DEP/DUA/1/27/04 (Normalised version)

James Low

(1781-1782)

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James Low.

As to disease of this patient no doubt

While at same time an affection which in this country no less frequent than obstinate

Symptoms are dyspnoea, cough & copious expectoration of viscid mucus.

Here may without hesitation conclude that two former symptoms affection of breathing & cough, are consequence of matter discharged by expectoration being lodged in air vesicles & bronchiae.

In some instances, matter thus this discharged evidently purulent in others plainly [mucus]

When of former kind the disease is Phthisis Pulmonalis when of latter Catarrh.

Not in every instance however that can positively say is entirely either one or other.

And even where evidently principally mucus yet sometimes very difficult to determine whether does not contain some mixture of pus.

Farther to be observed that in some instances catarrhal evidently does degenerate into Phthisical

Would not therefore pretend to say that this disease may not yet occur with present patient.

But that at present merely catarrhal may infer from several circumstances.

1 Expectorated matter so little [approaching] to appearance of pus that positively asserted to be mucus in history of case.

2 Patient entirely free from anything like hectic fever in so much that pulse heat & appetite whether for solids or fluids perfectly natural.

3 Patient has passed period of life during which at least Phthisis is most common.

From these considerations then no difficulty in pronouncing that disease merely catarrhal.

Here however proper to observe that does not exactly correspond to definition of Catarrh as entering Nosological¹ systems.

And particularly to that of Dr Cullen

Here indeed one of great characteristics, Muci ex glandulis bronchiorum excretio aucta.

But at present at least no symptoms of Pyrexia.

Although febrile symptoms however entirely absent, yet no objection to disease being catarrhal.

For well known to everyone who has been least engaged in practice, that these present only at beginning of affection.

And that in place of terminating in health, often degenerates into chronic state.

In this condition as with present patient often continues for many years.

Or at least if slight interval during summer is again removed with cold [winter]

In this state most frequently affects those advanced in life.

Hence in many practical systems has obtained name of Catarrhus Senilis.

But in many instances occurs where from age of patient can with no propriety have title of Senilis.

And even with present patient although passed 50^th year that name could not be considered as applicable.

Hence then at whatever age occurs am inclined to think that with much greater propriety may get name of chronic catarrh.

And have no doubt in pronouncing present case to be an instance of that affection.

Here indeed to be observed that in different nosological systems several species of this affection pointed out.

Mr Sauvages in particular has enumerated no less than seven

Most of them however in my opinion with impropriety.

For in reality either merely symptoms of other genera as Catarrhal Rubeolosis.

Or should properly constitute genera by themselves as in Catarrhal [Ferin] & Epidemic.

Both these diseases [sui] generis depend on peculiar & specific contagion

And accordingly in practical lectures shall consider one under title of Pertussis other of Influenza.

From what have just said, naturally follows that objections just made to Sauvages species of this disease extends also to Dr Cullen.

For although he has admitted two species only. Catarrh a frigere & Catarrh a Contagio, yet hold latter of these notwithstanding similarity of symptoms to be in reality distinct & separate genus.

Upon whole then consider present case as instance of Catarrhus benignus of Sauvages Catarrh a frigore of Dr Cullen

Respecting pathology of this disease almost all practitioners agreed in opinion.

In state in which occurs in our patient is very generally admitted immediately to depend on increased secretion by mucus glands of lungs.

And this universally admitted very generally at least the affect of cold.

That cold should have this affect by producing determination from surface to external [parts] by no means unnatural supposition.

And accordingly disease most readily induced where change of determination great

As for example when circulation on surface increased by previous exposure to heat.

In this manner at least greater part of Pathology disposed to explain well known fact, of frequent occurrence of disease in consequence of transition from heat to cold.

A very different theory of this affection [now] lately published at this place by Dr Jones.

And that too as means of introducing a practice as different from what formerly [pursued].

