DEP/DUA/1/11/08 (Normalised version)

Edward Byrymner

(1776-1777)

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Edward Brymner.

Disease very distinctly marked.

And at same time one not less frequent than troublesome & obstinate.

With present patient not to same height as with some others under care.

Particularly in case of John Johnstone who labours under same affection.

From this variety in different stages has different names

Not only among vulgar but even among people of science.

Thus with present patient some would refer it to head of cough.

For by most nosologists¹ Tussis ranked among genera of diseases.

While in case of Johnstone might from difficulty of breathing being greater be referred to genus of Asthma

What has been termed Asthma Humid.

Cannot help thinking however that these appellations improper.

And that both diseases not only of same genus but even same species.

In my opinion present & similar affections of which at present several instances under care to be referred to title of Catarrh.

Do not indeed correspond to catarrh as defined by several authorities

And as referred to class of Pyrexia.

Cannot help thinking however that this method of arrangement exceptional.

And if merely consider profluvia as morbid increase of natural discharge form an order of diseases among which great affinity.

These either may or may not be attended with fever.

When however occurs not to be considered as essential but merely as accidental symptom.

Taking profluvia in this sense would refer catarrh to it as being an affection the essential part of which consisted in increase of mucus discharged by lungs.

And either may or may not have fever.

One species of Catarrh indeed which may seem strong objection to this

And in which fever probably essential part of disease.

What I allude to is the epidemic catarrh.

This however cannot help thinking with great impropriety referred as species of this Genera.

Is evidently a disease which in nature no essential agreement with catarrh from cold.

Depends upon a peculiar febrile [illegible].

And no more analogous with catarrh from cold than smallpox with cutaneous eruption having some resemblance to them.

These observations respecting nosology of catarrh reckoned necessary before giving name to this disease.

And in view now given of it case of present patient without hesitation to be referred to it.

Is sufficiently characterised by copious viscid expectoration.

For can be no doubt that troublesome cough merely consequence of accumulation of this matter in breast.

Will occur however as second question how far genera now defined of different species

And to which of these present case to be referred.

Must own that am one of those who reckon multiplication of species of diseases both unnecessary & improper.

True indeed that general cure will by no means apply to all cases falling under it.

But neither will cure of species apply to all varieties.

And in practice cure must in every instance be adapted to peculiarities of the case

Would only subdivide in general therefore by great & leading marks.

And here two conditions which require being distinguished.

That is whether disease occurs as acute or chronic affection.

In first case appears as almost immediate affect of particular accident.

Is attended with considerable degree of fever

And in no long time terminates either in health or in some other affection.

Of all others most common sequels are either phthisis or chronic catarrh.

Any observation on former here out of place

And at present more than one instance under care which will afterwards lead us to consideration.

By latter chronic catarrh understand increased discharge of mucus by lungs without fever.

And most commonly without any degree of inflammation.

This disease as I observed at commencement both common and troublesome.

And as such is subject of discussion with most practical authors.

Commonly distinguished by appellation of Catarrh Senilis

And cannot be refused that is chiefly a disease of old people.

Yet as sometimes occurs at early period of life consider chronic catarrh to be less exceptional name.

And indeed could hardly be termed senilis with present patient a man not 50.

From these different considerations then would say that Edward Brymner is affected with chronic catarrh.

A disease in the end often proving fatal

But for most part not suddenly so.

Rather by wearing out constitution than in any other manner.

Although sometimes indeed kills by immediate suffocation.

With present patient however has not gone to any great height.

And strength little impaired.

Besides not yet arrived at very advanced period of life.

Hence some grounds for hoping even complete recovery.

More probable however that will not be able to rid patient of all remains of disease.

But that will continue more or less to be affected with it during winter season.

Hope however that under proper treatment complaint may at least be considerably alleviated

Particularly if situation of patient at home can cooperate with our measures.

In this affection great objective must be the restoration of secretion to natural state.

And principle means of affecting it is by diminishing determination to lungs.

Hence no less necessary to avoid cause promoting determination there, than to use such means as will increase flow of blood to other parts.

Of all causes determining to internal viscera most considerable is cold to surface.

Hence this affection uniformly observed worst during winter months.

And one of these in which passing winter in warmer climate of highest utility.

Where that as in present case unattainable cold particularly to be guarded against by proper clothing & comfortable lodging.

As by this means uniform circulation chiefly to be supported.

But besides this breast also relieved by increasing flow to neighbouring parts.

And with this view nothing more permanent good effect than some drain in form of issue or seton.

With same intention also Emetics often useful

Have particular effect of giving powerful determination to surface.

Although indeed not permanent.

But in this disease farther serviceable from another circumstance.

Uneasy symptoms although ultimately from increased discharge yet more immediately the effect of accumulated mucus in breast.

Hence considerable relief from all means unloading breast by promoting expectoration.

And with this intention no remedy more immediately serviceable than emetics.

These however at utmost to be repeated only at certain intervals.

Hence relief to be expected from something more permanently producing same affect.

And with this view if be any such would naturally think of these remedies which after collecting at lungs produce tendency to excretion.

Existence of all such indeed some medical writers are disposed to deny.

But must own that cannot help holding on this subject a different opinion.

Can see no more difference in supposing it possible that effects of medicine entering circulation should appear at secretory organs by breast than by kidneys or salivatory glands.

And am farther persuaded that such an action confirmed by observation.

Particularly observed from effects of many of same substances which after introduction into circulatory system show effects on kidney.

Such for example as squills.

And have affect in relieving complaint by affording additional stimulation to excretions.

While aid expectoration seem also to produce change on state of secreted mucus

And as excreted is evidently of less viscid & tenacious consistency.

This probably not effect of any alteration on state of mucus as secreted.

But happens merely from excretion occurring before in consequence of stagnant viscidity acquired

By these means therefore although little tendency to cure yet of considerable service as alleviating the disease.

On these general principles have begun & mean to conduct practice in this case

viz By Issue by Squills & by repeated Emetics.

Last however to be used only occasionally

That is when from much difficulty of breathing reason to suspect considerable load on breast

Hope that by proper use of former these may be less necessary.

And indeed know no medicine from which greater reason to expect considerable benefits.

May indeed change drain to different situation or to different form.

And with squills may conjoin Gum Ammoniacum or Assafoetida.

Or may substitute to it one or other of these.

But such changes excepted will probably make no other unless from circumstances of disease with which are not at present acquainted.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.