DEP/DUA/1/29/32 (Normalised version)

Rose Campbell

(1782)

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Rose Campbell. July. 5.

Concerning disease to which this patient subjected no room for doubt.

For although cough dyspnoea & oppression at precordia such as occur in catarrh yet many other symptoms here characterising Phthisis.

This might even be inferred, from state of expectoration.

Have indeed, from patient going to the country, had no opportunity of determining, by most accurate tests what proportion of purulent matter it contains.

And some evident marks as viscid blush & green colour, such as in common both to pus & mucus & to mixture of both.

But in peculiar bad taste & still more in tinge of blood have strong evidence of purulence.

This supposition also corroborated by state of tongue.

For notwithstanding feverish symptoms & although white fur about edges yet is clean at point & towards middle

Such a clean state of tongue an almost uniform attendant of purulent [expectoration]

And indeed after certain continuation not only produces painful rawness but even ulcerated state in mouth & tongue.

But this evidence of purulent expectoration here neither only, nor even strongest proof of Phthisis

This still farther demonstrated by hectic fever.

Now often affected with shivering fits at uncertain periods

And these succeeded by increased heat with hectic flushings

With these symptoms also pulse uniformly accelerated to great degree.

And to all others to be added copious night sweats.

From all these particulars taken [together] then, no doubt not only of presence of hectic fever, but to great degree also.

And accordingly when consider both nature of disease & progress already made prognosis must be very unfavourable.

In estimating danger of Phthisis however different kinds of it to be attended to.

Have elsewhere endeavoured to establish characteristic marks of these different kinds.

And these distinguished by names of catarrhal, ulcerous, & tuberculous.

Of these there catarrhal phthisis unquestionably the most favourable.

And as of this kind am inclined to view affection of present patient.

For according to account of origin, was effect of fatigue, & much exposure to cold.

And from appellation which she herself gives it, that viz of [sitting] down cold, may conclude that for some time under form of catarrhal affection.

From these circumstances then presume that purulence separated principally from surface of lungs.

Even supposing this to be case however cannot lead us to entertain any sanguine hopes of recovery.

For although more recoveries from this, than other instances of Phthisis, yet in majority cases is fatal.

And with present patient as has already been remarked many unfavourable symptoms have already taken place.

Among these may rank tendency to haemorrhage with which commenced as well as bloody expectoration with which often attended.

But still more grounds for alarm from degree of hectic fever & of night sweats which have already ensued

And is also a very unfavourable circumstance that menstrual discharge has left her.

For while want of this evacuation will tend to aggravate affection, indicates also failure of circulation at extreme vessels at least in some parts.

Upon whole then have very little expectation of being of service to this patient.

And opinion is that in no long time will fall victim to her disease.

Still however not in such a situation that attempts may not be made to recovery.

Even operation of nature alone have in some such cases done a great deal.

And something at least may be effected by proper application of art.

With this intention have had recourse with present patient to a medicine which have of late years tried in many different cases of phthisis.

And although not in all or even in majority of cases with success yet I think in some, with manifest advantage.

The remedy to which here allude is the Gum Myrrh.

For most satisfactory account yet published of advantages to be derived from this remedy in Phthisis, may refer you to Dr Simmons treatise on consumption¹.

Will there find, that for several years past, very much used by several eminent practitioners in London

And that too in all species & varieties of consumption.

In my own practice here both before & since Dr Simmons publication have very frequently used it

And unless where from peculiarly irritated state of alimentary canal had effect of inducing looseness never saw any evil resulting from it.

Do not however hold it equally useful in every case

As far as my experience goes is principally serviceable, in ulcerous Phthisis.

That is where vomica of considerable size formed in lungs & has burst.

In such cases am inclined to think that good effects principally depend on its inducing adhesive inflammation.

And thus promoting healing of ulcers.

At least this opinion may I think be supported by much more probable argument than that of Dr Simmons who is disposed to refer effects to antiseptic influence.

Into this inquiry however cannot here propose to enter.

May only observe that while has effect of altering state of inflammation on same grounds will have influence also in altering state of separation at surface of lungs.

And thus in catarrhal Phthisis, where purulence furnished from that source, may also be useful.

But in most cases, where to be employed, with view to action on stomach, requisite that should be combined with refrigerant.

And in cases of catarrhal consumption this particularly necessary.

For these often requisite to diminish impetus of circulation both in system in general & at lungs in particular.

In most cases, as refrigerant with the Gum Myrrh, recourse had to Nitre

Here however from bound state of belly induced to employ Cream of Tartar

And as imagined that benefit might be derived from obviating costiveness ordered it in pretty large proportion.

To quantity viz of ℥p. thrice a day united with ten grains of Myrrh.

And as already observed this last also of itself tends to open belly.

This medicine, taken at least without inconvenience.

And had effect of keeping belly natural.

But during course of first week, could not say that product of any farther benefit.

And as determination to lungs still seemed to be very great, recourse was had to a blister

With view of increasing determination to part, was directed to be converted into an issue.

While at same time with intention of operating both as a demulcent, as counteracting strangury, & as obviating thirst, was advised to use an infusion of Linseed gently acidulated.

These practices however did not seem to have very great influence.

Perhaps in some degree from blister not rising well, & not being succeeded by copious discharge.

But whatever might, be cause as intention not answered from issue was [unnecessary] to continue it.

Especially as while not attended with discharge, was a source of irritation without, being product of any benefit.

While issue omitted however powders of Gum Myrrh & Infusion Liniment for drink directed to be continued as before.

And at last report were informed that symptoms considerably alleviated.

But whether this in any degree to be ascribed to medicine employed very doubtful.

Not improbable that another circumstance had more influence.

Change viz of patients situation from town & country air.

Well known that in Phthisis few practices more beneficial.

Here therefore reasonable to infer that had some share in change for better which had taken place.

But from whatever cause it may have arisen, am inclined to think that this change but temporary only

And very apprehensive that notwithstanding every measure, that can be employed will in end prove fatal.

At same time still no discouragement at least, in persisting in use of Myrrh.

And is my intention, to give it here a fair trial.

Mean also to increase dose, as find that patient can bear it.

And if, under this course, patient has recovery, unless some obvious circumstance leading to different conclusion, shall be inclined to attribute something to this medicine.

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Explanatory notes:

1) Samuel Foart Simmons, Practical observations on the treatment of consumptions (1780).