DEP/DUA/1/11/15 (Normalised version)

John Johnstone

(1776-1777)

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John Johnstone

Of this case still less room for doubt than preceding

Have no hesitation in referring it to same genus that viz of Catarrh.

And from continuation alone may be pronounced of chronic kind.

Still farther corroborated by state of pulse appetite & belly.

May however remark that absence of fever not essential.

And were it even present in this case would give no additional difficulty with regard to disease.

This the rather mention that not impossible that may soon occur.

For in advanced stages of this disease fever supervenes as consequence of affection.

And seldom even that disease proves fatal by suffocation till some degree of fever has occurred

Perhaps more frequently patient cut off by fever induced than proper suffocation from mucus

Will not therefore alter opinion if such should occur although yet no evidence.

Cough & difficult breathing great symptoms of this disease constitute by much greatest part of patient’s complaint.

And already of two years standing.

With that remission however which change of temperature in summer very naturally produces in this disease

And which patient might even enjoy throughout year if able to spend winter in warmer climate.

Is said also indeed to be affected with weakness & frequent vertigo.

These however consider merely as consequence of his disease

Proceeding from long continuation & severity of cough.

And even indicating tendency to other consequences which have already observed resulting from this affection.

In this view more doubtful of Prognosis than in former case.

Not merely less chance of being able to cure or alleviate complaint.

But greater danger that may soon prove fatal

Is indeed an affection by which few are suddenly cut off.

Yet as far as my observation goes is one proving fatal particularly to many of labouring poor

Particularly at advanced periods of life.

From manner in which necessary to live naturally liable to the disease

And from condition of habit, together with variable state of weather as much as severity the disease supported.

Not surprising that when from this [com] strength exhausted should prove fatal.

Have therefore I own some apprehension that present patient may not even hold out for this winter season.

Must at same time however observe that have seen disease even to greater heights hold out for several years.

And hope that may even be able to give aid in instance before us.

Of general principles on which this to be attempted after what just said of last case nothing need now be added.

Here also cure to be chiefly expected by secretion of mucus in breast being restored to natural state.

But with this patient more expectoration necessary to unload breast.

And to use means promoting expectoration.

For from difficulty in this cough greatly exacerbated.

And from stagnation during night acquires such viscidity that not discharged without very great difficulty.

These principles will explain any plan of practice in present case

Began patient with conjunction of two medicines in same formula commonly known by title of expectorant viz. Gum Ammoniacum & Squills.

From this mixture think I have very often seen benefits as promoting expectoration.

Nor can I by any means be persuaded of contrary by doctrine of those, who from theory disposed to maintain that no expulsants but emetics.

Yet although expectations from this medicine did not intend to trust to it alone

Was intention to conjoin use with repeated emetics & with an issue.

These the means which have hitherto followed & shall yet probably prosecute for some length of time.

Must evidently appear however that intended rather with view of relieving symptoms than for radical cure.

And own that till symptoms much relieved & breast unloaded should here be suspicious of any remedy diminishing secretion.

As would have reason to apprehend bad affects from restraining excretion.

If however can obtain considerable ease to patient may probably make some attempt in this way.

May use on principles which mentioned in preceding case, the Peruvian Bark.

Or may have recourse to other astringents either from vegetable or mineral kingdom.

Is indeed chiefly from latter that by introduction into alimentary canal effects can be expected to be exerted over whole system.

Yet present case requires from many circumstances that should proceed with caution

And I own that at least at commencement would be unwilling to try any strong astringent.

One of vegetable astringents which in such a case as present might I think be ventured on without hazard.

I mean the Terra Japonica.

This long supposed an earth now known to be a vegetable extract.

And prepared from species of Mimosoideae.

Of astringent powers on alimentary canal am well satisfied.

Not however so certain that from them exerts affects on system in general.

At least not so violent as to give grounds for apprehension.

May therefore introduce this as part of present treatment

And if find any benefit from it may have recourse to more active astringent.

Upon whole however greater probability that shall never obtain sufficient relief of symptoms for venturing on use

And more than probable that may rather be our objective to think of other means of alleviating these.

After what already done however at a loss to think what can be employed with this view with greater probability of success.

May indeed have occasional recourse to blister as well as emetics.

And may substitute Colchicum to squills & Gum Ammoniacum.

But upon whole without more certain defence against cold whether by climate clothing or lodging little to be expected

And disease may even be aggravated in spite of all efforts.