DEP/DUA/1/19/14 (Normalised version)

William Bouchier

(1778-1779)

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Case of next patient William [Bouchie] in no long time favourably terminated under our care.

From principle symptoms of disease cough dyspnoea & copious expectoration could have no difficulty in referring it to genus catarrh.

Especially as in appearance of matter expectorated nothing giving slightest countenance to supposition of mixture of pus.

And no indication of hectic fever or other circumstances giving countenance to phthisis affection

While however disease thus evidently of catarrh was without fever.

And although patient not at that period of life during which could get name of catarrhus senilis yet could have no difficulty in giving it appellation of chronic catarrh.

Especially as had now subsisted with patient to [some] degree for space of three years.

And applied for our [assistance] only in [consequence] of peculiar aggravation of complaint from which rendered more distressing to him.

Circumstances of case during summer, of itself a strong evidence of this affection.

For among other marks of disease may be reckoned one of most characteristic that always aggravated by cold weather.

From all these particulars then could entertain no doubts with respect to principle part of patients affection.

Yet affected also with one other symptom respecting which some difficulty whether belongs to this or not.

That is swelling of legs at night.

This we can have little doubt depends on water collected in cellular membrane of parts.

To be considered therefore as giving indication of the incipient state of another disease anasarca.

And well known that from Anasarca as affecting lungs, some of most distressing symptoms in present case, Cough & Dyspnoea arise.

Then however without that state of expectoration which here occurs.

Besides these symptoms as arising from anasarca occur only when the disease has arisen to a considerable height.

Swellings however as here taking place to slight degree only.

And without other symptoms attending incipient state of anasarca scarcity of urine, [thirst] etc.

Can have little doubt then that cough & Dyspnoea not the consequence of anasarca

But that from these together with debilitated state of patient anasarca affection has here derived its origin.

This then opinion as to nature of disease to which patient was subjected.

Observations on Prognosis now precluded from being already brought to favourable termination.

Here may only observe that relief which patient obtained occurred sooner than I expected.

Did not indeed look upon disease as attended with any threatening symptoms

But very frequently happens that where complaints even much slighter than those of this patient continue with obstinacy notwithstanding best instituted plan of cure.

And when do yield is generally in more slow & gradual manner than in this case.

But although case has had so far favourable progress that have dismissed patient yet must observe that by no means consider him as free from danger of relapse.

This particularly apt to happen from even slightest exposure to cold.

In this respect however present [season] has been [practically] favourable.

And in all probability complaint would not have been so far alleviated in so short time, if weather had been more severe.

With this circumstance however am inclined to think that treatment here directed for patient, at least in some degree conspired.

Of this then come next to make some remarks.

In this affection consider what may be reckoned proximate cause of the disease to consist in increased mucous secretion by the lungs.

From matter thus accumulated filling air vesicles Dyspnoea arises.

And from irritation cough.

Great objective in cure then first to free lungs from this matter

And then to prevent fresh accumulation.

With these intentions remedies here directed were employed

As means of evacuating mucus already accumulated had recourse to emetics.

These indeed unquestionably operate most immediately, as discharging contents of stomach.

But can be no doubt that few more expedient or effective expectorants.

Probably consequence of concussive agitation & general effort to which they give rise.

And in this way, well known that often product of considerable & immediate benefit when lungs oppressed.

But besides this hold that in such affections as present, useful also on other principles.

Particularly as giving determination to surface of body.

By this means often affects as removing that determination to breast by which disease supported.

And thus have tendency, not only to alleviation of symptoms, but to radical cure.

Notwithstanding these advantages however very frequent repetition never perhaps advisable.

For unavoidable consequence is that tone of stomach weakened.

Hence then even where seems product of best affects, to be used with caution

And after first or second dose some interval to be allowed.

With present patient two vomits taken during course of first week.

And obvious operation of both these as could have wished.

Not however attended with that relief of symptoms which expected.

For after use of both cough & Dyspnoea continued nearly in former state

In this situation then less encouragement for repetition of emetic.

But had they been [even] more successful should have wished to [intermit] use at least for week

And was intention, if matters had continued in same state to have directed repetition.

But in mean time ordered for patient the use of Squill pills as much with intention of occupying intermitting time as with hope of great benefits.

Must however observe that hold squills to be in such affections both an active & useful medicine.

That these as entering circulation exert action on kidney no one will deny.

And for my own part am as fully satisfied that act also on other secretory organs particularly those by lungs.

From this circumstance however may seem ill adapted for such a case as present.

For here suppose affection supported by increased secretion

But if in this way influence rather adverse is more than compensated by action as promoting excretion.

By this means mucus discharged before acquires viscidity & thus both cough & Dyspnoea mitigated.

Hence then though no great tendency to radical cure while alleviated symptoms allows better opportunity for system to recover itself.

That was product of this affect in present case at least probable.

For from time that use begun expectoration more free & easy.

In this situation in place of returning to emetics thought it better to continue squills & augment use.

And from persisting in this course patients complaint so far mitigated that considered farther attendance as unnecessary.

As have some heard nothing of him am in hopes that continues free from return

Next case this day fortnight