DEP/DUA/1/31/26 (Normalised version)

Jean Duff

(1782-1783)

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Jean Duff

This patient but for short time under our care.

Reckon it necessary therefore to say very little respecting case.

Especially as from not being able to find her abode very little chance of having any farther direction of treatment of case.

As far however as could judge of affection, from history introduced into our register¹ both important & dangerous.

At same time in circumstances with which attended nothing that could be considered as uncommon.

When applied for our assistance principal symptoms consisted of cough dyspnoea & pain of breast

These taken merely by themselves in most instances not very alarming.

But well known to be the incipient symptoms in Phthisis as well as in Catarrh

And here from circumstances by which preceded very great grounds for being alarmed.

For present affection ushered in you will observe by very profuse bloody discharge.

Was indeed matter of some doubt whether this haemorrhage from lungs or from stomach.

The great extent to which suddenly took place led patient herself to suspect that from latter of these sources

And will not venture to say that conjecture without foundation.

Yet when consider that blood [afterwards] evidently coughed up more probable that entirely from lungs.

And no doubt that vessels [there] capable of affording evacuation to any extent

This haemoptysis indeed from time that patient came under our care had entirely ceased.

But well known that after ceasing again very apt to return.

And in case before us this the rather to be dreaded from quickness & strength of pulse conjoined with marks of plethoric habit.

But either with or without return great reason to dread termination in Phthisis.

For in at least majority of cases notwithstanding every precaution this event takes place.

Must indeed be allowed that danger not to be estimated by quantity of haemorrhage.

Even contrary perhaps is the case.

At least for my own part [persuaded] that more to be dreaded where but slight appearance of blood with frequent [recurrence] & long continuation than from profuse haemorrhage at once as in present instance.

Another circumstance somewhat in patients favour is sex.

For no doubt that with men haemoptysis much more alarming than with females.

Particularly when with latter occurs as vicarious to menstrual discharge.

And although this cannot strictly be said to hold in present case yet would seem to happen at least in some degree.

For although menses regular as to time yet scanty in point of quantity.

Whereas formerly we are told were very profuse.

From these circumstances then, some grounds for expecting favourable termination.

But must own that inclined rather to different opinion.

And think it more probable that affection will terminate in fatal Phthisis than in recovery.

But besides pectoral complaint in history of case another affection also mentioned.

Cutaneous eruption viz. on different parts of arms but particularly betwixt fingers.

From appearance as well as situation could have no doubt in considering this to be Psora

Which still farther confirmed by child with whom she sleeps being also subjected to same affection.

This part of disease however although troublesome did not consider as in any degree dangerous.

Reckoned it sufficient therefore to recommend to her to have recourse both for herself & child to friction with Sulphur.

And medicine prescribed for her, entirely directed with view to other affection.

With this intention had first recourse to refrigerant powders with Nitre & Gum Arabic

And as means of alleviating both hoarseness & cough directed also the Mistura Oleosa.

Under these medicines for space of week continued free from any return of bloody spitting & hoarseness much diminished

But was distressed with bound state in belly.

In this situation reckoned continuation of oily medicine which not very agreeable to her unnecessary.

And to Nitre substituted Cream of Tartar taken in such quantities that hoped it would move the belly.

What however has been effect of it have not been able to learn as have since seen nothing of patient.

But whether for present has got better or not must own reckon future health extremely uncertain.

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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.