DEP/DUA/1/11/17 (Normalised version)

Robert Robinson

(1776-1777)

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not to be written.

Robert Robinson.

With case of this patient have I own very great difficulty.

At same time symptoms from which at least strong presumption respecting general tendency of complaint.

Symptoms to which allude are the discharge by vomiting & cough.

No room for supposing that any mistakes respecting bloody discharge.

And at least strong presumption for purulent evacuation.

May be inferred both from colour, taste & smell.

Still more from quantity at once discharged.

For since came under care has vomited it up even to extent of pound at a time.

But discharge of blood & pus not merely by vomiting.

Certain that former fluid also evacuated by expectoration.

And although not same certainly presumption also of latter.

May conclude therefore that somewhere very considerable abscess.

But difficulty respecting situation.

Of all viscera lungs perhaps most frequent seat of suppuration.

And from this situation could easily understand why blood & purulent matter discharged by expectoration.

But to this supposition some objection from quantity at once discharged.

Seldom that any vomicae in lungs continues to extent of pound.

Still greater objection from mode of discharge.

Evacuation by vomiting.

Would argue that wherever origin situated at least immediately from stomach.

Natural therefore to think of some other supposition than that solely confined to lungs.

And here may occur as method of [solving] difficulty that more than one abscess.

One may exist entirely in thorax, another communicating with stomach.

May be supposed that one abscess so situated in consequence of adhesion & erosion as to have communicated both with lungs & stomach.

But perhaps upon whole difficulty to be explained on supposition of mistake of patient.

Not improbable that matter seeming to be discharged by vomiting from stomach is in reality expectorated from lungs.

And that computation of patient respecting quantity higher than ought to be.

Till more satisfactory evidence however respecting case must here remain in state of uncertainty.

Am afraid however that little room even for uncertainty respecting conclusion.

And great reason to apprehend fatal termination.

Would not indeed represent case of patient as totally irrecoverable.

As have already often remarked some chance from discharge of pus.

And in proportion to continuation of disease does not yet seem to have much affected constitution.

Gives therefore presumption that not ready absorption

And indeed from description of matter might conclude that well digested pus.

From this however less tendency to hectic fever than from putrid sanies.

Yet very rarely happens that internal suppuration even in most favourable circumstances are not in end fatal.

And with present patient, extent of affection evidently such as to threaten greatest danger.

Must therefore own that favourable conclusion of present case more than expect.

And from prognosis being hitherto slow cannot infer that will continue so.

Yet of this greater presumption than if hectic symptoms had rapid increase.

May hope therefore that better opportunity of trying what can be done by aid of medicine.

Yet must own that in present case much at loss respecting general plan of cure.