DEP/DUA/1/24/17 (Normalised version)

Robert Hume

(1780-1781)

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Robert Hume.

Disease from several circumstances doubtful.

But in any view not without danger.

Consists principally of pectoral complaint.

Severe cough viz with viscid expectoration.

These well known symptoms of different diseases.

And judgement to be formed by concomitant symptoms

Here room for three different suppositions.

Catarrhal affection Phthisis Pulmonalis or Pertussis.

Of these diseases latter indeed when in state called formed, characterised by a very striking symptom.

Viz Kink or Hooping.

But in some instances does not occur for long time

And that too in very bad cases.

In others of slighter nature disease runs whole course without any appearance.

Absence therefore for two months no certainty against affection.

And here some circumstances favouring supposition.

At present to be met with among many children in Edinburgh.

And do not learn that this patient before subjected to it.

Fits of coughing also observed terminate by vomiting.

A circumstance if not characteristic of Pertussis at least very common

This however far from amounting to any strong evidence.

And here I think still stronger reason for believing that a more dangerous disease.

Chiefly divided in opinion whether Phthisis or Catarrhal.

But of two most inclined to former.

Season of year indeed such that mere catarrh affection supported for great length of time.

And even with infants may degenerate into chronic state.

But here many other concomitant symptoms seldom attendant on Phthisis

At head of these may mention periodic febrile [accession].

According to history of case regular attacks every afternoon.

And this [accession] continues for considerable time.

During night another appearance favouring that supposition.

viz Partial sweatings.

These not always attendants of Phthisis

And sometimes take place where [absent].

But when combined with cough & fever always give ground for apprehension of Phthisis.

Another circumstance also since came under our care which would lead to same conclusion.

Looseness viz with which affected.

Very much appearance of colliquative diarrhoea.

A symptom well known frequently occurring in Phthisis

To all these may add another circumstance

viz constant quickness of pulse.

Upon whole then although no certainty yet strong presumption of Phthisis.

Supposing this the case however hold it to be question of importance in practice to determine species.

Have already observed that with view to practice distinction of greatest consequence into three species.

Catarrhal. Ulcerous & Tuberculous

And here also room for doubt.

Chiefly however whether first or last.

For of proper ulcerous consumption [illegible] [illegible]

Expectoration indeed copious

But certain that principally mucus.

And if contains any pus at utmost [be] inconsiderable mixture.

Cannot therefore be supposed to proceed from vomica already burst.

As little reason to suppose that large vomica in lungs unburst.

For patient not affected with any violent or fixed pain.

No constant dyspnoea.

And no particular difficulty of respiration when laid on either side

Principal difficulty then whether catarrh or tuberculous.

And here circumstances favouring each supposition.

Copious expectoration in favour of former.

Appearance of patient of latter.

For very much the fine skin & [beat] complexion of scrofula patients.

Must however be observed that as far as can learn has not scrofula as hereditary.

And while [parents] free has not appeared in other child of same family.

Has occurred also at early period of life.

For when scrofula affects lungs most commonly later than on other parts.

And accordingly tuberculous consumption most frequent from 15^th to 28^th year.

But yet on other hand occurrence of tuberculous consumption even at early period by no means rare.

And even in own practice have seen younger children fall victim to it.

Not appearing on other parts no reason why should not affect lungs.

For where hereditary or family disease those most apt to die Phthisis with whom scrofula swellings not [obvious].

In all circumstances mentioned then no grounds for certain conclusion.

In such doubtful cases perhaps best distinguishing mark, from examination of [expectorated] matter.

For if contains mixture of pus reason to presume that separated from surface of lungs.

This oftener than once attempted in present instance by what hold to be best criteria viz caustic alkali.

And although experiments not conclusive yet such deposit on addition of water as [would] argue some mixture of pus.

At same time unless alkali here capable of dissolving pus also, is but very inconsiderable.

And own does not seem sufficient to account for symptoms.

Yet upon whole think it [fully] as probable that catarrhal Phthisis as any other.

And with this idea more favourable prognosis than if conclusion that certainly tuberculous.

At same time in state of uncertainty [cannot] help being very apprehensive of patients fate

And even if entirely catarrhal yet unquestionably very dangerous.

Especially [after] with constant quickness of pulse colliquative sweats & diarrhoea have proceeded to such length.

For although these at times diminished yet never entirely free.

And often mitigation of one has happened only on occurrence of other.

Upon whole then if patient recovers is I own more than expect.

At same time very far from [viewing] as desperate case.

And many measures which may at least be tried with some probability of [success]

Here have hitherto conducted treatment on supposition of Phthisis.

And have principally at least had in view its being a catarrhal Phthisis.

In this affection great objective is to alter state of separation by superficial vessels.

An end principally to be effected by diminishment of impetus of blood there.

And by restoring tone to these vessels whether by acting on them in particular or by strengthening whole system.

But besides these general intentions becomes requisite also to obviate symptoms.

And from attention hitherto necessarily bestowed on last have yet done little towards former.

This however will more particularly appear in taking short [illegible] of [illegible]

Began treatment of this case will observe by repeated emetics.

At that time more in doubt than at present whether catarrhal or phthisic.

But this practice promotes some advantage on either footing.

And whether tuberculous or catarrhal Phthisis not [ill] accommodated.

For besides general effect of [unloading] lungs serves in both as determination to surface.

In catarrh thus favourable as altering state of separation at lungs.

In Tuberculous tendency to bring about resolution.

In obviating effects of emetics not disappointed

And probable that some share both in temporary alleviation of cough & diminishment of febrile [accession].

But how far any influence as tending to radical cure a much more doubtful matter.

Still however effects such as to encourage to repetition.

But as means of alleviating cough & that might not at same time seem inactive employed also mucilage mixture.

To this will observe besides mucilage & water added considerable proportion of Vinegar.

In this had in view the employment a cheaper substitute for a medicine of late very famous in Phthisis

I mean recent vegetable acid particularly under form of Lemon juice.

Juice of Lemons to great extent of late used in Phthisis with high [reputation]

And I think is chiefly in Catarrh that can expect benefits from it.

Operation would principally refer to diminishment of impetus of circulation thus producing [alteration] of state of separation

Same intention in some measure from [acetate] acid

Which for Dispensary patients can be afforded at much cheaper rate

And this only reason for preference in present case

After this course however begun another symptom & that too of alarming nature appeared viz Looseness.

This might proceed either from emetic operating downwards or from mixture.

Reckoned it however more probable that affect of the disease

Yet determined me at least for some time to omit both.

And in place substituted a medicine with view of checking looseness viz Infusion Japonica

On use of this has now entirely ceased.

Yet other symptoms much as before.

Have again therefore had recourse to Mixture Mucilage as formerly.

If does not renew looseness shall wish to continue it for some time

If does shall be obliged entirely to desert it.

And with view to derivation from [breast] recourse to blister with issue

But besides these other measures probably also requisite.

And have thoughts of trial of Peruvian Bark or Cicuta.

If these unsuccessful regulated by future circumstances.

And by opinion which shall then entertain with regard to nature of disease