DEP/DUA/1/30/07 (Normalised version)

John Reid

1782

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John Reid November 23^d 1782

When this patient applied for assistance was doubtful as to nature of case.

But I own then entertained strong suspicion that subjected to a very dangerous disease.

Many of worst symptoms cough, dyspnoea & difficult expectoration such as well known to occur both in Phthisis & Catarrh.

And here undoubtedly several particulars rather against supposition of Phthisis

Patient past that age at which Phthisis commonly occurs.

For most part a disease from 15 to 25. Our patient however already [approaching] to 40^th year.

If age against Phthisis, so likewise was habit.

For in place of sanguine temperament with which most frequent was here markedly of melancholic habit, with which perhaps most rare

Disease in greater number of instances, occurs with fair florid complexions light hair & light eyes.

Our patient however, of dark eyes, black hair, & swarthy complexion.

Disease also occurred from a cause oftener giving rise to catarrh than Phthisis.

Exposure viz to cold, after body much heated.

But what still more in favour than any of these, had no evident hectic fever.

Pulse at 80 & not affected with hot or cold fits.

But notwithstanding these circumstances, still different particulars in case giving apprehension.

Matter expectorated had not indeed evident characteristics of pus.

But at the same time, of that kind which often contains mixture of purulence.

And this especially to be suspected when as in present case much pain of breast.

For with mere catarrh, after has been of any considerable continuation, this rarely the case.

If however grounds for apprehension from pain of breast, still more affection of respiration.

For not only laboured but quick also.

Something also alarming in state of pulse.

For though not quick yet feeble.

Though no cold or hot fits, yet [illegible] flushing, at times in cheeks.

A circumstance indicating at least some degree of febrile attack.

But from all circumstances, none from which more alarmed than state of tongue.

Had a peculiar clean & red appearance.

A circumstance which although may proceed from different causes, yet almost never fails to be concomitant of purulent [expectoration]

Hence then where from other circumstances reason to suspect this, serves very much to corroborate suspicions from different [source]

While from these circumstances suspicion of Phthisis must also observe that among various particulars favouring idea of Catarrh, nothing in [compatibility] with supposition of Phthisis.

For although most common in early life & with sanguine temperaments yet no age or temperament exempt.

Though cold most common cause of catarrh, yet also sometimes induces catarrhal Phthisis.

In some constitutions, hectic fever though existing, not distinctly marked in state of pulse.

In some instances of Phthisis does not take place till disease has made very great progress.

Hence then from none of them grounds for certain conclusion against Phthisis.

And farther to be added that Phthisis in its nature a most insidious disease

So that in many instances has made very considerable progress before known to exist.

Upon whole then though not free from doubts with regard to case yet very apprehensive that subjected to Phthisis

And can at least say that have attended many patients, where much less reason to be alarmed, & who in no long time fell victims to that affection.

In present case however now I think apparent that apprehension without danger.

For patient again so far recovered as to be able to return to usual employment.

A circumstance superseding all observations on prognosis.

From present case however in way of prognosis learn at least one particular.

Shows us that Catarrh even with more threatening appearance may in short time have favourable [termination]

And that too by powers of system alone.

Here even on supposition of catarrh, at time when patient came under care should not have given it as my opinion that it would have terminated so soon.

For when that disease degenerated into chronic state often continues with great obstinacy.

Is particularly aggravated by any exposure to cold, & accordingly remarkably distressing during winter months.

In so much that few diseases, in which greater benefit derived from change to more temperate climate.

Was not therefore to be expected that during so severe a winter, would soon go off with patient who from occupation must pass great part of time in open air.

Change for better then, which has here taken place, more I own than should have suspected.

While at same time this favourable change could I think in no degree be attributed to the practices here employed.

For in treatment of this case as you will observe from register¹ have had opportunity of doing but very little.

And as far as treatment went, was [entirely] directed to suppositions entertained with regard to nature.

That viz of Phthisis

Was with view to this affection, that had here recourse to a remedy, of which I own have good opinion

I mean Gum Myrrh.

This article as well as others of similar nature, has for long time, been with some employed in present affection.

But practitioners by no means generally agreed respecting propriety of it.

For by [some], this & indeed all healing Balsams, as called, have been condemned as pernicious.

That such their effects in Phthisis, you will find strongly contended for, in paper in London Medical Observations by accurate observer Dr Fothergill.

Later observations however than his, made at same place have been published in support of the medicine here employed.

Particularly highly extoled by Dr Simmons in late treatise on Consumption².

And among other authors in support of it mentions being employed in great number of instances in Guys hospital under direction of Dr Saunders with very remarkable success.

How these observations to be reconciled with those of Dr Fothergill, will not pretend to say.

Can hardly I think be denied [that] in some degree contradictory to each other

Yet am inclined to think that would be found less so than might at first imagine if proper attention paid to [different] [symptoms] of Phthisis

For in this disease, I apprehend three distinct species may be established.

These in practical course shall endeavour to describe & illustrate under titles of Catarrhal. Ulcerous. & Tuberculous.

At present would only observe that while imagine, that in most cases may be readily distinguished by symptoms so also considerable differences in mode of treatment.

And that Myrrh though in one prejudicial, may be advantageous in another.

Am inclined to think that principally useful in ulcerous.

That often used with advantage in catarrhal.

And that of all Phthisis least fitted for Tuberculous.

In this way, then, when speak of Phthisis in general, contradictory observations with regard to cure, may each of them be well founded.

But besides this must also add that Dr Fothergills observations do not apply to Gum Myrrh in particular.

And objections which makes against [healing] balsams in general, may not be so strong against this, as some others.

But in whatever way to be explained must here observe that for my own part have good opinion of Myrrh.

Since Dr Simmons publication in [part] have frequently employed it in Consumptive cases.

And I think in many of them with advantage.

At same time must observe that opinion not so high as from Dr Simmons publication one would be inclined to form

But am much mistaken if have not seen good effects from it.

And same also sentiment of some other practitioners at this place who have of late frequently used it.

Was then on footing of former experience that had here recourse to this medicine.

And on supposition of Phthisis, hoped that on fair trial might find it product of some benefits.

From termination however which disease has already had, can have little doubt, that idea of Phthisis is a mistaken one.

And as little, that relief which patient has obtained in no degree to be attributed to medicines employed.

For some time indeed, took medicines regularly.

But during part of that period, disease in place of being alleviated, became so much worse, that was confined to bed.

Consider this however only as consequence of progress of Phthisis affection, & of loss of strength, to which subjected those labouring under it, thought it advisable to persist merely in same plan.

At succeeding report was I own surprised to find symptoms considerably relieved.

This on supposition of Catarrh might perhaps in some degree have attributed to Cream of Tartar with which Myrrh here united, if had either been attended with effect of moving belly or increasing discharge of urine.

But as neither of these the case more probable that relief obtained was natural effect of progress of disease to recovery.

And this not a little corroborated by a circumstance which afterwards happened.

Continuation viz of progress to recovery [without] [aid] of any medicine.

For although Myrrh with Cream of Tartar ordered to be repeated, yet medicines were never sent for.

Hence then upon whole, consider case as example of simple Catarrh having favourable termination.

And at least serves to show that some instances threaten Phthisis, where yet affection may have speedy favourable termination

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.

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