DEP/DUA/1/11/14 (Normalised version)

James Bruce

(1776-1777)

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James Bruce

Symptoms of case not numerous

And one respecting which do not imagine that foundation for much difficulty.

Principle complaint cough & difficult expectoration.

These have already observed may arise from different causes

Particularly from every cause which has any tendency to irritate lungs or to occupy space which should be allotted to atmospheric air entering breast.

Such for example as water, blood, purulent matter in thorax itself.

Have seen that may be produced even by causes without abdomen as enlargement of liver.

In present instance however no room for suspecting any one of these.

Water in breast seldom without oedematic swelling elsewhere.

Blood would either give constant difficulty of breathing or be discharged by expectoration.

And if purulent matter besides pain of breast & various other symptoms should have hectic fever.

No affection without thorax on which can suppose it to depend

Naturally led therefore to ascribe both cough & difficulty of breathing to effects of mucus accumulated in lungs.

And that supposition corroborated by mucus expectorated.

Vomiting with which affected consider to be a circumstance of very little consequence.

And affect only of violent fits of coughing when stomach at same time distended.

For to be observed that affected him principally if not only after full meal.

From all these circumstances then no difficulty in concluding disease to be catarrh.

And from continuation with absence of fever would pronounce it of that kind which have formerly distinguished by title of chronic catarrh.

From all that have seen cannot pronounce either cough or difficulty of breathing here to be very severe.

Patient has not suffered from it any great loss of strength.

Nor can be disease comparably speaking be considered as of long standing.

From all these circumstances then cannot help thinking that here grounds to hope for complete cure.

Not however to be expected that will soon be brought about.

Nor can it be looked for during continuation of present weather.

May reasonably expect even that will now be much aggravated.

At least if patient does not guard carefully against inclemency of weather by keeping much within doors & by proper clothing

Hope however that upon whole, although progress to cure not uniform may get gradually better under care.

And as weather becomes warmer complaint may at least be much mitigated.

After what already observed of case of Brymner less necessity for being particular as to general plan of cure with present patient.

Chief indication in cure is morbid state of secretion from mucus glands of lungs.

And endeavours chiefly to be directed to restoration of this to natural state.

Both by avoiding circumstances increasing determination to breast & by promoting more free circulation in other parts.

With first intention particularly necessary to guard against exposure to cold

With last various medicines may be employed

Among these, emetics from influence as producing free circulation on surface by no means the least effective.

And repeated at proper intervals often attended with very considerable effects.

Was intention therefore to employ this in present case.

And to conjoin use with squills.

These indeed am inclined to believe from collecting at excretion of mucus have affect rather as increasing than diminishing secretion.

But to compensate this as affording additional stimulation have affect likewise as promoting excretion.

Thus tend to unload breast & diminish violence of cough.

While at same time have also chance of being serviceable as proving diuretic.

When these medicines first begun seemed to have good effects

And was intention to have persisted in this course for some time.

But cough becoming more frequent & seeming in some measure to depend on tickling in fauces a demulcent was judged necessary

And with this intention had Spermaceti in form of tincture.

As from this imagined that reaped considerable benefits resolved on continuing it alone at least for week or two

With resolution however of afterwards returning to former plan if should be found necessary.

That this will be case reckon highly probable.

Reason to apprehend even that both may be insufficient.

And that may be obliged to superadd to these still other means of cure.

Among these one of first to which will probably have recourse will be a blister.

And for obtaining more permanent affects to be kept open by epispastic ointment.

Besides these still another medicine which have often been led to imagine might be useful in this affection.

That is Peruvian Bark.

Of efficacy of this can say nothing from my own experience.

Nor indeed do I recollect to have heard it recommended by others.

Expectation proceeds totally on idea of nature of the disease.

And on efficacy of bark as restraining mucous discharge in other cases.

Thus for example consider it to be very useful medicine in Gonorrhoea after virulence of disease overcome

And with those who are averse to injections have often I think seen from it very remarkable affects as checking running.

On same grounds have been disposed to think that might sometimes be useful in chronic catarrh.

And in case of failure of medicine already suggested may perhaps try it here.

May however remark that is a medicine not altogether without ambiguity.

And while has tendency to diminish secretion may also have affect as diminishing excretion.

And thus may increase both difficulty of breathing & aggravate severity of cough.

May be necessary therefore during use to continue draining issue

And to conjoin even use of vomits at due intervals.

While point out these however as measures which have in view with present case would hope that symptoms will not require them.

And that patient by measures before mentioned may be dismissed if not cured at least considerably relieved