He contends that common catarrh is a disease which is affect of heat.

And that most ready & effective mode of cure, is exposure to cold.

If novelty be sufficiently recommendation to trial of new practices this does not want that charm.

For as far as I know has never once been proposed by any former writer.

But in my opinion before any practice deserves attention should be supported at least by probable evidence & free from obvious objections.

Any refutation however of present doctrine altogether unnecessary.

For requires only to be stated to refute itself.

Are indeed told in Dr Jones book that Dr Brown the author of this discovery made first experiments on himself

And that since that time successfully employed on several of his friends

Here however to be observed that no account is given of symptoms to which either Dr Brown or his friends subjected.

Had a full & fair relation of symptoms been given many readers might [perhaps] have been disposed to think that cold operated as remedy of very different [diseases]

As at present related therefore is more assertion without vestiges of proof.

And indeed may with justice be [observed] that progress of medicine little less retarded by bare assertion being passed for truth, than [be] even wildest & most extravagant theories.

Greatest caution therefore due on part of every one in receiving medical facts as well as medical opinion.

And even where facts well authenticated yet a few solitary instances never to be put in opposition to daily observations.

Even admitting therefore instance mentioned by Dr Jones in way he himself would wish, can be of no consequence.

For what weight will case of Dr Brown even when supported by a few [friends] have in scale when put in opposition to daily experience & common sense of all mankind.

Catarrh is so well known to be effect of cold, that disease itself much more frequently passes by that name than by any other.

He who denies that cold frequently produces it may as well deny that one & two make three.

He who affirms that is to be cured by exposure to cold may as well affirm, that cough & the expectoration of mucus never take place as symptoms of the disease at any period during whole course.

In short is to me matter of very great astonishment that any man of common understanding ever allowed himself to be so far misled as to adopt the opinion.

[Extraordinary] however as this [tenet] is, yet must be admitted that is by no means most [extreme] in publication to which I allude.

But with other parts of it have at present no concern.

May only observe that after [careful] perusing this new publication am still disposed to hold same sentiments with regard to catarrh as did formerly.

With this idea of disease then come next to give opinion as to Prognosis.

And here may observe that in present circumstance of patients complaint, nothing immediately alarming.

For although considerable affection of Respiration yet circulation continues in ordinary condition.

While appetite for food, discharge by belly, & other natural functions continue unaffected.

Besides no symptoms whatever of supervening affections [such] as dropsical [complaint] or like

Till these however occur & have even subsisted for considerable length of time seldom that affection has fatal termination.

And indeed even where measures for cure ineffective by no means uncommon for patients to continue subjected to this complaint for space of many years after which frequently fall victim to other affection.

Hence then will at least appear to me a very uncommon occurrence if shall turn out fatally under care.

At same time must own entertain equally little expectation of being able to obtain here an expeditious cure.

Are indeed possessed of means, by which in urgent circumstances mitigation of affection may be obtained.

But after continuing for considerable time is very difficult matter to remove it.

This especially the case during the winter season.

And indeed, as formerly happened with our patient is very common [illegible] to find it disappearing during temperate [summer] weather & again beginning on commencement of winter.

But in case before us while season unfavourable is still more so, that has now continued with him during whole course of last summer.

From this may conclude that [disposition] to increased secretion by lungs now so great that even free circulation on [surface] does not prevent it.

Besides this both patients rank of life & age are unfavourable circumstances.

Though cannot be called old yet is now arrived at that period of life when this disease most common & most obstinate.

Were he in rank of life to admit of it, might reasonably entertain greater hope of cure from passing winter in warm climate.

But not only obliged to be subjected to severity of weather here but also to frequent exposure in earning livelihood

And probably also during remission from labour but a cold & [uncomfortable] dwelling

Under these circumstances then shall not be surprised if affection rather augmented than otherwise.

At same time shall at least have opportunity of trying those measures from which in such complaints relief often afforded.

