DEP/DUA/1/25/15 (Normalised version)

James Hamilton

(1780-1781)

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James Hamilton.

Principal affection pain of side

And as to nature some doubt.

Two suppositions.

Might be dependent on muscular affection, or [disease] of integumentary.

Or might proceed from affection of Thoracic viscera or membrane.

At first inclined to former opinion.

And on that footing began treatment.

To this in some measure led from situation

Seated in under part of false ribs.

More frequently the situation of Rheumatic affections than of affections of Thoracic viscera.

But still more from aggravation in consequence of pressure or motion.

For this a necessary consequence of its being muscular.

As indeed is also augmentation from cough

For this in very quick & violent motion of all surrounding parts of chest.

Here however to be observed that this a doubtful circumstance.

And fixed pain of breast attended with cough equally symptom of affections of Thoracic viscera.

At same time less suspicion as free from every febrile symptom.

Pulse & heat perfectly natural.

Discharge by belly & urine regular.

And even respiration unaffected.

Also favourable that pain of side but of short duration

While cough of long standing.

Hence then, if any connection, cough rather consequence than cause of affection of side, on which pain depends.

On these grounds then first opinion [formed] & treatment begun.

Now however more doubtful as to it being just.

And since that, treatment more [directed] to pectoral complaint than to muscular pain.

At same time even on former supposition this necessary.

For no doubt that pain whatever cause, must be supported as long as cough urgent.

As doubt respecting nature of disease, so also of prognosis.

At first hoped that would be of very short continuation.

After first measures unsuccessful however inclined & look upon it in more serious light

Yet at no time considered it as threatening much danger.

And although possibility of degenerating into Phthisis yet no appearance of it.

Now I think so far diminished that may consider it as happily terminated.

And next to inquire how far this effect of treatments here employed.

On supposition of muscular pain, employed in this instance an application which had lately occasion to mention as used in case of Margaret Rose

A combination viz of Vitriol Aether & Laudanum liquid.

There as in that case also conjoined with Camphorated Spirit of Wine.

But useful as giving necessary dilution & likewise as increasing power of application.

From this application as in former case sense of heat excited.

But not here attended with alleviation of pain.

Conclude therefore that after continuation for eight days without effect, nothing to be expected from it.

And that either mistaken as to nature of complaint or that inadequate to cure.

Urgency of pain now still more than formerly connected with cough.

And whether from affection of lungs or membrane lining them, or of still more superficial parts expected benefit from Blister

While at same time as producing derivation from breast & taking off effects of uncommon sensibility well calculated against cough

With these intentions then ordered [application]

And that might derive greater benefit application directed to seat of pain.

While had recourse to blister however directed also another measure.

Use viz of Cream of Tartar.

In this had in some measure in view refrigerant power.

But still more with intention of gently moving belly.

By this hoped that if disposition to inflammation existed, might be in some measure diminished

And that by producing determination from breast might obtain some alleviation of cough.

In these different intentions however in some measure disappointed.

Blister indeed rose well & free discharge

But neither followed by alleviation of pain of breast, nor of mitigation of cough

More free expectoration indeed took place.

But this rather inclined to consider as depending on progression of affection than on [remedies] employed

While thus disappointed in effects of blister equally so in Cream of Tartar.

For had not even effect of opening belly.

This indeed not surprising when consider that given only to extent of ℥i.

For in order to produce any [degree] of catharsis 3 or even 4 times that quantity necessary.

Expected however that might at least do something.

And with certain constitutions would have had considerable effects.

But would appear that patient had not been of such habit.

Notwithstanding want of success however did not think of immediately deserting this plan.

But that might better obtain effects [ordered] continuation of Cream of Tartar to double quantity

And with view to full consequences of blisters ordered that drain should be supported by epispastic ointment.

By latter application however whether from want of proper attention or other circumstance little discharge supported.

While even increased dose of Cream Tartar no more effect than before.

To these therefore could in no degree ascribe relief which patient had obtained by next report.

This however inclined to think was in part if not altogether to be ascribed to another measure at same time directed.

Began now to suspect that cough great cause of severity of pain.

And that only by mitigation of former that could produce alleviation of latter.

Cough I suspected might be effects of irritation

And that therefore might be countered by demulcent lubricating fauces.

Was with this intention that had recourse to mucilage mixture.

And in order still more powerfully to take off irritation conjoined with Laudanum.

This not taken to full extent of anodyne.

But to quantity of ten drops only in evening dose.

Under this medicine whether from mucilage or anodyne considerable relief.

Violence of cough not only abated but severity of pain diminished.

These effects was I own as well as patient himself in great measure inclined to attribute to medicine employed.

And therefore no hesitation in ordering continuation.

Still however expected some benefit [from] opening belly.

And as Cream of Tartar itself insufficient ordered addition of small proportion of Jalap.

This the rather necessary from Laudanum now employed.

But whether from this circumstance, or from peculiarity in constitution, two drams of Cream of Tartar with Ji of Jalap no [effect]

Still however cough & pain of side continued to diminish

With continuation of anodyne mucilage mixture therefore augmentation of Jalap ordered

But from addition of ten grains in day rather more influence than wished for.

Now however, cough much easier, pain of side almost gone.

Reckoned therefore farther continuation unnecessary.

And although still continued Mucilage Mixture yet flatter myself, that for present at least, not requisite to employ any farther measures with this patient.