DEP/DUA/1/18/11 (Normalised version)

Nelly Drummond

(1778-1779)

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Nelly Drummond.

Of case of this patient much might be said.

And that both with respect to nature of affection, probable event & treatment.

As of late however has attended but little & probably may not be seeing more of her, reckon it less necessary to say much.

Symptoms such as to render it in good measure doubtful whether subjected to Phthisis or to Catarrh.

For in different particulars here in mentioned cough, dyspnoea, expectoration, state of pulse etc nothing giving certain evidence of Phthisis.

No doubt that appearances in catarrh often nearly approaches to those.

And but seldom at least that Phthisis continues for so long period as present complaints have already subsisted without proving fatal.

Yet on other hand greatest number of circumstances rather in favour of supposition of Phthisis as [otherwise]

Cause from which originates well known frequently to lay foundation of Phthisis.

As consequence of smallpox find often inflammation & suppuration in every different part of body.

And not unfrequently affects lungs

Such however are told was commencement of present case.

While a cause readily giving rise to Phthisis cannot easily suppose that should induce catarrh.

Although duration of affection against Phthisis yet not less so with catarrh.

For patient has not arrived at that period of life when reasonable to look for catarrh of chronic kind.

Nor are complaints particularly aggravated by those circumstances known to increase it example Cold

Is not observed particularly severe during winter & to cease in colder weather.

This however is almost uniformly case with chronic catarrh.

Hence then from this circumstance still less reason for supposition of Catarrh than of Phthisis.

Might probably be here [fermented] with certain test from nature of expectorated matter.

Matter according to description given us in every respect a purulent appearance.

And if really found such must necessarily consider disease to be Phthisis.

Need hardly however observe that common tests proper for distinguishing matter from mucus, taste, smell [illegible] in water, effects of burning, etc subjected to great fallacy.

Have indeed been furnished with much more certain diagnosis by late ingenious Mr Darwin and one affection distinguished from other by having recourse either to vitriol acid or to Caustic alkali.

For some account of his method of distinction may refer you to a late Volume of medical Commentaries.

These however merely result of Experiments.

But the whole dissertation will soon I am told be published by his Father.

Here however unnecessary to speak of it as patient never put it in power to give trial to this diagnostic

Where expectation or purulency tongue almost in every instance clean & red.

This however particularly case with our patient.

In as far however as can judge from other circumstances matter expectorated really purulent. Besides Smell & Taste confirmed by Tongue

Hence disposed to consider her as subjected to Phthisis

Yet must conclude with observation that without farther test no absolute certainty.

And if patient has not discontinued attendance shall be endeavour to employ such.

In present view of case disposed to give an unfavourable prognosis.

For if really subjected to Phthisis is a disease from which recovery at utmost but rare.

And that too even in most favourable cases.

Of such [nature] indeed suppose present case to be

For always at least better chance where matter has free discharge, than where retained in vomica.

Or where hectic fever excited from sanies yielded by tubercle without any proper purulent expectoration.

Is also somewhat in favour of patient that disease for so great length of time has had so little effect in debilitating.

For would argue that purulent matter yielded of mild & bland nature.

Hence then even although supposition true patient may yet recover.

Still more so if in idea of disease are mistaken & affection really catarrhal.

Yet disposed to consider chance as being upon whole rather against her.

And from symptoms having been of late much aggravated should not even be surprised at fatal termination in short time.

In practice in such cases as present great objective to be aimed at is the healing ulceration of lungs.

And till this can be affected the obviating effects of purulent matter [absorbed] into circulatory system.

Healing of ulcer in this as in all other cases must principally at least be work of nature.

Yet different particulars by which may in some measure be aided.

Chiefly I imagine to be done in 2 ways.

By promoting viz free discharge of purulent matter from lungs.

And by endeavouring to bring on that degree of action of vessels which forwards adhesion or what has been called adhesive inflammation.

With view to accomplishing any of those ends however have here had it in power to use very few medicines.

For although considerable time since patient admitted on list yet has attended us very little.

And from absence of late not improbable that shall see nothing farther of her.

Here neither hectic fever nor any other symptoms very urgent.

Consider no measures therefore as here necessary for counteracting influence of purulent absorption.

And while dyspnoea not very urgent copious expectoration showed that purulent matter had already free discharge.

Conclude therefore that with this intention also nothing at present requisite.

And was willing to direct whole attention to inducing adhesive inflammation.

Was with this view that put patient on use of Gum Myrrh.

An article of which have already had occasion to give opinion when speaking of case of John Thomson.

And which notwithstanding opinion of Dr Fothergill am inclined to consider as an useful remedy.

In this sentiment confirmed not only on [authority] of some eminent practitioners but likewise on own observations.

Circumstances of present case such as suppose particularly suited for this remedy.

And if patient returns to attendance will be endeavour as far as circumstances will permit to give full & fair trial.

May probably as has been recommended by Dr Moses Griffith unite it with small proportion of salt of steel.

This plan which intended to prosecute if patient had continued attendance, & which probably shall follow if renews it.

But as chance that this may not be case hold it unnecessary to suggest any thing farther.