DEP/DUA/1/31/16 (Normalised version)

Alexander Burr

(1782-1783)

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Alexander Burr.

Disease of this patient could not be represented as very distressing to him or in its nature very important.

Yet little doubt in considering him as subjected to a complication of different affections.

Complaint first mentioned [in] history & [illegible] indeed chiefly the subject of practice was a catarrhal affection.

This evidently indicated by cough, dyspnoea & state of expectoration.

These indeed symptoms in common both to catarrh & phthisis.

But here there could be no suspicion of latter affection.

That merely catarrhal evidently indicated by absence of hectic fever, & of all other symptoms indicating Phthisis.

Particularly by strength being very little if at all impaired.

Indicated also by age of Patient.

For while had long passed that period at which Phthisis most frequent had arrived at age at which catarrhal affections known to be most common.

In so much that with him the disease might justly be styled an instance of Catarrhus Senilis.

When consider however that affection occurs at early periods of life more properly called chronic catarrh.

And this appellation could have little difficulty of bestowing upon it when consider that had already subsisted for space of several years.

As is common indeed with that affection had not uniformly continued

But while suffered considerable mitigation during summer again aggravated in the winter.

This however often observed to happen & as well as long duration another objection [against] any suspicion of Phthisis

Besides common symptoms of catarrh several others in present case evidently referred to this cause

Particularly headache & watchfulness during night.

For both one & other we are told arise only as consequence of severe & frequent coughing.

Perhaps also to consider as in some degree symptoms of catarrh, the [sickness] & inclination to vomit with which often affected

For no doubt that both especially [vomiting] often consequence of severe fits of coughing

Here however other stomach complaints.

For when vomiting takes place, observed to be attended with discharge of sour or bitter tasted matter

To these symptoms also, flatulence at least at times superadded.

Hence then besides disease of [breast] here also affection of alimentary canal

But to these two diseases still a third superadded.

And that too probably unconnected with both.

Need hardly add that what here allude to is local affection of tongue

To this disease do not know that any proper [general] name that has been given

Yet an affection not unfrequently to be met with in practice.

And in several instances which have had occasion to treat have found it both distressing & obstinate.

And while resisted different modes of cure was also product of very severe pain.

Here neither pain nor obvious affect so considerable as have often met with

Yet I own was apprehensive that would not be soon terminated.

And must acknowledge that this event has taken place more quickly [than]

How far the consequence of remedies employed shall afterwards have occasion to consider

With regard to stomach complaints these but very slight.

And during time that he was under care were very little an object of attention.

Although evidently marked an affection of that organ yet hardly consider them as what required to be subject of [that]

And event I think has shown that this supposition not erroneous.

For during course of attendance, without any particular practice directed against them stomach complaints entirely disappeared.

Of Catarrhal affection also favourable termination has so far taken place that patient now dismissed from farther attendance.

This no more than from proper management & mild weather had reason to expect.

At same time cannot by any means look upon that affection as completely removed.

And still reason to fear that by any accidental exposure to cold affection may be again be renewed.

To such however labouring poor at this season of year necessarily very much exposed.

Will not therefore be at all surprised if find him soon again subjected to return of this part of affection

Yet may still observe that in beginning of present month all complaints so far removed that farther attendance unnecessary.

How far this affected by treatments employed in this case next our business to inquire.

Began practice by directing for him the use of an Emetic.

And here you will observe that employed Ipecacuanha to extent of ℥p.

To this led from a circumstance mentioned in history of case respecting a former Emetic.

Ipecacuanha to quantity of Ji slow in operating.

Was therefore to [secure] more expedient effect that ten grains more employed.

Here may perhaps be matter of dispute whether this addition proper or not.

For respecting doses in which Ipecacuanha ought to be exhibited many controversies.

By some contended that in general over dosed.

Or at least that though from giving it to quantity of scruple¹ no bad effects, yet that from much smaller quantity all same effects produced.

And that greatest part of what taken rejected by first vomiting without producing any effect.

