DEP/DUA/1/29/08 (Normalised version)

Robert Haitley

(1782)

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Robert Haitley.

Most urgent symptom in case of this patient is cough with which affected.

This cough with such expectoration & dyspnoea that can have little hesitation in considering affection to which he is subjected as being either Phthisis or Catarrh.

In these affections however so many symptoms in common that in many cases till disease has made considerable progress distinction very difficult, if not impossible.

Case before us not altogether without doubt.

But of the two affections, am inclined to think that by much greatest probability of Phthisis.

Of this some presumption from cough being most troublesome, in the afternoon.

In catarrh commonly most distressing after sleeping in the morning.

And then both cough & dyspnoea the consequence of that viscidity which mucus acquires during night.

In Phthisis on other hand usually most severe when feverish exacerbation takes place.

And this more frequent at least in afternoon than any other time

Here indeed must be admitted that cough besides being troublesome at night also severe in [morning].

Hence then this circumstance if taken by itself, but of little weight.

Severity of cough in morning however by no means an objection to supposition of Phthisis.

And if some slight presumption of that affection from exacerbation of cough in afternoon, still more from state of matter expectorated.

Besides colour & viscidity of pus, is also represented as having very disagreeable smell.

And as thus rendering the breath very offensive.

But besides this gives also disagreeable taste in mouth.

To all these circumstances giving presumption of purulence still another to be added.

Mixture viz of blood in matter expectorated.

This, if ever happens at least very rare in cases merely catarrhal.

And if any doubt as to purulent state of expectoration from circumstances before mentioned this sufficient entirely to [remove] it

But besides evidence of purulent expectoration, here also distinct marks of hectic fever.

Of this at least strong presumption from chilly fits

With these we are told patient frequently affected.

And that too, even when at work, & may be supposed to be kept warm.

Are not indeed told that these shiverings succeeded by augmented heat.

But from state of pulse, may I think presume their being febrile.

In pulse indeed a peculiar observation.

Not only liable to frequent intermissions but in other respects also irregular

Particularly observed to vary very remarkably in point of strength.

But with these irregularities uniform [quality].

A circumstance which when taken with others, always considered as grounds of distinction, between Phthisis & Catarrh.

To these circumstances may add also, another giving probability of Phthisis.

That is from which affection had at commencement.

Began we are told with spitting of blood, pure & unmixed, to considerable quantity.

Is not indeed in every instance, that haemoptysis terminates in Phthisis Pulmonalis

But must at least be admitted, that haemoptoe one of the affections of which Phthisis frequently sequela.

And when succeeded by cough, with such expectoration, & such hectic symptoms as described in present case, little doubt that such transition has taken place.

From all these circumstances then taken together, can have but little hesitation in pronouncing that present patient subjected to Phthisis.

And from this view of disease are necessarily precluded from favourable prognosis.

Would not indeed represent patient as past all hopes of recovery.

And of different kinds of phthisis am even inclined to consider his case as favourable.

At least Phthisis from Haemoptoe, which commonly depends on considerable ulcer formed in lungs less certain, & rapidly fatal, than what arises from tubercle.

If however ulcerous consumption, & such hold disease of present patient to be, less dangerous than tuberculous is more so than Catarrhal.

And I own expectation of recovery here are not great.

Should not even be surprised, if in short time disease makes such progress that patient incapable of farther attendance.

Reckon it however more probable that shall here have opportunity for trial of different practices.

But how far, these will have much influence in removing or retarding progress of disease, dare not venture to say.

Here from idea given of [affections] principle morbid condition to be combated, is state of ulceration in lungs [furnishing] purulent matter.

And this to be removed by inducing adhesive inflammation.

If this can be effected, radical cure of the disease, will be brought about.

But before that can be accomplished may naturally suspect that urgent symptoms will occur which necessary to obviate.

Practices however to be directed, with this view, must be accommodated to occurrences.

And in mean time endeavours to be principally employed in at least attempting radical cure.

What now said will explain to you intention in practices [already] advised.

Have you will observe put this patient on course of Cicuta.

Need not observe that this remedy, of late introduced [freely] [intended], as cure for Cancer.

And although has by no means answered expectations of everybody in that affection yet employment there has at least demonstrated, free use that may be made of it.

And for my own part must be of opinion, that in many other ulcers particularly those of scrofula tendency has often good effects.

Accordingly has of late come into frequent use in Phthisis cases

Here employed in what I [reckon] one of best forms that of powder of leaves.

But with view of affording [proper] [illegible] & at same time giving some mitigation of cough this powder added to mucilaginous mixture.

Cicuta at present in mixture to quantity of Ji in ℥i.

So that patient at present takes grain X – thrice a day.

On this course if nothing [particular] occurs is intention to continue till see whether Cicuta can give disposition in ulceration to heal.

And according to circumstances may gradually increase quantity.

With this course however other practices principally with view of obviating symptoms may be conjoined.

And accordingly have already had recourse to a blister directed to be converted into an issue

This intended for diminishing determination to lungs.

From which may both expect mitigation of cough & that tendency to healing of ulceration will be augmented

But still more hope that will have some influence in preventing haemorrhage from lungs which still continues.

If present course proves unsuccessful & no reason to alter opinion of disease two other practices which propose to try in succession.

The use of Gum Myrrh & of Mezereon.

But if either of these employed shall afterwards speak more fully of intention in view.

If [continuation] of disease attendant [practices] must be accommodated to idea then adopted.