DEP/DUA/1/19/02 (Normalised version)

Robert Hunter

(1778-1779)

---

Robert Hunter.

Symptoms occurring with this patient by no means uncommon at his period of life or at this season of year.

Severe cough attended with Dyspnoea so frequent with old people that in many of best systems of practice even has got name of catarrh Senilis.

And such very properly applicable in case of present patient who is nearly arrived at 70 years of age.

But although most frequent with old people yet not confined to these.

And imagine therefore that with greater propriety may obtain name of chronic catarrh.

Symptoms of this affection in different cases very little varied.

Principle variety what respects state of expectoration.

Almost always thick viscid mucus.

Sometimes to great degree, sometimes more scanty

When latter of these circumstances case as happened with our patient breathing in general the most affected.

For depends not on scanty secretion but on matter accumulated in air vesicles of lungs & small branches of Trachea.

Such accumulation of secreted mucus then consider as having been principle cause both of cough & Dyspnoea with present patient.

At same time some reason to suspect that was not sole cause.

Is indeed true that patient not subjected to any of those symptoms considered as most certain characteristics of Hydrothorax.

But of this some presumption from dropsical swelling of legs.

And well known that the disease often subsists when no mark by which can be [distinguished]

Hence then when Dyspnoea very great with other dropsical appearances reason always for suspecting either anasarca of lungs or [affection] into cavity of Thorax.

This then foundation of suspicions in present case

And not impossible that either in progression of disease shall have stronger evidence of it or after death of patient more certain proof from dissection.

For here must own am by no means without apprehensions respecting termination of affection

Chronic Catarrh indeed in uncomplicated state will often continue for many years & to high degree without cutting off patient

Yet in end particularly when patient far advanced in life often even of itself proves fatal.

Still more however to be apprehended where reason to think that conjoined with others.

Particularly when these of still more dangerous [nature]

And such dropsical affections will unquestionably be allowed to be.

If opinion therefore not a mistaken one present case rather unfavourable as otherwise.

At same time recovery would be by no means surprising.

And if on present attack does prove fatal am inclined to hope that will not be for considerable time.

During that period measures may be tried both with view of alleviating & removing complaint.

And here according to idea given of affection alleviation chiefly to be expected by removal of matter accumulated in lungs or cavity of breast

While what properly speaking to be called cure must be affect of prevention of fresh accumulation.

In this instance suppose dyspnoea in part effect of water in part of mucus.

Former may be carried off in different ways but particularly by the Lymphatic absorption.

While latter in as far as already [secreted] to be carried off only by expectoration.

But with respect to both of much more consequence to prevent farther deposits.

And this to be done by giving due vigour to affected parts but still more by derivation of fluids from these

And is particularly on this latter principle that many patients regularly affected with chronic catarrh during winter as regularly free from it during summer.

For during latter period temperature of weather gives determination to surface during former determination from surface to internal parts.

These then what I take to be principle objectives to be aimed at in treatment of this affection.

Some varieties indeed will occur in particular cases depending on circumstances.

Such for example as removal of irritation from fauces by matter lubricated there.

But what now stated will explain [intentionally] with respect to most of practices directed in present instance.

And on these shall next offer some remarks.

First measure with this patient was application of blister to side.

From this measure expected advantage both with view to catarrh & dropsical part of affection.

Cannot indeed be supposed to have any influence as [abstracting] from lungs mucus already deposited there.

For probably is that thicker parts can in no case be taken up by absorption

But in as far as fresh [secretion] depends on determination of fluids to breast must have tendency to diminish it.

And accordingly few practices found more affective in this disease than epispastic [vesication] & even suppuration.

That is purulent discharge induced & supported either by issue ointment or [illegible] [contrivance].

Here however expected more from [illegible] blisters than from continuation of purulent discharge.

For if some advantage to be looked for as counteracting catarrh still more to be hoped for on supposition of water deposited in breast.

Of all modes of evacuation in cases even of hydrothorax blisters one of most effective.

And not less so where water in place of being lodged in cavity of Thorax in [illegible] [illegible] of lungs

From blister therefore with both these views entertain expectations of benefit.

And by effects at first produced meant to regulate [conduct] as to repetition.

But even supposing blister product of greatest advantage yet did not think that cure to be trusted to this alone

And accordingly directed also at same time another medicine a combination viz of equal parts of Cream of Tartar & Nitre.

Of these articles formerly, when taken at least to certain extent, has very considerable affect as acting on alimentary canal

In this way now in very common use as a cathartic.

And frequently given both with intention of emptying intestines & of evacuating from system.

When employed however with latter of these intentions, & meant to operate as purgative must be given to great extent.

Here utmost that wished from action on intestines was merely effect of gently moving belly.

And from this hoped that while determination to breast somewhat diminished, stimulation arising from irritated fauces as affecting circulation [through] whole system might also be removed.

