DEP/DUA/1/35/22 (Normalised version)

Andrew Ross

1784

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Andrew Ross. June 25^th 1784

In history of this patients case have many of those symptoms which are in common to Phthisis & Catarrh.

Particularly pain of breast cough, dyspnoea & expectoration of viscid yellow matter.

And indeed no symptom mentioned in history which does not often occur in both diseases.

Hence then diagnosis here must be difficult.

Especially when consider how far Phthisis an insidious disease & how great progress has often made before distinctly marked.

Would by no means therefore with confidence pronounce that present patient may not be subjected to it.

Or even that has not already made considerable progress.

Yet at present at least, several circumstances leading to contrary opinion.

Has nothing of shivering fits or febrile accession indicating hectic state which may be considered as great constituent of Phthisis.

Pulse seldom more quick than should expect at his time of life

While pain of breast though distressing yet rarely for any length of time fixed to particular part.

To these to be added that patient hardly arrived at consumptive period of life

And that disease derived origin from a cause very frequently operates as inducing similar affection merely of catarrhal kind viz exposure to cold.

Hence then although here danger of Phthisis & thus fatal termination yet upon whole disposed to hope more favourable.

And flatter myself that by measures counteracting catarrhal affection may in no long time be overcome.

To this disease therefore practices hitherto employed almost totally directed.

Began by ordering application of blister to [pained] part.

From this hoped that as far as pains consequence of inflammatory tendency, might be counteracted.

But expected still more advantage from diminishment of [increased] secretion to breast by giving determination elsewhere.

As a means of still farther alleviating cough had recourse to a mucilage mixture.

With view of gently [ acidul] this & thus rendering it more pleasant [added] to it a proportion of Syrup [ Acit].

And as means of allaying & mitigating irritation such a proportion of Tincture Thebaic that grain V in every spoonful of mixture.

From these remedies then expected mitigation both of pain of breast & cough

And in this expectation not altogether disappointed.

For after application of blister, which rose well pain of breast somewhat mitigated.

But neither from this nor from mixture any apparent mitigation of cough.

And while copious expectoration still continued was observed to have disagreeable taste & smell.

This was inclined to ascribe rather to stagnation of mucus, than to purulence.

And seemed therefore to indicate employment of some remedies which would have effect of completely unloading breast.

As such directed use of Emetic

And that purpose might be most certainly answered ordered that should be twice repeated before next weekly visit.

Besides unloading breast expected also that would have considerable effect as [changing] mode of circulation.

For no doubt that by determination from lungs, to surface have often good [effect].

From these therefore conjoined with continuation of former mixture expected mitigation of cough.

But in this also disappointed.

For although both vomits operated well, yet cough & expectoration still continued.

But although had hitherto failed yet [expected] that on same principle relief might be afforded.

And in order to diminish determination to breast seemed necessary that more permanent determination should be made to some other part.

For this purpose not only [directed] repetition of blister, but conversion into issue.

Issues indeed as being both inconvenient & troublesome should in general be [avoided] where can be done.

And particularly with young subjects on whom the [entailing] a habitual discharge must always be disagreeable.

But at same time in diseases where change of determination requisite few remedies of greater efficacy.

And accordingly in case before us has already had considerable influence both in mitigating cough & relieving breathing

But patient as may indeed be suspected from pain which produced [averse] to continuation.

And from this [joined] to circumstances already mentioned shall be desired of persisting in use no longer than absolutely necessary.

Hope however that effect may be such as soon to enable us to omit use.

And that by continuation of mucilage mixture alone cure may be accomplished.

If this not case have thought of adding to mixture a proportion of powder of Cicuta.

And if this also fails, practices then directed by situation of patient at the time.