By these hope that some mitigation at least may be obtained.

And even not altogether without [expectation] that from practices not generally in use may derive still greater benefit.

In this affection it naturally occurs as object of importance, with view to cure, that air vesicles of lungs should be unloaded from viscid mucus accumulated

But still of more importance to restore secretion by lungs to natural state.

This well known in other cases to be affected by various circumstances.

Particularly by state of secreting organ & by determination of fluids to the part.

Hence then from circumstances influencing both, mitigation if not removal of the affection may be expected.

In latter way benefits obtained from warm climate, warm clothing & other means giving determination to surface in [general]

While again is from giving determination to particular parts & derivation from lungs that would account for good effects of blisters issues setons etc.

From all which no question that very considerable mitigation of symptoms has often been obtained.

In former way viz as affecting state of secreting organ fewer medicines employed.

And may even observe that articles used with this intention frequently apparently product of bad effects

This frequently the case with respect to Peruvian Bark.

Well known to be a medicine often [successfully] employed to diminish increased secretion in other cases.

And such diminishment a necessary consequence of astringent & tonic powers.

In case however of chronic catarrh although may have some influence as diminishing secretion has still more as diminishing excretion.

Hence gives rise to accumulation in breast augmenting dyspnoea.

And by this means in end aggravates most urgent symptoms of affection.

This still more the consequence of use of opium.

Influence as restoring discharge well known.

As necessary consequence of very powerful effect which has as diminishing action

Hence daily in use as restraining inordinate discharge, by alimentary canal, under form of diarrhoea.

But in catarrh although effective means of relieving of tickling cough yet by no means applicable in such cases as present.

For much more effective as preventing excretion than as diminishing secretion.

Hence although temporary mitigation of cough yet augmented dyspnoea & in end renders cough more severe.

For not only greater quantity of mucus to be expectorated but from longer stagnation has acquired greater viscidity.

And indeed some of those people long habitual to this affection, do not like to want it.

For then always in worst health

A circumstance not to be wondered at when consider how much influence want of any accustomed discharge has on system.

At least where proper compensation for that discharge in other respects is not made.

Hence then appears that in [employment] of remedies with view of restraining discharge as affect condition of secreting organ caution at least necessary.

Yet far from thinking that never to be attempted.

And accordingly in present instance remedy principally employed is used with this intention.

After these observations on general plan of cure, will be necessary to add but little of particular practices here employed.

Have directed for this patient the use of repeated Emetics.

The action of vomiting I hold to be most immediate & most powerful expectorant.

And emetics here intended with [view] of discharging mucus already accumulated in lungs.

But besides this are farther of service also as giving determination to surface.

With use of emetics you will observe combined a remedy not commonly used in such affections the Pulveris Fol. Uva Ursi.

This article here employed from hopes that it may have affect as diminishing increased discharge.

Must however admit, that of influence in this way, in chronic catarrh have for my own part no experience.

This remedy, need hardly observe, first introduced into practice, by Dr De Haen of Vienna.

By him recommended as highly serviceable in calculous cases.

Experience however has now abundantly demonstrated, that, as affecting calculous itself, has really no influence.

But at same time many practitioners & these too men of accurate observation of opinion that highly useful in ulcerations & other affections of urinary passages

And particularly in Cystorrhoea or Catarrh [vesiac], an affection which principally consists in increased mucus discharge from bladder.

Of its good affect in a complaint of this kind have very lately had a very strong instance in a gentleman of this city who by means of it is now perfectly recovered from very alarming & distressing affection of urinary passages.

From similar instances, in former practice had often occurred to me, as means of restraining mucus discharge also by lungs.

And have accordingly often suggested in lectures use of it in such cases.

When threw out such [history] last winter, a gentleman then present afterwards favoured me with three cases which had fallen under his observation in which use had in this affection been attended with success.

In one of these patient affected both with chronic catarrh & a disease of urinary organs.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.