DEP/DUA/1/24/15 (Normalised version)

William Rob

(1780-1781)

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William Rob.

After what said of some former patients little of present.

And especially as from irregular attendance little object of practice.

Complaint similar to those occurring in several other cases already considered.

Consisting of cough, dyspnoea & expectoration of viscid mucus.

This discharge as may naturally be expected not accomplished without difficulty.

But when accomplished gives considerable relief

Hence then little reason to doubt that this at least principle cause of symptoms

And that may denominate affection an instance of chronic catarrh.

Hence however selected as being somewhat singular.

Particularly with respect to course to [which] attributed.

This patient by occupation will observe a flax dresser¹.

And attributes his affection to nature of business.

Can be no doubt that air which flax dressers breathe, must often contain very considerable quantity of dust & other extraneous matters.

And in this as well as other occupations where similar state of atmosphere inspired, have often seen great inconvenience.

Am not however disposed to think that can be considered as cause of disease.

But where morbid secretion of mucus will have very considerable tendency to aggravate affection

For by measures of viscidity very apt to be retained.

And accordingly often even discharged in large quantity by expectoration.

In this manner then from accumulation must aggravate dyspnoea.

And from irritation must increase cough.

Perhaps even on latter principle, with some condition of lungs may increase secretion.

But when this the case patient should be constantly subjected to disease while continues employment.

And have met with more than one instance where on this account change became necessary.

This however evidently not case with patient before us.

For with uniform continuation of profession has sometimes been subjected to it sometimes not.

Hence then consider his occupation in life as being a cause merely aggravating affection.

And although does not trace it to any particular occurrence when consider season at which has come on as well as former attacks, would look upon it to be effect of winter cold.

In symptoms of case when came under care nothing alarming or uncommon.

And patient, though past 50^th year yet not so far advanced in life as to give grounds for apprehension from that source.

When to these circumstances added former recovery little hesitation in expecting it also on present occasion.

True indeed said now more severe than ever.

At same time patients in general much disposed to make present evil the worst.

And symptoms had by no means occurred with that degree of severity which often observe.

From these considerations then entered on practice, in hopes that patient would soon get better.

And that although might not be able to bring about complete cure should yet obtain temporary suspension of symptoms

In this expectation some grounds for presuming that have not been disappointed.

At same time as patient has not lately attended & as have not seen him since cannot with certainty speak of present situation

Of general plan of treatment in this case or of particular remedies employed not necessary to say much.

Here great objective for obtaining immediate relief discharge of mucus & other matter accumulated.

And for producing radical cure the prevention of fresh accumulation.

With these intentions had here recourse to repeated emetics & squill pills.

Former principally meant for immediate discharge of mucus.

And have already oftener than once observed that know no means of promoting expectoration more certainly or expediently than action of vomiting.

But besides this also useful in [illegible] affections as giving determination to surface

With regard to squills can be no doubt that this root impregnated with [peculiar] acrimony.

When taken to great extent acts very powerfully on alimentary canal.

In smaller quantity & more slowly introduced equally little doubt that enters circulation.

And in this way effects particularly apparent as increasing secretion of urine.

By augmentation of this discharge often happens that in affections of breast in particular patient derives no inconsiderable benefit.

Expected then that on this footing might here be of service.

But for my own part am of opinion that more to be looked for from it as acting upon lungs.

For have little doubt that on [secreting] organs there has similar [operation] as on these of kidney.

And that by inducing quicker & more ready excretion prevents that accumulation on which both cough & dyspnoea depend.

This opinion indeed with regard to action of expectoration is by some altogether denied.

But in adopting this sentiment I agree at least with by much greater part of practitioners.

And indeed influence of squill pills as facilitating expectoration in such cases [confirmed] by undeniable facts which are subject of daily observations.

In so much that with many patients becomes a familiar remedy to which have of themselves recourse without medical aid.

And whatever may be said by medical theorists may with confidence venture to say would be impossible to convince them that do not derive benefit.

This being case may seem very extraordinary that Squill pills rejected from previous edition of Pharmacopoeia² while [placed] in all former.

To this however College not led from considering it as ineffective medicine or improper formula.

Reason of omission was that these pills whether preparation of recent or dry squills should always be made up for immediate use & given in fresh state

And no doubt that few formula of pills more apt to be injured by keeping

Was thought also that another advantage might result from it.

That greater latitude viz to practitioners to vary preparation of squills at pleasure.

And mere opportunity of combination with any particular corrigent best accommodated to patients stomach.

Notwithstanding these particulars however still think that want of fixed formula an omission.

And will probably be replaced in next edition

For, want of Rx in Pharmacopoeia has not banned them from shops of [Apothecaries]

And in almost all kept as directed to be prepared by last edition.

When here present then are to consider them as prepared by that formula.

Under two emetics & pills patients complaint very considerably relieved.

In this situation thought former unnecessary but directed continuation of latter.

Since that however have not seen patient at this place.

What therefore present state do not know.

Yet more probable that cause of [desertion] has proceeded from having no farther occasion for assistance than any other reason.

Probable however that shall not see him again – Hence suggestions unnecessary

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Explanatory notes:

1) A worker who separated the coarse part of flax or hemp with a hackle in preparation for the spinner.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.