DEP/DUA/1/32/18 (Normalised version)

Peter Campbel

(1783)

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Peter Campbel.

Case of this patient consists of very few symptoms.

And I think clearly affords example of a disease both very frequent & very troublesome

Principal complaint cough with copious expectoration.

Complains also of Dyspnoea with weight & oppression at breast

This however consider merely as consequence of matter accumulated in air vesicles not fully or freely discharged.

And from state of health in other respects can have no doubt in considering disease to be a catarrhal affection.

Has now however subsisted for space of about 9 months.

And for long time past has not been attended with any febrile symptoms

In this state obstinate catarrh in this country in particular very common.

And from period of life at which most frequent have name of Catarrhal Senilis.

To this appellation however in present case, age of patient not yet 30 a strong objection.

And indeed am inclined to think that at every period of life may with much greater propriety be named Chronic Catarrh.

To this affection then consider present patient as subjected.

And from this view am not inclined to look upon affection as dangerous.

Yet when consider season of year & status in life cannot expect speedy recovery.

And not impossible that danger greater than disposed to think.

For although not fatal by itself will in some habits induce phthisis

And Phthisis an affection of that insidious nature which often makes very considerable progress when not observed.

Hence then notwithstanding present opinion should not be greatly surprised at terminating even in death.

Yet hope that by proper attention notwithstanding unfavourable circumstances affection may soon be mitigated.

And that patient may even be in such state that farther attendance here unnecessary.

At same time cannot I think reasonably hope that till warm weather will be entirely rid of affection.

In treatment of this affection [great] objective for relief of patient is removal of mucus from air vesicles of lungs.

But radical cure to be obtained only by restoring secretion to natural state.

First of these effected by means promoting expectoration

Last chiefly by derivation from lungs to other parts

Was with this [latter] intention that when patient came first under care directed use of blister.

And to obtain more permanently the [affect] of derivation ordered that discharge should be supported by issue ointment.

From blister itself copious evacuation & manifest relief of symptoms.

That attention however which could have wished does not seem to have been employed in supporting discharge.

As thus little evacuation imagined that continuation would prove rather painful than advantageous to patient.

And that more might be reaped from repetition of blister.

For from frequent application even of [proper] blister to same place have copious discharge with almost no inconvenience.

And in many habits of equal [advantage] & much more easy than application of issue ointment.

During that time trial of many remedies without material benefit.

Cannot now therefore expect sudden removal or alleviation of what in great measure [constitutional].

But on other hand see nothing in case of alarming nature.

And may continue for years to come without any very considerable [difficulty].

If however shall again resume [attendance] may at least try measures both with view to alleviation & radical cure.

First of these ends according to idea given of disease, to be accomplished by counteracting effects of mobility.

Second by removal of it.

With both intentions a variety of practices in use

And in some cases at least with no inconsiderable success.

Effects of mobility as inducing spasm & pain most effectively counteracted by strong impression on nerves.

Influence of these from action either on nerves of stomach or any other sensible [extremities] communicated to brain.

And thus from influence on sentient principle effects which would otherwise take place are prevented.

Mind no longer affected in same manner by impression formerly having influence.

This effect in many instances produced by impression of stimulating nature.

In many others by sedative.

Thus for example find proper hysterical fits anticipated by large dose of Spirit of Hartshorn on one hand or Laudanum on other.

And that too after symptoms commonly forerunners of fits have occurred

When consider opposite influence of these can neither I apprehend with propriety attribute anticipation to stimulating nor sedative effects.

For while influence of one to mitigate pain, allay action & induce sleep that of other to excite pain & to rouse

Yet no doubt that from both same immediate effect on disease.

Must therefore suppose that in both cases arises merely from strong or powerful impression.

And indeed among different stimulants & sedatives not certain that from any two precisely same impression.

Probable even that not merely different in degree but in kind also.

But such means then might have hoped in present case to mitigate affection

But still cure to be obtained only from removal of morbid degree of mobility.

And for this again change requisite both in state of Nervous fluid & in moving fibres in general.

First to be effected by means altering state of action at brain as secreting organ.

And last by means altering state of moving fibres as simple solids

With view to these different intentions [might] here have recommended various practices.

