DEP/DUA/1/37/58 (Normalised version)

John McPherson

(1785)

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John McPherson. April 23^d.

Symptoms in case of this patient not very numerous.

Sufficient however to mark a pectoral affection even of an alarming nature.

From cough, & pain of breast alone grounds for suspicion of Phthisis.

And this presumption not a little increased from feverish fits & night sweats.

But still more from bloody expectoration, with which cough has at times been attended.

And upon whole though no certainty, yet here but too much ground for suspecting Phthisis.

Still however could not be considered as of most dangerous kind.

Of this sufficient proof from reflection that before patient came under our care had been subjected to it for several years

In much shorter period, where Phthisis of exquisite kind, not only distinctly marked, but even fatal.

This accordingly generally the case in the Tuberculous Phthisis.

But in present case no appearance of scrofula habit or any other mark which could lead us to suspect that of this kind.

Wanted also, that copious expectoration, which very generally, perhaps universally the attendant of Catarrhal.

While again, from constant fixed pain, referred to particular part of breast, had strong presumption of vomica in lungs yet unburst.

In point of danger hold this species to be intermediate between other two.

More so than catarrhal, less than tuberculous.

Upon discharge of matter some chance of recovery.

But upon whole probability is that will fall victim to the affection.

In treatment of this case intent to make trial of Gum Myrrh.

A remedy which as have already had occasion to observe, in present course, much celebrated in Phthisis affection by some of London Practitioners.

Particularly by Dr Saunders of Guy hospital, & Dr Simmons, to whose treatise on consumption¹, may refer you, for best account of it.

From slow progress of this case, may have opportunity for full & fair trial.

Have here accordingly directed it, as combined with Cream of Tartar.

For to be observed, that with use, some refrigerant is in general required.

And am inclined to think, that in most cases at least, Cream of Tartar, preferable to Nitre, which has been generally used

On this medicine, then is [intention] to continue patient, for some length of time

Using however occasionally such [other] practices, as circumstances might render necessary.

And here imagined, that some benefit might be derived, from a gentle Emetic.

As such, had recourse you will observe to Ipecacuanha.

And here took this opportunity, of trying in way of Experiment, how far the Emetic power of Ipecacuanha, counteracted by acetous acid.

From some late Experiments, by a very ingenious Gentleman, Mr Irving, reason to infer that has in this way very considerable influence.

While at same time, determining action to intestinal canal.

Perhaps acting by restoring inordinate action of vomiting as it does hiccups.

Here therefore directed that Ji of Ipecacuanha should be taken in ℥i of Vinum.

But on this occasion while vomited well, had no effect in producing looseness

As a second trial, took future opportunity of giving same quantity of Ipecacuanha in ℥iii of distilled Vinegar.

And on this occasion also, was in usual time, followed by some vomiting.

But produced also two or three loose stools.

Upon whole, would appear, that with this patient the Acetous acid did not take off, at least entirely, the Emetic power of Ipecacuanha.

And from some other trials, am inclined to think, that this will happen with most stomachs.

But at same time from these also am convinced that by acetous acid may determine action to intestinal canal.

And this I am inclined to think a particular of no inconsiderable importance in practice.

Besides Emetics have also in conjunction with Myrrh directed for this patient, a mucilaginous mixture containing [small] proportion of Tincture Thebaic & Vitriol acid.

From first have in view the mitigating tickling cough.

From the last, the restraining wasting sweats.

If answers these intentions may be continued.

If not is still my intention to go on with the Myrrh conjoining such other practices as circumstances may occasionally require.

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Explanatory notes:

1) Samuel Foart Simmons, Practical observations on the treatment of consumptions (1780).