DEP/DUA/1/14/13 (Normalised version)

Adam Kirby

(1777)

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Adam Kirby.

Disease of this patient one with regard to which do not consider us as subjected to much difficulty.

At same time do not look upon it to be simple or uncomplicated affection.

Greater part of complaint such as have already oftener than once had occasion to mention

Consisting of cough, difficulty of breathing with expectoration of viscid mucus.

With combination of these affections, occurs at least as most probable supposition that two former to be referred to latter as cause.

And that while stagnating viscid mucus accumulated in breast cause of difficulty of breathing at same time from acting as irritating cause gives rise to cough.

On these grounds then would consider present affection as principally depending on increased secretion of mucus.

Or in other words to be catarrh.

And notwithstanding state of patients pulse which considerably quicker than natural standard must pronounce chronic catarrh.

Of this sufficient evidence not only in absence of other febrile symptoms heat, thirst, debilitation etc but also from continuation.

Before came under our care affection had subsisted for about 9 months.

True indeed that this not unfrequently case where nearly same symptoms from Phthisis.

For from this also cough & difficulty of breathing

But besides that affection characterised by condition of expectoration in viscidity of which have sufficient cause for symptoms almost no circumstances giving countenance to supposition of Phthisis.

Though pulse quick yet nothing resembling hectic accessions.

Patient not affected with any fixed pain in breast

Nor any circumstances in habit or former condition of life giving countenance to phthisis

While far past age at which that affection almost alone takes origin has arrived at period when catarrhal complaints of chronic nature by much most common

And in modification of cough here catarrh particularly characteristic.

Attacks in very severe fits which continue seldom less than 1/2 hour often two hours at time

Such fits almost never the concomitant of Phthisis.

These coughs in general rather frequent than severe.

Nature indeed differently modified according to cause of Phthisis.

But for most part under form of what called short tickling cough.

While on other hand in chronic [stage] of catarrh fits of coughing continue till expectoration takes place.

And where mucus very viscid this not affected till fit of very long continuation.

Is indeed in some measure in common to both to have cough aggravated on first going to bed.

And indeed naturally follows that cough should be aggravated by change in circulation produced by application of cold bed [clothing] to surface.

But in some measure peculiar to catarrh to be severe in the morning.

Is necessarily consequence of stagnation & consequential additional viscidity acquired by mucus during night.

From this source however cannot look for aggravation of cough in phthisis.

And accordingly not in reality observed.

But while all these circumstances concur in leading us to pronounce present case catarrh one circumstance mentioned in history which would naturally occur as particular.

That is peculiar sense of suffocation taking place during severe fits of coughing.

This indeed not infrequent even from interruption when coughing must give to action of respiration.

Will also in some measure be effect of obstruction to larger branches of trachea while viscid mucus by successive agitation brought gradually higher

But that in present case not from either of these causes evident from mode in which relieved.

Patient we are told freed from it by eructation of wind.

From this then might I think conclude that difficulty of breathing in some degree effect of distension of stomach by wind.

And that on discharge of this more room afforded to lungs.

Thus then from first history of the disease may infer also some affection of alimentary canal giving rise to uncommon extrication of wind.

But of such an affection have since had farther evidence from after circumstances of complaint.

While cough considerably alleviated still continued to have various symptoms evidencing the affect of wind.

And these not merely appearing during fits of coughing.

Nor confined solely to upper part of alimentary canal.

Complains of being much & even constantly affected with wind through whole tract of bowels.

Could therefore be little doubt that with catarrhal affection there was here united, that state of alimentary canal favourable to extrication of air from aliment.

This then opinion which entertained respecting name & nature of affection to which this patient subjected.

And with these sentiments of his disease could not consider our patient as in any great [danger]

Would not indeed be understood to [effect] that might not be cut off by either.

And well known that both when to high degree not unfrequently mortal affections

But in present case had put on no such appearance as could lead to dread of such conclusion.

Although however from these considerations was disposed to look upon affection as free from danger yet did not expect speedy termination.

For both one & other affection very obstinate.

And often that medical aid particularly at late period of life of little avail.

Then even stomach complaint remained with much greater obstinacy than at earlier periods.

Probably as cannot then employ to equal extent most effective modes of cure.

Particularly free use of exercise in open air.

But if reason for doubt respecting affection from wind still greater with regard to catarrhal affection.

And this as already observed considered to be by much most considerable part of disease

To patients far advanced in life this affection particularly common.

And when becomes so is very rare that get rid of it.

For most part when gives even not great inconvenience is yet in effect continued during remainder of life.

And often even observed that when cough absent are worse.

That is, cough stopped only in consequence of some more material affection.

May indeed be considered as favourable circumstance [there] that since patient came under care cough considerably mitigated.

