DEP/DUA/1/32/15 (Normalised version)

Charles Watt

(1783)

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Charles Watt. June 12^th.

Symptoms of this patients case not very dissimilar from last.

At least also consists principally in cough & dyspnoea.

But as in former case pronounced these to be merely catarrhal so in present on the other hand, but too much reason to suspect Phthisis.

Here no difficulty to that supposition from age of patient, or duration of complaint.

For still within limits of what reckoned the Consumptive period.

That is, at age when consumption most common.

Affection but of few months standing.

And during that time patient very considerably emaciated.

In so much that from examination of face, particularly projection of cheek bones might even consider him as [approximating] to facies Hippocratica.

This however must observe seems evidently to depend much on make of face.

And therefore less alarming.

But at same time is in him connected with make of body rather favourable to Phthisis.

viz Long neck & narrow chest.

But to these circumstances others still strongly indicating suspicion of Phthisis are here added.

This particularly the case with respect to expectorated matter.

For remarked that not only of purulent appearance but also of very bad taste

From these indeed, cannot by any means with certainty infer pus.

And on this account wished to have had opportunity of examining expectorated matter by Caustic alkaline lixivium.

Which in my opinion affords very certain test of presence or absence of purulency.

For in concentrated state operates as a solvent of mucus.

But if with mucus any purulence connected on addition of water is deposited.

This trial however have not hitherto had opportunity of making.

As from diminishment of expectoration patient could not collect it.

Still therefore must conject only from other circumstances.

But while appearance taste & smell gave presumption of pus, state of tongue also in favour of that supposition.

For this we are told peculiarly red & clean towards point.

Such a state of tongue however a very common attendant, nay may almost say a necessary consequence of purulent expectoration.

Hence then justly to be mentioned among other suspicious circumstances.

Upon whole then when consider insidious nature of Phthisis here but too much grounds for suspecting it.

Pulse indeed it must be allowed not remarkably quick.

In history of case little above natural standing.

But this unquestionably no security.

And at times considerably quicker.

Even such varieties however no less [threatening] than greater permanent quickness.

Upon whole then all circumstances of this case led me to conclude that was Phthisis.

But suppose it such another question to be determined of importance in Practice.

To what species of Phthisis viz are to be considered patient as subjected.

For in this disease on all [hands] admitted that very considerable diversity.

In my opinion with view to practice may be most usefully distinguished into three [Species].

The ulcerous where matter [formed] from large vomica.

The tuberculous, where [indurated] glands passes into suppuration yielding only small quantity of bloody sanies

Or the Catarrhal where purulent separation takes place merely from internal surface of lungs.

Into distinctions of these species cannot here propose to enter.

Would only observe that consider disease of our patient as being of latter kind.

To this led, from origin of his disease, accidental exposure to cold.

From copious expectoration, evidently containing at least mixture of mucus, & without appearance of blood which must attend eruption of Vomica.

Besides wants fixed pain of breast very generally the attendant of the ulcerous

And without constant tickling dry cough again occurring in tuberculous.

From this idea of disease prognosis as favourable as can be, at least, in any instance of Phthisis.

For unquestionably more recovery from catarrhal than any other.

Besides this season of year also much in favour of patient.

Particularly as admitting of exercise, & affording diet most conducive to recovery.

To these as a circumstance not less [flattering] than either may add also change for better which has taken place.

For since came under care expectoration much diminished cough much easier

Hence then notwithstanding dangerous nature of Phthisis here grounds for hope

And shall not consider recovery of patient as any evidence that supposition respecting disease ill founded.

Must indeed be admitted that in greater part of instances where Phthisis said to be cured, the disease has never existed.

At same time is I think no less erroneous to assert that from Phthisis no recovery.

In more than one instance, am very much persuaded, that have seen best effects resulting from that remedy employed with this patient.

I mean the Gum Myrrh.

At first indeed you will observe prescribed an Emetic for patient.

This however done principally with view to alleviation of cough by unloading [breast] & to prepare for Myrrh by unloading [his] stomach

For most full account of use of Myrrh in Phthisis, may refer you to treatises by Dr Simmons & Griffith¹

Since these publications, have often employed.

Principally as in present case, conjoined with Cream of Tartar as a refrigerant.

Since began this remedy, affection for present at least much alleviated.

And patient now looks upon himself, as almost perfectly recovered.

In this however, would be very wrong, to put too great dependency on his feelings.

Especially as in Phthisis, to be considered almost as part of the disease, that patients never aware of their danger.

And in general even in uncommonly high spirits.

Would not therefore be at all surprised to find that in end yet falls victim to it.

At same time must own that entertain hopes of more favourable conclusion.

And expect that in no long time may be able to dismiss patient from attendance.

In that event whether can with justice attribute much to medicine, or not, shall yet consider case as example of recovery where at least strong presumption of Phthisis.

If such recovery however, does not take place, may be obliged to have recourse to other practices.

If such necessary, shall probably have next recourse, to Blisters & Issues conjoined with Cicuta.

In this respect however, must be very much determined, by situation of patient, at the time.

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Explanatory notes:

1) Samuel Foart Simmons, Practical observations on the treatment of consumptions (1780); Moses Griffith, Practical observations on the cure of hectic and slow fevers and the pulmonary consumption (1799).