DEP/DUA/1/14/08 (Normalised version)

Pratrich Trotter

(1777)

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Pratrich Trotter.

Respecting disease of this patient when first came under care must own was much at loss.

And although has now attended regularly for above space of month opinion respecting it little more settled than before

Here could be no doubt that [affection] under which he labours to be considered as having seat in breast.

But a question of much difficulty to determine whether merely of catarrhal or phthisical nature

Was willing if could to flatter myself that of no worse tendency than former

Yet must be acknowledged that many circumstances giving countenance to latter supposition.

Cough & pain of breast are indeed by no means uncommon occurrences for some length of time without Phthisis.

But with our patient had subsisted for months together before came under our care.

Farther to be observed that during that time had increased in violence.

And for this increase of severity no manifest cause.

That is no evidence of augmented secretion of mucus acting as constant irritating cause.

Cough here said to be dry.

Or in other words with very little expectoration.

This however very frequently the case when effect of that irritation to lungs attending Phthisis

But besides all particulars mentioned two others still more unfavourable than any yet mentioned.

These are state of pulse & disposition to sweat which took place at time when came under care.

Pulse in general above 100 strokes in minute

Such quickness however an almost constant symptom in phthisical affections.

And although this condition may occur with catarrh yet when wanting always consider as giving presumption against Phthisis.

While at same time happening to a patient affected in manner ours is gives presumption of constant irritating cause supporting celerity

With this state of circulation also sweatings a very frequent [occurrence] in phthisical affections.

And indeed one of those [events] attending advanced period of hectic fever from which patients particularly exhausted.

In general remarked also as in case before us that these sweatings particularly occur in morning.

From all circumstances taken together then would appear that here grounds at least for apprehension of Phthisis.

And here next occurs as question what particular kind of Phthisis principally to be suspected

For hold that general wasting of system with hectic fever may originate from different morbid affections of the lungs.

Consider it in every instance to originate from absorption of purulent sanies.

This however may I apprehend be [illegible] in three different ways.

Either by separation from surface of lungs.

By being separated in form of vomicae consequence of preceding inflammation.

Or by separation from a tubercle that is a hard [inducted] swelling probably in every case originating from a diseased lymph gland.

Of these the last viz tubercule perhaps [universally] to be considered as depending on scrofula

Second vomicae often consequence of haemoptoe

Although this as well as first may frequently depend on catarrh.

And indeed am disposed to consider neglected catarrhal affections to be one of [chief] sources of Phthisis in this country.

Although however patient ascribed disease to cold yet if really Phthisis presumption was that depended on tubercle.

For here nothing resembling expectoration of purulent matter.

This however uniformly the case where separate from surface.

Pus indeed may be lodged in vomicae & give hectic fever where no purulent [expectoration].

But then usually other Phthisis [symptoms] attended with difficulty of breathing.

Which indeed must be necessary consequence if vomicae of any considerable size

And besides this patients seldom able to lie but on one side.

While at same time pain of breast fixed to particular spot.

Such appearances however all here wanting.

Serves therefore to give presumption of [affection] depending on that irritation & separation [which] tubercle [furnishes]

But although from all particulars mentioned presumption of tubercle yet by no means amount to certainty.

For as Phthisical complaints often make remarkable progress unobserved so coughs from other causes will put on very exactly appearance of Phthisis.

And here though quickness of pulse yet regular accession of hectic fever wanting.

And even in sweating to be observed [does] not as is frequently case in Phthisis occur in partial manner.

To all this may add that no [appearance] of scrofula in habit of our patient.

Nor as far as can learn has it existed in any of family.

And lastly patient in point of years already considerably past the consumptive period

That usually included between 15 & 25.

Our patient however has arrived at 50^th year.

From these different circumstances then some probability that disease may be of less fatal tendency than phthisis.

On such a supposition however can hardly style it catarrhal.

For see no evidence that increased secretion by the lungs

Probability therefore is that convulsive [affect] of coughing depends not so much on peculiar stimulation as on peculiar sensibility.

And on such a supposition I [apprehend] symptoms of this patients affection may be explained.

Yet though a possible cause reckon reality of existence very doubtful.

And after all rather disposed to supposition of Phthisis.

In this situation then will naturally [conclude] that apprehensive as to termination of disease

Do not indeed reckon recovery from Phthisis even depending on tubercule to be impossible.

But at same time every species of phthisis highly dangerous.

And of all others that from tubercle the most dangerous.

Is farther in affection in removal of which by medical aid can do very little.

Hence principle hopes of recovery to be founded on second supposition thrown out

That viz affection depends on peculiarly irritated state of lungs.

And was chiefly on this supposition that practice hitherto followed with this patient has proceeded.

Will indeed occur to you that on idea mentioned might naturally have had recourse to use of sedatives.

For in these have most immediate means of allaying irritability.

Many of them however although productive of immediate diminishment of irritability yet augment that state afterwards.

Wished therefore to try a remedy which though product of [more] [slow] would [induce] more permanent affect.

And was with this intention that had recourse to Peruvian Bark.

To this the rather induced as in such a case as present apprehend may have even good effects in phthisis.

In this affection in general objected to from tendency which has to diminish expectoration.

For by this means often augments difficulty of breathing

But in present instance nothing to be dreaded from this circumstance.

As evident that whatever cause of cough at least is not a matter which can be [decreased] by expectoration.

Even on supposition of tubercle therefore may as in other cases where purulent matter [observed], [counteract] inflammation of sanies [entering] system from this source.

And thus mitigating most urgent symptoms febrile affection & sweating.

Was farther of opinion that some chance of being of serviceable in this last way whatever might be cause.

And that from tonic power might [restore] sweating as increasing resistance at surface.

These then reasons by which [induced] to make trial of it.

And on whatever principle has operated seems at least to have been so far product of good effects.

While therefore appears this [promising] shall persist in use.

If however affection again increases [some] other measures may be tried.

May have recourse to opiate on [supposition] of peculiar irritability.

May employ mercury on idea of tubercle

Or may direct use of epispastic as [promising] some good affects on either [supposition]

But of future plans of cure can speak with little confidence till have formed more decisive opinion as to nature of the disease.