DEP/DUA/1/22/12 (Normalised version)

Archibald Campbell

(1779-1780)

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Archibald Campbell.

Some presumption that both this & next patient subjected to same disease.

If this however case are at least in very different states.

And have here chiefly selected them as exhibiting variety of examples of same affection.

Cannot however without hesitation assert that are same affection.

But whatever doubts as to other with present no great ambiguity.

In history so many strong marks of Phthisis that little difficulty in considering patient as subjected to that disease

Before came under our care distressing cough & pain of breast with dyspnoea of long continuation.

And had even for considerable time been attended with hectic symptoms.

Was subjected to frequent shivering fits succeeded by flushings of heat

Particularly by use of acid & alkali.

These as [proposed] by late ingenious Mr Darwin have often had occasion to mention.

Formerly however could refer only to results.

But now the Experiments published at full length by his father may be had in shops of [bookmakers]

Where furnished with proper opportunity for trial affords incontestable evidence

Where wanting other marks to be foundation of judgement

These often succeeded by very copious sweating.

Which, from affects here resulting from it, great debility induced, was necessarily led to consider as of colliquative kind.

And indeed besides debilitated appearance [examination] of habit already indicated in countenance.

With all these appearances has at same time constant quickness of pulse.

From these different particulars then strong presumption at least of Phthisis affection.

And if farther confirmation wanting [afforded] in state of expectoration.

Discharge by coughing, to very considerable extent a yellow coloured matter.

Had not indeed opportunity afforded us of determining by most accurate tests whether purulent or not.

Yet of this from appearance some presumption

Still stronger from being at times observed to be streaked with blood.

And when with frequent occurrence of other febrile symptoms observed that tongue moist & clean strong presumption

For to be observed that such a state of tongue constantly [accompanies] purulent expectoration.

Though before parched dry or covered with mucus becomes particularly clean.

And in many cases even assumes in this way preternatural appearance.

Acquiring very much both state & appearance of raw flesh.

Thus often one of most distressing symptoms to patients with which affected.

Do not indeed [represent] affection to such degree as occurring in every instance of purulent expectoration.

But while tongue continues covered with thick white mucus, is strong presumption against purulence.

On other hand such an appearance as here took place serves to give additional strength to conjecture.

And upon whole from history of case when came under care little doubt that at least principal & most alarming part of affection phthisis.

Besides Phthisis symptoms indeed, some others here occurred which might possibly be unconnected with it.

This particularly might be suspected with regard to impaired appetite. sickness at stomach & frequent vomiting.

And that rather as had been affected with these symptoms even for years before any Phthisic appearance.

Besides though these symptoms on some occasions connected with Phthisis yet not at least generally so.

And even sometimes where vomiting from cough yet appetite in place of being impaired particularly keen.

But whether connected with Phthisis complaint or not hold it of little consequence.

With regard both to prognosis & [cure] reckon Phthisis alone as only subject claiming attention.

And even from commencement prognosis could by no means be favourable.

Cannot therefore represent measures employed during course of attendance here as having had any good affect.

For although first report rather favourable as otherwise yet no more than every day observed.

Medicine which began in this case & to which proposed to have given fair trial one respecting which practitioners not agreed.

Use viz of Gum Myrrh.

This as well as many other vegetable Balsams a remedy very long in use against Phthisis.

But by many supposed that these from healing qualities highly pernicious

All healing Balsams particularly condemned by that very able practitioner Dr Totts.

And with express intention of banishing them from practice in this affection has written a paper in late volume of London Medical Observations.

Other practitioners however founding also on fact & observation have given different accounts

And particularly recommended by Dr Moses Griffith in observations on cure of hectic & slow fevers.

In a late treatise also by Dr Simmons

Practical observations on treatment of consumption¹ farther [testimony] in support of it.

From that particular appears that has been long & of late very much used at Guy’s hospital in London.

Particularly by Dr Saunders who within these ten years past, though at first prejudiced against it, has prescribed it in upwards of 300 cases.

And from such experience fully convinced of efficacy.