This however perhaps as much affect of warm weather as of any remedy employed.

And do not doubt, that whether from one or other cause severity will again be increased during winter.

But from season of the year alone may look at present for alleviation of this part of affection.

Which also may be somewhat aided by use of proper remedies.

And if from these can also diminish affection from wind must own that is utmost that here expected.

And if patient continues to enjoy same relief as for some time past shall think of dismissing him.

Since this patient came under care have not employed great variety of measures with view to relief.

Considering catarrh as most [material] part of affection thought first of taking measures to alleviate it.

On opinion delivered of affection should look for radical cure from restoring augmented discharge to natural standard.

Hence might expect cure from use of astringents & tonics.

But although quantity of secretion ultimate cause yet immediate cause is retention of that quantity in breast.

And with our patient retention seemed not so much effect of very great secretion as of want of disposition in lungs to excretion.

And when excretion not properly carried on, viscidity acquired of course comes to be great.

Considering this therefore to be case in instance before us looked on means of promoting excretion to be most essential.

For this purpose various medicines long in use known by title of expectorants.

And although some modern practitioners disposed to deny existence of any such yet cannot help thinking that stimuli [entering] circulation may be collected at this as well as other [excretory] organs.

From greater part of expectorants indeed while propensity to excretion augmented some influence also as augmenting secretion.

A circumstance which may necessarily suppose unfavourable in such complaints as present.

But influence in this way more than counterbalanced by affect in producing discharge.

Naturally occurred therefore as most proper remedy to be here employed.

Of all the expectorants of kind now mentioned gave preference to the Gum Ammoniacum.

To this led as hoped likewise might have some good effect on affection from air in stomach.

For while imagine it capable of [action] as stimulant on collection at excretion of [mucus] hold likewise that had in some measure effect of foetid gums in primae viae.

And that by antispasmodic & stimulating influence there tends to expulsion of wind.

On first employment of this medicine were not disappointed in expectations in either of these ways.

At least while had evident effect of producing frequent eructation at same time cough was somewhat relieved.

For cannot help thinking that might reasonably infer that relief from this cause when consider that from farther continued state of expectoration manifestly changed.

Became according to observation of patient evidently less viscid than formerly.

Not then surprising that duration of fits of coughing at same time much shortened

Any may be considered even as additional proof that [violence] effect of peculiar viscidity of muscles

While therefore reckon it not improbable that relief of cough in some measure effect of warmth of weather would not consider medicine as of no affect.

But although cough became gradually easier whether from this or any other cause, affect from air in bowels not equally diminished.

And solution did not continue to have power of producing such frequent eructations as before

In this situation thought of employing a carminative stimulant still more powerful.

And was with this intention that had recourse to Pill Gummosa

A formula of which already oftener than once occasion to speak.

Consists of several [Gums] as Galbanum & Myrrh nearly resembling the Ammoniacum.

And what more near affinity & still more powerful than either the Assafoetida.

On this imagine principle efficacy of remedy to depend.

And hoped that by addition of these pills to former mixture affects might be more powerful.

In this however disappointed.

For while cough continued easier other [affection] nothing mitigated.

In this situation then thought it unnecessary to continue measures with view to cough.

And omitting both former medicines gave a prescription to patient solely with view to wind in bowels.

In this employed as a stimulant more immediately acting upon stomach, a medicine in which greater part of composition peppermint water.

Need not observe that activity of this depends on diffusion of a warm essential vegetable oil in water

Effect of this from stimulation to stomach when wind lodged there is almost immediate [expulsion]

In this way affect even as instant as ardent spirit.

While at same time not in other respects product of equally bad affects.

And probability is that if some of fair sex who have recourse to cordial spirits for stomach complaints would employ simple peppermint water would never become [illegible].

But although look on efficacy to be [constant] & immediate did not here trust to it alone.

From addition of syrup indeed expected no efficacy.

But was principally intended to diffuse & suspend in watery menstruum the other addition viz. Tincture Fuliginis.

This hold to be remedy of same nature with pill foetida.

And here used with same intention.

Consider this although derives name from the Fulligo to be principally a Tincture of the assafoetida.

And in general give it even preference to Tincture Foetida strictly so called from menstruum which is employed.

In one case menstruum [merely] weak spirit of wine with which can venture to use [illegible]

But in other is Spirit Salt Ammoniac Vini.

Which although caustic volatile alkali somewhat diluted yet must be exhibited with [sparing] hand.

From formula here directed then expect more immediate & more powerful affect than from those before used.

And hope that will so far relieve complaint that may soon dismiss patient.

If however does not may have recourse to other stimulants & tonics to stomach.

But as already observed at utmost here expect alleviation only.