DEP/DUA/1/26/15 (Normalised version)

James Forrest

(1780)

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James Forrest.

Complaints not numerous.

And are at same time what frequently to be met with in practice.

Yet so much in common to several different affections that do not distinctly mark disease to which subjected.

Only complaint to which constantly subjected pain of breast & dyspnoea

These occur in many diseases.

Particularly in Catarrh. Phthisis Pulmonalis & Asthma.

And in case before us circumstances giving countenance to each of these suppositions.

Is something at least in favour of supposition of Asthma that affection aggravated in fits

And these too not occurring as is common in catarrh oftener in course of day, or regularly in morning from [stagnation] of mucus during night, but at intervals of two or three days

This much more frequently at least the case with Asthma than with Catarrh.

And perhaps may also be considered as another circumstance in favour of that supposition, that fits terminated by expectoration.

For this at least a circumstance in common both to Catarrh & Asthma.

In latter affection with termination of fits often very considerable mucous discharge.

But if these circumstances leading to suspicion of Asthmatic affection, many others against it.

Fits here occurring of much shorter duration, than those of Asthma generally observed to be

Not attended with those symptoms which the universal concomitant.

Particularly sense of stricture in breast.

But above all do not consist in dyspnoea.

Consist entirely in frequency of cough

And no farther attended with dyspnoea than this may naturally be supposed to produce it.

Hence notwithstanding circumstances mentioned above can have little doubt in asserting that patient not subjected to this affection.

If some circumstances giving suspicion of Asthma so many from which might be inclined to suspect Phthisis.

Well known that Phthisis is an affection in which, pain of breast, cough, & dyspnoea are constant symptoms.

But while these symptoms in common to this with other affections some other particulars leading to suspicion that as here occurring depend on Phthisis.

This some grounds for suspecting from cause by which induced.

Affection, originates, we are told, from fever to which subjected about six weeks before

Well known however that Phthisis not unfrequently consequence of fever.

Suspicion also of Phthisis from continual quickness of pulse.

While rare in pure catarrh almost uniformly occurs in Phthisis.

Suspicion also from sweatings during the night.

These well known to be not only one of most common but also most alarming symptoms in Phthisis

And at same time no frequent occurrence either in Catarrh or Asthma.

At least as regularly continuing every night, & without arising from any particular cause.

If these particulars however give suspicion of Phthisis others giving difficulty.

If common for fever to be followed by Phthisis, is no less frequently followed by catarrhal affection

And is in favour of this latter supposition, that both cough & dyspnoea mitigated [illegible] commencement.

For at least very rarely that this happens in Phthisis cases.

While again no more, than naturally to be expected, in cases of catarrh.

And in case before us, what would incline rather to suspicion of Catarrh than Phthisis, is mode of attack.

Began with constant cough, & copious expectoration.

And at same time the matter discharged, by expectoration according to description clear mucous matter without any purulent appearance.

And still no reason to suspect [even] any mixture of purulent matter, in what discharged by expectoration.

Even in quickness of pulse, & sweating, have not what to be reckoned common appearances in Phthisis.

For these in general at least the attendants only of distinctly marked hectic fever.

These however no accession whatever under form of shivering.

No acceleration of pulse at particular [hours]

Sweat not particularly observed to be an occurrence in morning when with Phthisis patients, very generally ensues as consequence of [illegible] accession.

But happens during whole course of night.

And from this circumstance may infer that rather consequence of warmth in bed than anything else.

Upon whole then should rather ascribe both quickness of pulse, & sweatings to state in which system left by fever than to any other cause.

And from this state of system, not improbable, that catarrhal affection here puts on appearance, somewhat different from what commonly occurs.

Upon whole then though case with many peculiarities yet look upon it as being a catarrhal affection.

And as derives appearance which here puts on from cause giving origin to it, viz fever.

Or at least from state & condition of body induced by fever.

On this view of case prognosis more favourable than would be either if entertain [supposition] of Asthma or Phthisis

And while less reason to dread, that affection would be tedious than in former case, no less dangerous than latter.

Here however as not altogether without uncertainty as to [cause], so also must be uncertain as to termination.

And if either of former suppositions well founded, may yet prove both a tedious & dangerous affection.