Does not indeed pretend that successful in all these cases.

But among different remedies employed has found more evidence in favour of Myrrh than of any other.

And in many cases in which proved successful no other medicines employed.

If practitioners have differed as to virtues so also as to method of exhibition & cases to which best adapted.

By Dr Saunders generally exhibited alone

By Dr Griffith united with salt of steel & nitre.

Former meant as [illegible], latter as corrigent

By Dr Griffith recommend in all hectics

By Dr Saunders represented as chiefly useful in those from debility where pulse small & quick & patient highly irritable.

Where haemoptysis, or much inflammation has in general found it too heating.

For my own part have for some years past had a good deal of experience of use in this affection.

And from experience which have had am inclined to think favourably of it.

Have observed however very little or rather no benefit from it in cases where hectic with dry cough

And am inclined to think that there operates as changing nature of matter discharged.

And where from many other circumstances reason to think that Phthisis consequence of scrofula turbercle.

Have chiefly observed successful where hectic with copious expectoration apparently purulent.

And where this matter mixed with bloody sanies.

In these I think have seen remarkable effects from it as diminishing hectics.

Probably operates in same manner as when changes ichor or sanious discharge from old [sores]

Has long been supposed that in these cases from external application gives disposition to heal.

And alleged even when taken internally to produce same favourable change on appearance of purulent discharge as when used externally.

If any foundation for this assertion must be equally of use whether ulcers obvious or not.

And thus in those of lungs as well as well as external sores may have good effects.

Practitioners indeed much divided in opinion on what principle this happens.

Some disposed to attribute it to introduction of active quality into circulatory mass.

And to topical action of these as again collected at extreme vessels.

Others again suppose effects internally to proceed totally from action on stomach & from these exerting antiseptic & antispasmodic power

For my own part am far from considering first doctrine in excepting light that some modern writers disposed to do.

Nor on other hand can I consider latter as free from objections.

Into this however do not here propose to enter.

If in reality has virtue attributed to it, if can ascertain cases to which best adapted & best mode of exhibition in these, the ascertaining principle of operation a matter of less consequence.

From what now said will observe that disposed to consider it as an useful [article] & particularly in cases such as present.

Here therefore wished to have had opportunity of giving it full trial.

In most instances, though frequently exhibit it alone reckon it preferable to conjoin it with some corrigents.

And particularly with view of [prevailing] healing quality & counteracting tendency to inflammation.

From this then in general give it as combined with refrigerant salts.

Where have employed adjuvant, [prepared] by Dr Griffith, the salt of steel have never observed any very particular affects.

With regard to refrigerant to be used, am chiefly determined by state of belly.

When constipated use Cream of Tartar.

Where tendency to [contrary] state give preference to Nitre.

And indeed consider latter as of the two the most powerful refrigerant.

But from bound state of belly with this patient led to Cream of Tartar.

If however sometimes constipation in Phthisis more frequently colliquative diarrhoea.

And this the Myrrh has common tendency to increase.

Hence then has sometimes led me either entirely to give up use, or to conjoin it with Gum Kino or Succus Japonica

And had present patient continued use before this time such addition would have been necessary

At first however opposite state required different treatment.

From continuation for space of week on Myrrh with Cream of Tartar, complaint upon whole rather alleviated.

This relief however not of long continuation

For during succeeding week debility increased so fast that unable to come abroad.

In this situation conceived such reluctance to medicine prescribed & indeed to every medicine that reckoned it improper to urge.

Symptoms since that have had common progression of Phthisis.

And though still alive yet almost daily losing ground.

Little doubt that very short time will bring complaint to fatal termination.

Here then as indeed in many other instances to which Myrrh apparently well [adapted] have employed it without success.

Still however cannot consider it as affording grounds for concluding against the remedy.

For here could not be said to have fair trial.

And even if after such had failed yet still would have considered it as meriting farther trials.

For not alleged by any one that always successful.

And if ever successful a valuable practice

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Explanatory notes:

1) Samuel Foart Simmons, Practical observations on the treatment of consumptions (1780).