very consid determ to surface.

And free circulat [thus] begun in extreme vessels, often afterw supportd by their own action.

Partic if by [prop] warmth future constrict of superf vessels is prev.

Thus then no uncom pract here to have recourse even to repeat emet.

And some with which whom to prev. very distress dysp. are even essent necess.

But at same time must own that consider habit use as a bad pract.

For though tempor relief yet from freq repet have effect of weakening tone of stom.

And thus prod of inconv in many diff ways.

Reckond it therefore prefer. to employ other artic with view to contin adv. thus obt.

And among others is of great conseq to prevent long stagnat of mucus in breast

For thus not only greater quantity to be expect but encr. viscid.

Hence the advant of artic prom more freq expect.

And this prop I am inclind to think possessd by some subst. carried to lungs in course of circulat.

Among these Squills have long & I think very justly been consid as one.

No more diffic in conceiv that should [reach] [excret] here than those of urine.

On all hands however allowd that act on later.

And I think no less strong evid of action on former.

Do not indeed adopt opin of those who suppose that have power of cutting or dissolv phlegm already [secretd]

But have in many cases at least app of doing so, from matter expect being afterw much less viscid.

This however conseq only of being expect before viscid obt.

Thus effect in augm secret, [unques] unfav in this disease, more than counterb. by more speedy excret.

Accord with many subj to chron catarh, Squills pills a habit & as it were a family med.

While howevr thus desirous of prev accumul in breast, wishd also to dimin secret.

And as means of effect this wishd to give augm determ to some other part.

This also indeed, in some degree an effect of the Squills.

For from augm determ to Kidn dimin that to lungs.

Accord from diuret in gener. benef in this compl.

But besides what thus obtaind wishd also to do something farther by inducing nerv, & what might be calld, artif disch.

For this purp. directed the appl. of a blister to the breast, afterwards to be conv into an issue.

Need hardly remark, that thus very consid augm disch, through part in which situated.

And that too, much greater than in proport to mere quant of matter disch.

For not to consid disch by issue as a mere putrid disch. of putrid matter

An issue to use language of a late elegant writer may justly be consid Nova quasi glandula.

And as consist in pecul separ. in same manner as in case of othr glands a very consid prop of blood both brought to it & carried from it.

Thus gives consid change in balan of circulat.

And by augm flow to one part tends to dimin it to others.

Is I appreh on this ground that highly useful in many diseases.

And partic benefice when disch can be inst, near the part from which wish determ to be made.

In case of lungs howevr having as it were circle by themselves, this almost unattain.

At least many places equally near.

Accord from circum of conven drain here often inst from back from arm or from leg.

But whatever may be prin on which to be expl. cannot help thinkin that have seen pecul benef by drain from breast.

And disch from thence obt even with less inconv than from most othr places.

Here therefore consid it as [desir] prefer.

On these diff grounds then expectd that benef might be reapt from pract here directed

Cannot howevr say that expect by any means answ.

And that too although weath by no means so unfav for such comp as we gener have in this country.

For in as far as wintr markd by frost & snow have hitherto we may almost entirely escaped it for this season.

And in point of temper. have had clim of Ital or Spain rather than that of North of Scotland.

Such a season then might have expected, if did not aid, would at least not have counteracted med.

But whatever might be cause benef from pract empl. by no mean so great as in such circum should have expected.

At first indeed thought all her sympt consid relievd

And after emet & blister was in partic much less distressd both with cough & dysp.

This relief however but tempor only.

And at succeeding report though dyspn still moder, yet cough very severe.

While mucus so viscid, that [expec] accompl. only with great diffic.

And this too although issue contin. to have free disch.

This aggrav however consid as effect of some accid expos to cold.

And hoped that by contin of pract the wishd for relief might be obt.

But to intended plan patient herself do not do justice.

For allowed issue to heal up.

And must be admitted that such drains though often adv. are yet always troublesome & not unfreq painful.

Issues partic so at commen.

And must also be confessed, that have effect of debilit more than in prop. to quant disch.

Hence then, could here hardly [entert] hopes, that should be able to induce pat to persist in use.

And by directed repet, should prob have obt no othr effect than that of desert. from farthr attend.

In place therefore of repet of Issue had here recourse to anothr pract from which hoped more immed relief might be obt.

The use viz of Opium.

This artic in cases of chron catarh is I must allow a very precar one.

In some cases have seen it do much good in others much mischief.

Can be no doubt that more effect than any othr artic we possess [allays] irrit to inord action.

And while thus dimin freq. of cough, also removed a cause of augm secret.

For no doubt that by freq concuss & agitat of lungs mucus secret is augm.

On these prin are prob. to explain benef sometimes reapt from it in this affect.

But whatever may be prin, unquest that in some cases has very consid & very salut affect.

In others however from influ as susp. cough without dimin secret. tends to augm accum in chest & of course encr. dyspn.

Nay in some inst even reason to believe that has thus given rise to suffoc.

Hence therefore great cautions always requis in empl.

And are chiefly to judge of prop. of persisting in it from effects.

In my opin cases in which chiefly advant. those in which cough the effect of irrit.

And where encr. mucus secret. is very much effect of concuss.

From presumpt that this the case with pres patient then here ventured on trial.

Began however with small quant only, half a gr viz the prop cont in five of Pil. Theb.

And with this quant of opium at night directed contin of Squill pills to extent of ten gr in morning.

Under this course has now cont for some weeks.

Cannot however sat that with any consid adv.

For although sympt sometimes better sometimes worse yet no perm change.

At last report found that [illegible] the Opium, had from freq of cough slept ill in the night.

And that during day much affectd with sickness prob. in conseq of squills.

If these sympt contin shall prob rather think of deserting pres plan than augm quant either of one or othr med.

And in place of what now employ Vin. Nicot.

At same time not improb that domest situat of this pat, with respect to expos to cold, more than suff to counteract any thing we can do for her.

And that till we get still warm & more steady weather all our efforts in vain.