And none perhaps from which greater hopes of radical cure than cold bathing.

Influence of this as tending to brace system & remove morbid degeneration of mobility, now well established.

And advantage, to be derived from it in Hysteria confirmed by daily practice.

Here while no circumstance tending to forbid use, farther indicated by attention to [illegible]

For observed by patient that complaint easier during cold weather in winter than heat of summer.

A circumstance which while leading to use tends also to corroborate conjecture as to nature of affection.

To this then may perhaps in end think it necessary to recommend [patient]

But present a very unfavourable season for commencement.

Wished therefore, at least in first place, to make trial of other measures.

Reason however to hope that state of weather will not much longer aggravate affection or counteract influence of remedy employed.

In this case however have not you will observe had recourse to many different remedies.

Began practice you will observe by directing an Emetic.

From this hoped that should [both] unload breast.

And that thus might both [relieve] cough & diminish tendency to inordinate action.

For well known that by one inordinate action, another often most [effectively] removed.

Thus nothing more influential in stopping singultus than action of sneezing.

Besides this led to use of Emetic also from different consideration.

Advantage viz often resulting from it in cases of Croup.

In that affection when fits of dyspnoea the greatest no remedy of equal efficacy [illegible] [illegible]

There indeed it is true, relief the consequence of free discharge of large quantity of mucous matter retained in Trachea

A circumstance in all probability not taking place with present patient.

And could not by any means represent this case as an instance of croup.

Still however the analogy such as naturally to suggest employment of an Emetic.

With view of exciting vomiting here had recourse to Ipecacuanha.

An article from which I am inclined to think can with more certainly depend on exciting vomiting than Emetic Tartar.

There however expectation disappointed.

For in place of vomiting looseness excited

And that too by a dose which with an infant at so early a period of life might have [expected] vomiting

Of effects therefore as an Emetic [were] entirely disappointed.

And whatever good consequences resulted from it to be attributed to influence as opening belly.

Not improbable that this may have had some share in producing that [relief] of which informed at succeeding report.

Was however more inclined to attribute relief to another medicine employed at same time.

For when ordered Emetic directed also you will observe use of oily mixture.

To this also principally led from [analogy] to Croup.

In that affection for my own part at least, but little expectation of it.

Am however informed on what reckon good authority that has often been employed with success.

And at least certain that impression which makes has often effect of [taking] off inordinate action.

In this way then imagined that might here be of some use.

But was still farther led to it from hoarseness with which patient affected.

For this as well as some degree of laboured respiration you will observe a constant symptom.

And have already hinted that though it no improbable supposition that cause of severe fits of dyspnoea connected also with case of these symptoms.

Well known however that nothing more affective in hoarseness than oily mixture.

From these considerations then led to hope that might be useful in present case.

And in this hope have not I think been disappointed.

For as already observed during course of first week though vomit did not operate patient considerably relieved.

This then at least sufficient inducement to continue employment.

But at same time still expected benefit from an Emetic.

While therefore advised that he should persist in oily mixture directed also Solution of Tartar Emetic with view of exciting vomiting.

And though Ipecacuanha had failed yet this attended with desired effect.

Here however not to be concluded that Tartar a more certain Emetic than Ipecacuanha.

For notwithstanding what happened in present instance is of the two most liable to operate by stool.

From vomiting here excited however patient derived evident benefit.

And accordingly at succeeding report directed continuation of Mistura Oleosa alone.

Hoping that by this alone, remains of affection might be overcome.

At last report however although the mixture continued yet found that attacks of difficult breathing more frequent.

This however as well as patients [mother] was inclined to think might be attributed to state of weather

But as Mistura Oleosa had now been continued for some length of time directed that should be omitted ordering repetition of former emetic.

And if patient again as much relieved as formerly, will confirm sentiment of advantage.

In that event may perhaps be in condition to be dismissed without any farther medicine.

But if attacks shall still continue frequently have now thoughts of trying him with some of those antispasmodics of tonic nature.

Particularly Zinc or Peruvian Bark.

By these hopeful that returns may be prevented.

If this however shall not be the case, or if any circumstances shall occur preventing use of them, practice must then be accommodated, to condition in which shall find patient.