But besides action on intestines, Cream of Tartar in many instances at least exerts affect also as entering circulation.

And like many other articles of saline tribe is especially thrown off by kidneys, where operates as stimulant, increasing action & augmenting secretion.

But if Cream of Tartar often employed as Diuretic Nitre no less so.

And among articles of this class has been very long & very commonly in use

Of late in several instances have employed Cream of Tartar & Nitre in conjunction.

And am inclined to think that thus obtained more effective diuretic than from either separately.

Do not indeed by any means represent as a medicine which will certainly operate by Diuresis.

And am inclined to think that no article of whole class on which dependence can be put.

Principle advantage of this combination that sits more easily on stomach, than equal quantity of Nitre by itself.

And that less apt to run off by stool than if consisted wholly of Cream Tartar.

To these as well as to either used by itself different corrections might be added.

But even without any addition have found it in many cases not only not product of inconvenience, but followed by best affects.

Was in hopes therefore that from this medicine should derive some good effects as moving belly, still more as promoting diuresis.

For by this means expected that water deposited about organs of [respiration] would be absorbed & discharged from system.

[illegible] myself that from this conjunction with blister dropsical affection might be removed.

And that might even alleviate catarrhal complaint by determination from breast to kidney.

In answering these expectations however medicines here used but of little avail.

In obvious operation of blister indeed were not disappointed.

For not only rose well, but copious discharge of [serous] afterwards [ensued].

Nitrous powder also not followed by any effect which would have wished should not occur.

That is neither occasioned sickness at stomach, inclination to vomit, nor those fits of chilliness with which very frequently followed

But with respect to obvious operation were disappointed of effects in both ways.

For had neither influence as moving belly nor as increasing quantity of urine

Not surprising then that by use of these no alleviation either of cough, dyspnoea or swelling of legs should be obtained.

On latter of these symptoms could hardly expect that blister to chest should have any influence.

But was somewhat disappointed that had no effect in giving any relief to two former complaints.

Although however had thus failed did not from this conclude that repetition would be product of no advantage.

But before taking this measure [illegible] with a patient so far advanced in life as present that space of a week or two should [interval].

During that period was intention to persist in medicine before prescribed.

And to increase as far as possible chance of obtaining effects by augmenting dose.

With this view in place of ℥i of Cream Tartar ordered each dose to be prepared with [ Jii].

But besides this thought it advisable also to make another addition.

And both with view to Dropsical & catarrhal affections ordered Pill Scillitica.

Of this formula consider activity as entirely depending on article from whence derives name.

That is the Squills.

Look upon root of Squills to be one of most certain & effective diuretics with which are yet acquainted.

But besides acting as stimulant to kidney when enters circulatory system exerts also similar influence on other parts.

And particularly on excretories of mucus by lungs.

From influence indeed as increasing secretion there might be imagined that in present case would have rather bad affects as otherwise.

But while augments secretion, by fluid being thus of thinner consistency, renders excretion more easy.

And thus gives appearance at least of a property often ascribed to it, that viz of attenuating mucus.

A property however which after secretion has already taken place, cannot [come] to be [possessed] by any medicine.

But while Squills give this appearance at least from promoting new secretion serve still farther to be of service in catarrh on another principle.

For in consequence of reaching [excretories] promote efforts for excretion.

And thus also mucus discharged in [more] fluid state.

From influence as promoting expectoration often useful in freeing lungs from load with which before [oppressed].

Cannot however say that from use in present instance derived much benefit.

For though cough somewhat mitigated yet pills no influence in increasing expectoration.

While at same time no obvious effect at least as increasing quantity of urine.

Nor did this in any degree result from use of former medicine the Cream Tartar with Nitre in increased dose

While at same time still failed in effect of moving belly.

While in this situation Dyspnoea increased besides continuation of these medicines thought it advisable to have again recourse to repetition of blister.

And with view to increasing influence directed that should for some time be kept open by Epispastic ointment.

But even under this administration patient derived from it no manifest advantage.

While at same time urgency of cough led me to suspect that some benefit might arise from articles of lubricating nature.

With this view therefore [omitting] powder & continuing issue conjoined with pill Scillitica the use of Mistura Oleosa.

But these practices not more successful than formerly.

And while from issue very little discharged was at same time product of very great unease to patient.

Led therefore to discontinue it.

And as still disappointed both of influence of squill pill in promoting expectoration & in exciting Diuresis thought of substituting to these another medicine viz Spirit Nitre dulcified.

This considered when does operate to be one of most expedient Diuretics which can possess.

And as evacuant of Serous have in many instances seen best affects from it.

What however was influence with present patient have not been informed.

For since first prescribed have seen nothing more of him at this place.

And as probably may not visit us again unnecessary to say anything with respect to future plans of cure.

May only observe that after all [attempts] already made have proved fruitless, opinion of case more unfavourable than when began [treatment]