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    DEP/DUA/1/25/09 (Normalised version)

    Alexander Downs

    (1780-1781)


    Alexander Downs.

    Affection evidently of a complicated nature.

    Or rather when came under care subjected to two different diseases.

    And these probably totally unconnected with each other.

    Of these first mentioned in case & at same time most obvious a cutaneous affection.

    Not however extended over whole body but particularly confined to legs.

    Of difficulty of proper distinction among cutaneous affections have already oftener than once had occasion to speak.

    And need not here again enter into causes of it

    May only observe that from dry scaly appearance when came under care, might be considered as approaching to description of leprous affection.

    Yet from account given of progression more exactly corresponds with that of herpetic kind.

    For here incrustation succeeded only an eruption attended with considerable watery discharge.

    From this idea then, of this part of affection reason to conclude that less obstinate than if considered as of Leprous nature

    For proper Lepra when of any considerable standing a most inveterate disease.

    Still however could not view affection as of slight nature.

    For even herpetic eruptions very often difficult to remove

    And with present patient before came under [care] already of considerable continuation.

    Had subsisted for space of several months.

    Was indeed somewhat in favour of patient that affection only local.

    And that at same time attributed to local cause

    Yet must own did not expect that would have so speedily terminated.

    Conclusion which has already taken place supersedes necessity of farther observations on prognosis.

    For would now hope that patient entirely rid of this part of complaint.

    From commencement of treatment here however subjected as already observed to other symptoms

    viz Severe cough & dyspnoea with difficult expectoration of viscid mucus.

    This could have no difficulty in considering as catarrhal symptom.

    And in patient advanced to 50th year might perhaps without [impropriety] get name of catarrhal senilis.

    Yet may I apprehend in every case be with greater propriety styled chronic catarrh

    Of this affection in case of some other patients already occasion to speak in present course.

    In instance before us nothing remarkable.

    Neither any uncommon symptoms nor any ordinary ones to considerable degree.

    At same time with patient advanced in life, exposed to vicissitudes of weather & during season when changes most apt to occur could not look for speedy removal.

    The less to be expected as was intention, first to direct endeavours in [practice] cutaneous affection.

    And indeed for this principally [selected] as object of practice.

    Hoped however that even under [treatment] for that affection present might not be augmented.

    And expected that by measures directed to it might be mitigated.

    This indeed cannot say has yet taken place.

    But still hope that in no long time may be effected.

    Particularly if mild & steady spring weather

    And in forwarding attainment of this end something, may I apprehend be done by medicine.

    Is indeed with view to this that measures at present employed with patient [entirely] directed

    But as already observed treatment begun on different plan.

    And measures at first directed principally if not entirely with view to cutaneous eruption

    Began treatment will observe with what I call the Mistura Vitriol.

    viz. ʒi of Vitriolic Acid to ℥i of syrup & water taken together.

    Of use of this article as employed in cutaneous affections have already spoken.

    And present course has I think [afforded] some examples of efficacy.

    And that too both in instances of Psora & of Herpes.

    These used against affections generally extended over body & either arising from no obvious cause or attributed to infection.

    Here then wished to try employment in [local] disease & referred to particular accident.

    And in use were not disappointed.

    Had indeed no influence in way of obvious operation.

    And at same time from taking mixture to extent of ℥i twice a day no inconvenience.

    Under this however affection of leg [soon] began manifestly diminishing.

    And in space of few weeks had entirely left him.

    Has now since medicine intermitted [remained] under care for some weeks longer

    And during that time no return of affection.

    When consider that before subjected to it for many months without any [intermission] can have little doubt I think in attributing cure to this practice.

    And am now in hopes that for this part of affection no farther measures will be necessary.

    When began vitriol mixture however besides cutaneous complaint had also in view the catarrhal affection.

    My idea of this disease in chronic state is that all symptoms in great measure affect of augmented mucus secretion.

    Hence then although immediate ease from expulsion of what accumulated in lungs yet radical cure from secretion being [illegible]

    And as in case of other discharge may be expected from astringent.

    Well known however that few articles more powerful effect in this way than vitriol acid.

    While therefore medicine employed with another view still hoped to have opportunity of observing influence on this affection.

    Cannot however say that seemed product of any good affects.

    For at succeeding report both cough & dyspnoea rather augmented as otherwise.

    These circumstances I consider as certain indications that viscid mucus accumulated.

    And was even inclined to think that aggravation might be consequence of astringent as occasioning less free excretion.

    Reckoned it therefore advisable to employ some medicine with view of promoting discharge.

    And for this purpose had recourse to squills.

    An article the expectorant power of which some theorists indeed disposed to deny.

    But notwithstanding ingenious speculation anyone who has had opportunity of seeing or experiencing effects can have no doubt of them.

    By this however am very far from meaning to assert that will be certainly efficacious in every case.

    And in instance before us example of this

    But no more surprising that should not always have effect in this way than that does not always operate as diuretic.

    In that respect although often fails no one I apprehend will be hardy enough to deny general influence.

    Although therefore for first week but little alleviation of cough, yet ordered continuation for eight days longer.

    But as at end of that period symptoms still distressing had recourse to blisters.

    This also a practice with regard to rationale of which some have [entertained] their doubts.

    For my own part think that influence satisfactorily explained from change in mode of circulation.

    And from diminution of flow to lungs in consequence of augmented determination to part to which blister applied & discharge from thence.

    But however much this reasoning may be liable to objections nothing to [presently] question.

    For must on all hands be allowed that of much less consequence to determine how effect produced than what it is

    And no one will allow himself candidly to attend to facts can possibly deny that blisters applied to chest relieve many affections of lungs

    Accordingly in case before us found that both cough & dyspnoea alleviated.

    To secure these advantages however with that discharge [supported] for some time.

    And for this purpose have ordered issue by means of epispastic ointment

    Under this measure, with continuation of pills hope that patient may soon be in situation to be dismissed.

    If however present drain not properly supported may have recourse to [illegible] of blister.

    Or if symptoms of large accumulation in breast may attempt to unload it by emetics.

    But in preference to either of these if shall continue nearly in present state have in view another measure.

    A trial viz. of remedy which had lately occasion to mention in lecture on chronic catarrh use viz of Uva Ursi.

    But hope even that this may not be necessary.

    And that without farther aid patient may soon be dismissed free from affection.

Royal College of Physicians of Edinburgh,
11 Queen Street,
Edinburgh
EH2 1JQ

Tel: +44 (0)131 225 7324


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