DEP/DUA/1/35/08 (Normalised version)

Henry Bruce

1784

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Henry Bruce. June 4 1784

When this patient came under our care his principal symptoms cough & headache

And these attended with remarkable loss of strength a circumstance [attendant] on many affections.

Sometimes as a cause inducing other complaints.

More frequently as a consequence of disease

And indeed is as it were a natural & unavoidable consequence, of every disease which has subsisted for any length of time.

Hence in general increases in proportion to continuation of any considerable affection.

Here however duration of complaint not great.

But at same time when consider that had been attended with very considerable eructation still inclined to view it as being symptom.

And this discharge indeed of which in all probability consequentially to be considered as most important & alarming part of affection.

Had indeed been affected with no bloody expectoration for two or three days before came under our care

At same time when attend to the considerable evacuation of blood which had taken place for three successive days prior to these, must look upon it as better entitled to [appellation] of Haemoptysis than any other.

And no symptom in the case which is not frequently either consequence or concomitant of that affection.

Here as patient imagined that pain first induced by lifting heavy load may be [supposed] of [passive] kind.

And that this may have had share in giving rupture of vessels by lungs is at least I think very possible.

At same time from state of pulse, as well as headache, have indication of general fullness & tendency to increased action.

And may therefore presume, that at least accompanied with disposition to active haemorrhage.

In headache here something you will observe peculiar.

Though continues to certain degree through the day, yet always most severe in the morning.

In so much that upon first rising, is affected with considerable vertigo.

These I am inclined to think are consequence of horizontal posture.

And no doubt that then greater determination to head than in any other position.

Hence to be considered as giving some additional proof of fullness & increased action

May also perhaps be [stated] as matter of doubt, how far may not attribute to same cause, those morning sweats with which part affected.

Increased cuticle discharge may [unquestionably] arise either from augmentation of impetus or diminishment of [illegible] at surface

And here may be effect of former circumstances.

More reason to apprehend however that connected with latter.

And indeed a very common symptom of an affection of most dangerous nature which often a consequence of Haemoptysis viz Phthisis Pulmonalis.

In giving prognosis therefore in this disease tendency to Phthisis the circumstance most to be had in view.

Of this in case before us cannot be altogether without apprehensions.

For besides morning sweats other symptoms also somewhat alarming.

Particularly severe cough & quickness of pulse.

But at same time nothing here like decided Phthisis.

And upon whole rather inclined to hope favourable than otherwise.

This you will observe with present patient already at 24^th year, is a first attack.

Is in general however, from successive affects only, that termination in Phthisis occurs.

From haemorrhage itself, seldom fatal consequences.

And indeed with present patient before time that came under care, seemed as it were to be terminated.

Since he has attended here no threating of any return.

While at same time, health in every other respect better.

Hence then in hopes that for present at least, favourable termination will be obtained.

And although liable to dangerous return of affection, yet may soon be dismissed for present at least free from complaint.

Even if this however should be the case, cannot I own attribute much to remedy employed.

And recovery much more to be ascribed to operation of nature, than to effect of any medicine.

While however say thus much would by no means be understood to infer that practice here directed altogether useless.

And if principle part of affection really terminated before use begun had yet probable influence in preventing [return]

Here first objective was to diminish at least in some degree impetus of circulation.

To restrain & [mitigate] cough by which such constant irritation given, as to endanger fresh rupture of vessels

And so far to strengthen vessels that rupture will not so readily occur from trifling causes.

With first of these intentions many different remedies might have been [employed]

And indeed intention answered by whole tribe of evacuants operating without increased impetus

Of the evacuation none more directly operates, as diminishing impetus, than blood letting.

And may here naturally occur as question, why had not had recourse to that practice.

No objection occurred to it, from state of pulse.

While seemed to be indicated both by headache, & still more by pain of breast.

And do not doubt that in both respects patient might have derived from it considerable relief.

But was principally led, to defer [using] it from two considerations.

In first place imagined, that circumstances might occur when more urgently required.

And if used now would be less proper to employ it then.

But still more [deterred] from use, by great debility of which patient complained.

For to this part of affection could be no doubt that would add very considerably.

Wished rather therefore, to try how far diminishment of impetus could be accomplished by other means.

And for this purpose, had recourse to Cream of Tartar.

This directed to be taken to such extent, that hoped it would operate both as gentle laxative, & refrigerant.

While at same time expected, that by giving determination to intestinal canal, would diminish tendency to profuse discharge by surface.

To which in all probability, loss of strength not a little to be attributed.

On different grounds therefore expected that might here be of service.

But besides this remedy, had at same time also, recourse to another

A mucilage mixture viz with addition of Infusion Rosarum.

From this again need hardly observe that objective was to answer two latter intentions mentioned.

From lubrication of fauces by mucilage expected mitigation of cough.

While by astringent power of infusion Rosarum, more indeed from Vitriolic acid which contains, than from vegetable from which derives name, expected that vessels rendered tender by rupture, which had already taken place, would be strengthened.

And [for] Vitriolic acid also as well as from Cream of Tartar expected considerable effect in diminishing morning sweatings.

For in this way no doubt that this powerful astringent has very considerable influence.

On this course patient has uniformly persisted since treatment here first begun

Can not indeed say that every intention which have had in view has been fully answered.

And in particular patient still affected with some degree, both of headache & of sweatings.

But other symptoms, very considerably diminished

While cough much mitigated strength also considerably augmented.

And what of still more consequence has continued entirely free from any return of bloody expectoration.

Reason therefore to hope that soon all affections will be removed.

And that for this purpose nothing farther necessary than continuing in course already begun.

If however in this disappointed by fresh & alarming return of Haemorrhage may be obliged to have recourse to blood letting, blisters, or stronger astringents.

If on contrary terminates in Phthisis must direct plan of cure to that modification of the disease which shall occur.

But as already said am in hopes that shall have here upon whole a more favourable termination.

And that may soon be able to dismiss patient for present at least free from his complaint.