And that thus a superfluous quantity unnecessarily expended.

That this may in some degree be the case I will by no means deny.

When Ipecacuanha taken in powder a great part again discharged apparently very little changed.

And no reason to think that is in an inactive state.

But although thus some Ipecacuanha lost yet no doubt, that from increase of quantity operation quickened.

And not contended that from large dose any bad affects.

Probably from this circumstance of being rejected before activity excited that in some degree to account for safety of Ipecacuanha as an Emetic.

For almost never attended with effect of producing excessive vomiting [illegible] danger.

Probably from greater part of it being rejected as soon as any of it has induced such nausea as to occasion vomiting

Here therefore to use of thirty grains no other objection but very small unnecessary expense.

While at same time with a stomach not operated upon without difficulty had at least better chance of speedy affect.

While ordered the Emetic directed also the use of the Pill Scillitica.

These well known to be one of most common remedies used in such catarrhal affections.

And for my own part, no doubt in considering it as being often attended with very excellent effects.

These by much greatest part of practitioners ascribe to power as expectorant

But others admitting good effects deny that it can possibly have any such influence.

And attribute power in alleviating affections of breast to influence on urinary organs.

That by diuresis catarrhal symptoms often relieved is undoubtedly true.

And that Squills have effect of promoting diuresis undeniable.

But if act on this organ as [introduced] into circulatory system may also infer at least the possibility of acting upon others.

And in my opinion observation of effects in actual practice fully demonstrate influence in producing more free & easy excitation of mucus.

Probably from affording stimulation to excretion before [promoted] stagnation has acquired any great viscidity.

And from use in present case hoped that should be able to obtain that effect.

While emetic & squill pills intended against catarrhal affection another prescription directed with view to affection of tongue.

Such affections have already observed often in nature obstinate.

Sometimes however overcome by tonics as astringents, such for example as Peruvian Bark Infusion Rosarum etc.

But where resists these, have still more powerful modes of cure, in gentle escharotics.

And as such [burnt] [aluminium] in form of powder & blue vitriol in that of solution not unfrequently employed.

Here used an article in properties somewhat approximate to both.

Vitriolic acid viz diluted with large proportion of water.

In such a state nothing to be feared from corrosive power, yet had reason to hope for benefit both as gentle escharotic & astringent.

For obtaining [these] directed to be used in form of gargarism for wasting tongue

And this practice seems to have been product of very good effect.

For in short time pain & uneasiness very much alleviated.

From emetic also good effect seems to have been produced.

For although operated but little yet after operation both cough & headache easier.

In this situation repetition of Emetic seemed to be unnecessary.

Was satisfied therefore with merely directing continuation of Squill pills, & of gargarism with vitriolic acid.

At succeeding report affection of his tongue you will observe still more diminished than before.

But cough again rather aggravated.

While therefore gargarism seemed now unnecessary directed repetition of Emetic with continuation of pills.

But on this occasion did not seem to be followed by same benefits as formerly.

And as cough & dyspnoea still distressing to him directed a blister.

Than which few more effective means of relieving breast.

But though here product of considerable discharge had not that effect which might have expected.

In this situation directed dose of pills to be augmented.

And as another means of producing determination from breast, had recourse to a gently laxative electuary of Cream of Tartar & Sulphur.

Under use of these remedies affection so far alleviated that reckoned farther attendance unnecessary.

This however was I own inclined to attribute [full] as much to mild weather as to influence of remedy employed.

And while season temperate if patient can avoid accidental cold reason to hope that may continue free from affection.

At same time cannot by any means consider affection as radically cured.

On slightest exposure during inconstant weather, renewal of affection to be dreaded.

And should not be at all [surprised] to find him soon again applying for assistance.

But even if catarrh should be renewed still reason to hope that will continue free from other part of disease affection of tongue.

And present case has I think afforded example of power of vitriolic acid as countering this complaint.

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Explanatory notes:

1) A unit of weight equal to 20 grains, used by apothecaries and physicians.