DEP/DUA/1/33/28 (Normalised version)

William Aitken

1784

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William Aitken 18^th January 1784

With regard to complaint of this patient when came under care was I own somewhat doubtful.

And not without apprehension of dangerous consequences

Principle symptom you will observe consisted in pain of breast a little above Scrobiculus cordis.

This so considerable that could lie only on one side & not even thus when in recumbent posture.

For in order to obtain ease obliged to have his head raised

This pain attended also with very severe cough

From these symptoms had reason to apprehend some serious complaint of thoracic viscera.

From continuation indeed & from absence of fever not considering it as active pneumonic inflammation

And here characteristic marks both of Pleuritis & of Peripneumonia were wanting.

But at same time had reason to suspect [such] a degree of inflammation as might terminate in suppuration.

And thus give rise to Phthisis an affection in most instances terminating fatally

If however such an event to be dreaded even supposing conjecture well founded, as to nature of affection had yet reason to entertain hopes of more favourable conclusion

For by proper remedies might expect resolution of inflammation.

And this even in most violent cases is at least most frequent termination

But in instance before us no certain evidence that inflammation to any degree

Or at least may have been merely such as the attendant of Catarrh

And that affection at least to considerable degree catarrhal may infer from expectoration with which attended.

And here so much in doubt that treatment in part directed with both intentions

But whatever conjecture best founded apprehension with regard to case now at an end.

And from favourable termination which has taken place observations on prognosis now superseded.

This termination, am in part at least, disposed to attribute to practices here employed.

Particularly to the blister.

This remedy often employed in Catarrhal cases & with great advantage.

But here more particularly directed on supposition that pain was the effect of some local inflammation.

On this idea indeed may naturally be thought that should have had recourse to blood [letting].

But here even supposing that local inflammation had occurred was yet without increased action in whole vascular system.

For pulse with a man not arrived at 30^th year, only 80 & rather weak.

Saw no reason therefore for having recourse to general depletion.

And from blister I own expected more here than from topical bleeding.

Influence of blisters as useful against internal inflammation has been explained in different ways.

In general however considered as principally arising from antispasmodic power & from change in mode of circulation.

On these grounds however should hardly expect more from application to chest than to other parts.

For notwithstanding nearness communication with vessels affected not more direct.

Must own however that inclined to think that some advantage here arises from proximity of situation.

Perhaps to be explained from sympathy perhaps from some other cause.

But whether any superior advantage from application over pained part or not is yet unquestionable that as thus applied product of useful consequences.

And both with & without blood letting most salutary affects in removal.

If inflammation here existed may presume that to have been case

For no sooner had operation taken place than pain of breast very much alleviated.

And in short time entirely left him so that could lie with equal ease on either side.

With removal of this symptom considered disease as terminated.

And this termination, whatever nature was may I think be ascribed to the blister.

Besides blister indeed here employed also some squill pills.

Chiefly intended with view to cough & expectoration.

But of these shall more particularly have occasion to speak under case next in order that viz of Robert Mitchell.

This however delay till future lecture.

And may conclude present case with observation that affords example how far even alarming symptoms of breast will yield to application of blister over the pained part.