Even on supposition of catarrh, [although] no immediate danger yet in end may prove fatal

For from this cause patients advanced in life not unfrequently cut off.

And although our patient cannot be said to be in that situation, yet has passed his 50^th year.

But if thus unfavourable, condition of body with which has occurred, still more so.

And if fever has left system in such situation as to give particular modification of disease, has also augmented danger

This especially indicated by quickness of pulse & sweatings.

Upon whole then even in view of being a catarrhal affection, can by no means consider it as being either slight or free from danger.

And may the rather be supposed to prove obstinate from occupation in which patient engaged.

That viz of black smith.

For by this means, necessarily subjected to sudden & considerable vicissitudes of heat & cold.

By such however well known that this affection in particular manner both induced & supported.

But if these circumstances against [patient] season of year much in favour.

And [may] also look upon it as favourable, that since affection began considerably mitigated.

May then upon whole hope that shall soon obtain if not cure at least farther mitigation of affection.

For obtaining this, supposing affection to depend on state of mucous [illegible] taking place by the lungs, endeavours must be employed to alter it.

And at same time, so far to alter state of excretion, as to prevent retention & accumulation in breast.

From this reason to hope that both pain of breast & dyspnoea [prevented]

And that cause of cough being removed would of course cease.

These general intentions will explain most at least of practices to which recourse has here been had.

Began practice indeed by prescribing for patient an oily mixture.

And to this must own was led [rather] by attention to what had before happened in case than from any other circumstance.

By use of Florence oil we are told that cough when formerly most distressing was considerably alleviated.

And indeed found by daily experience that in many cases of catarrhal affections product of very considerable relief.

Is however in general supposed & probably with justice [that] acts only as lubricating fauces.

And indeed frequently happens that slight inflammation there gives irritability in consequence of which cough from slightest cause.

By lubricating & sheathing parts [him] this in good measure at least prevented.

In case before us however no [reason] to believe, that such a state to any considerable degree took place, from time at least that patient came under our care

Might seem therefore now less indicated

At same time relief which had formerly obtained induced to give farther trial.

And although for my own part consider relief as principally from action on fauces yet would not venture to assert that entirely from this cause

And if in any degree acts as demulcent from entering system influence may be still farther extended.

These then inducements to having here recourse to employment of it.

At same time however directed also squill pills.

For my own part no doubt that active power of squills as introduced into system capable of exerting influence after collection at [excreta].

And particularly that not only exerts action on Kidney, but also on [secreting] organ by lungs.

From this while tendency to increase secretion, has also effect of producing more ready excretion.

Thus the inconvenience arising from accumulation of mucus in lungs or viscidity acquired there in good measure if not entirely present.

If therefore in present instance should have any influence in this way might expect that patient would be relieved

How far relief which afterwards received in reality to be attributed to these medicines, will not pretend to say.

But after began use of them, for space of fortnight, less affected with cough, dyspnoea, or pain of breast.

In so much, that at report on first instance, found him complaining only of weakness.

Since that however, complaints have again returned with greater severity.

And particularly more affected with Dyspnoea

In this situation in place of continuation of oily mixture which while effect of [illegible] cough, might at same time diminish freedom of expectoration directed application of blister.

By this hoped that determination to breast might be diminished.

And that thus diminishment of separation of mucus, on which both cough & dyspnoea depend.

This reasoning indeed with regard to action of blister, in pneumonic affections some disposed to deny.

But without entering here into controversy, with confidence may assert, that in various affections of breast, product of greatest benefits.

And in none more manifest than catarrhal affections.

If therefore should not at present be product of benefits, expected, may be induced even to order repetition.

Or to support discharge for some length of time, under form of issue.

And with this by continuation of pills hope that affection may be overcome

At least shall probably do nothing farther than augmenting squills, till course now proposed has had fair trial.

If however shall be found [illegible] & if complaint continues nearly in present state, have thoughts of trying patient with gentle astringent.

And for this purpose is my intention to have recourse to Uva Ursi.

A remedy which in such cases have been inclined to propose rather on principles on which expected benefit than experience.

But which at same time am [informed] has lately been used in some such cases as suppose present to be with advantage.

While however at present suggest this trial must also observe that very probably before opportunity of making it, circumstances of case may be much [altered]

And in that case future treatment must entirely be regulated by condition in which shall then find patient.