DEP/DUA/1/23/16 (Normalised version)

David Dick

(1780)

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David Dick.

Another patient of whom since first prescription have seen nothing at this place.

Hence also hardly the subject of practice

Case in nature rather more doubtful than former.

But from every view, must be disposed to consider it as an obstinate & even dangerous affection.

One of principle symptoms pain extending from left hypochondriac region, to shoulder of same side.

This may proceeded either from affection of abdomen, or of Thoracic viscera.

But presumption rather of latter from cough & copious expectoration.

When to these add quickness of pulse, with night sweats, gives at least presumption of Phthisis.

And this presumption somewhat corroborated by age of patient.

Was now at that period of life, when Phthisis most common.

In this state with obstinate catarrhal symptoms, attended with paleness of countenance, debility, & other symptoms already mentioned, could not be without apprehensions.

And was disposed to consider it as being an example of a catarrhal Phthisis

But of this could have no certainty without other tests.

Particularly evidence whether in expectorated matter, any mixture of pus was, or was not contained.

This however from desertion of patient had no opportunity of determining.

And by same means also precluded from other evidence, which progression of case might have afforded.

Hence then in such state of [uncertainty] can say nothing of prognosis.

May only observe that even supposing it Phthisis, was yet of most favourable kind.

And by proper treatment not without prospect of recovery.

Of intended plan of cure from late observation on Phthisis need not be very particular.

Here became an objective of importance, in first place to free the lungs from matter already accumulated.

But although this completely affected yet little in reality done till alteration induced in state of separation at surface of lungs

And this alone [effectively] obtained from restoring due condition to superficial vessels on surface.

To these views then in practice endeavours would here have been directed.

And was as means of fulfilling first intention now mentioned that had here recourse to the emetic.

With some emetics considered as the only expectorant.

This however an opinion which must own, can by no means adopt.

Yet have no difficulty in considering as the most powerful.

Action thus arising indeed more immediately tends towards evacuation of stomach.

But has also very great influence as unloading breast.

Besides this however, here farther useful as giving determination to surface & thus diminishing impetus at lungs.

On these grounds then, from repeated emetics expected some relief.

And as answering such intentions am inclined to think that have often observed them of use, in Catarrhal Phthisis.

After emetics was here intention to have had recourse to Peruvian Bark.

And from this hoped at least for some effect as tending to restore due condition to vessels of lungs.

This practice however from his not continuing under care had never opportunity of trying.

And indeed never even learned which effect of emetic.

Hence [precluded] from any farther observations respecting practice in this case.