DEP/DUA/1/37/21 (Normalised version)

John Annan

1785

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John Annan. February 26^th 1785

Respecting disease of this patient somewhat at loss.

Am somewhat doubtful whether should consider it as instance of catarrh or of incipient Phthisis.

In symptoms to which patient subjected when came under care, none which do not very commonly occur in catarrh.

And indeed nothing which could be considered, either as alarming or singular.

While at same time, during this season, catarrh a very common complaint.

No appearance marking even the incipient state of Phthisis especially no marks of Hectic fever

One particular however mentioned in history of itself sufficient to give alarm.

That is state of affection at commencement.

Began we are told with very considerable haemoptysis.

This however well known frequently lays foundation for Phthisis.

While at same time as well known that Phthisis often marks considerable progression before any symptoms by which can be detected.

Hence then not altogether without apprehension as to that affection.

And from this, great uncertainty respecting prognosis.

If either really Phthisis already, or if that disease induced in consequence of it, will in all probability prove fatal.

At least even of most favourable cases, a very great majority have that conclusion.

Here however am still I own disposed to consider as mere catarrh.

And to hope that even independent of medicine by occurrence of fine weather may have favourable [termination]

And that this event may be somewhat promoted by practices which may here be directed.

As however doubts concerning disease created uncertainty in prognosis so must [also] with respect to treatment.

And while practice directed to catarrh must at same time have in view, the tendency to Phthisis

Here from difficulty of expectoration, depending on viscidity of matter, seemed to be first objective to unload the breast.

Was with this intention, that began practice, by directing the use of Emetics.

These need, hardly observe, are unquestionably most immediate, & effective expectorants with which are acquainted.

And accordingly in effects here were not disappointed.

For while both operated briskly, as consequence of operation, cough & dyspnoea [relieved]

Here however while first objective to expel mucus already accumulated was of no less importance to prevent return.

This often to be accomplished, by giving gentle determination from lungs, to other parts.

Particularly by promoting free discharge, both by stool & urine

Was with these views, that had here recourse, to [composite] powder of Cream Tartar.

An article consisting of equal parts of Cream Tartar & Flores Sulphuris.

And which taken to extent of two or three tea spoonfuls in day, has in general; affect of operating, both as gentle laxative & diuretic.

To this the rather led in present instance as seemed well accommodated to Phthisis affection.

At least both as refrigerant, & evacuant tending to prevent return of haemorrhage

In obvious operation of this medicine were not disappointed.

Had some influence on both discharges.

And under these considerable relief both of cough & dyspnoea.

But from some accidental interruption of attendance, medicines were for some time given up.

Upon this occasion, symptoms again considerably aggravated.

Particularly cough & dyspnoea.

A circumstance giving at least some grounds for inferring that relief not improperly attributed, to medicine employed.

At same time, can from thence draw by no means a certain conclusion.

For affections of this kind often subjected to aggravation from very trifling circumstances as accidental change of weather.

Often even without any obvious cause.

But whether arose from want of medicine or not, on return to use had [again] some remission.

Still however had reason to think that fresh accumulation had taken place in lungs supporting cough.

Accordingly had again recourse to an emetic as means of unloading it.

And hope that may again produce of good effect.

To this course then, of Emetics employed occasionally, & composite powder of Cream Tartar [used] during intervals am hopeful that disease may soon yield.

Especially if at same time a change to milder & warmer weather.

If however mistaken as to nature of disease, or if affection shall after degenerate into Phthisis this event hardly to be expected.

If therefore from continual obstinacy shall have reason to suspect this will have recourse to a blister converted into issue.

Which also one of those practices applicable both to Catarrh & Phthisis.

If still more decisive proof of Phthisis may here make trial of Gum Myrrh.

But in that case too much reason to apprehend that all trials to little purpose.