DEP/DUA/1/24/10 (Normalised version)

George Gordon

(1780-1781)

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George Gordon

Of disease to which this patient subjected after what said of some others now unnecessary to make many remarks.

Here as in several other cases principal symptoms cough, dyspnoea & pain of breast

And these attended with expectoration of considerable quantity of viscid mucus.

Not however without difficulty

In [other] cases with nearly similar symptoms of which have already [treated] of, not only last, those also of.

Hastie & Ainslie could not form very determined opinion.

From different circumstances however was led to give it as opinion, that in one instance of Phthisis, in another of Dropsical & in third of Catarrhal affection.

Have selected present case as affording example of affection where no room for doubt.

Exhibits distinctly marked instance of what commonly called catarrh Senilis.

But which when consider that not peculiar to age may with greater propriety be termed Chronic Catarrh.

Here no doubt I think that both dyspnoea & cough the effect of viscid mucus accumulating in breast.

And although did not suspect any particular cause of affection yet when consider period of attack probable that affect of cold.

This if not only is at least by much most common cause of such affections.

And accordingly nothing more frequent than to find disease in great measure disappearing during summer & again returning on cold weather.

With present patient however according to account given, present is first or at least most considerable attack.

As to termination when consider all circumstances of case not without apprehensions.

Disease exists with considerable degree of severity.

Has already continued for space of month during which time has been much aggravated.

But of all circumstances what most against patient is debilitated habit & advanced period of life.

In this condition, instances every day occur of patients cut by suffocation from mucus.

And should not be much surprised were such event to take place with present patient.

At same time not uncommon to find patient long subjected to same symptoms to much more considerable degree.

And by proper aid reason to hope that affection if not removed may at least be alleviated.

In obtaining this according to idea of nature of affection must be great objective to discharge mucus already accumulated

An end which as already observed perhaps more effectively obtained by emetics than any other means.

With a patient however so far advanced in life as present to general concussion which occasions some objections.

Hence then advisable, to try at first at least easier means of promoting discharge.

And at same time to conjoin such as from diminishing determination to lungs have tendency to diminish secretion.

Of measures for this purpose few more effective than application of blister.

Particularly if discharged afterwards suppuration under form of issue.

But same end may also be obtained by other & these more gentle measures.

And especially by determination either to intestinal canal or to surface.

Hence the advantage of gentle laxatives or natural looseness when does not [run] to any great height.

Hence also advantage from summer weather, temperate climate, proper clothing etc.

Is upon these principles then that to explain intention in practices which have here employed or which at present in view for this patient

Began by directing electuary of sulphur & Cream of Tartar.

This will readily suppose was intended as gentle laxative.

And not so much employed with view of obviating costiveness as of giving [some] determination to intestinal canal.

Am acquainted with few cathartics more gentle in effects & at same time more certain in operation than either of these

And if benefits singly often advantages from combination.

Particularly where Cream of Tartar by itself apt to gripe.

This effect often very [completely] [corresponded] by sulphur.

While again purgative power of Sulphur [briskened] by Cream of Tartar

Accordingly electuary of equal parts of these formed by syrup a very common prescription in different cases.

On present occasion the rather induced to it as from sulphur alone patient had formerly derived benefits.

But besides this at commencement of trial had recourse also to another remedy from which expected still greater advantage.

That was solution of Gum Ammoniacum.

Need not observe that Gum Ammoniacum which like other foetid Gums as have been called, partakes more of resinous than gummy nature long held in esteem as expectorant.

And although some disposed entirely to deny such operation, yet for my own part no doubt that active article may be collected at [excretion] by lungs as well as those of kidneys, salivatory glands or like.

While at same time observations of practitioners of all ages as well as daily experience demonstrates, power of this article as facilitating expectoration.

May be objection indeed to use in such cases that unfavourable as augments secretion.

But this more than counterbalanced by increased stimulation to excretion.

As in consequence of more expedient discharge never [illegible] that viscidity on which, [severity] of cough & dyspnoea depend.

With Gum Ammoniacum in state of solution here conjoined Squill vinegar.

An article from which am inclined to think same effect to be expected.

And to these with view rather of operating as corrigent covering taste & obviating nausea than with any other intention added Syrup Diacodium.

Under these medicines whether idea as to operation well founded or not patients complaint at first very considerably alleviated.

And can I think have little doubt in attributing to one effect of keeping belly gently open to other that of promoting more free expectoration.

Complaints it is true at last report were said to be again somewhat [illegible]

Yet while disposed to attribute this to some accidental exposure to cold am in hopes that by continuation of medicine may again be alleviated.

And that by persisting in this course may obtain as much relief as at this season of year & with such advanced age to be expected.

If however insufficient for relief may have recourse to squills to greater extent to blister issues & emetics.

In these however to be directed by circumstances after present trial.

Consideration of next case delay till [Saturday] lecture

And in place of delivering on Saturday next at usual hour hope it will not be inconvenience for you to favour me with a meeting on Friday next at 7 o’Clock