DEP/DUA/1/39/32 (Normalised version)

James Hutchinson

(1785-1786)

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James Hutchinson. April 8^th

Of case of this patient reckon it necessary to say very little.

For he also but short time subject of practice here.

In history of his case formerly mentioned that had many of those symptoms which occur in Phthisis.

And during short period of attendance saw no reason to alter this opinion

On contrary from variable state of pulse, & particularly great quickness rather confirmed of it.

Of Phthisis in this case [presumption] even from obvious appearance of patient.

Particularly from emaciation as indicated by approach to facies Hippocratica.

And from pearly cast of eye destitute of red vessels.

But with these were conjoined circumstances much less equivalent.

Particularly, pain of breast & cough

With these frequent hot & cold fits through day.

And often considerable sweatings during night & in morning.

Often also distressed with severe Diarrhoea

To this to be added that pulse uniformly quick.

Never observed under 85 in minute.

Sometimes at 130.

Had farther indication of Phthisis in peculiar cleanness of Tongue.

And, in conjunction with other symptoms, continuation of tolerable appetite, also in favour of that disease.

But perhaps might be considered as still stronger circumstance that disease in some degree hereditary with him.

For his mother we are told died of that affection.

Upon whole then, from all circumstances taken together, not only conclude this to be Phthisis, but even consider it as far advanced.

And may at least venture to assert, that in many instances, after much longer continuation, disease less distinctly marked.

With this idea of nature of affection, opinion of termination could not be favourable.

For in great majority of instances, notwithstanding utmost efforts of art, Phthisis proves fatal.

And from continuation of colliquative sweats & diarrhoea, had here reason to apprehend, that patient would soon fall victim to affection.

This so much case that thought very little to be done but to obviate symptoms.

And thus render patient at least somewhat easier.

Of different symptoms when came first under care most urgent was looseness.

And with view of obviating this, for my own part know nothing equally efficacious with Opium

While at same time that diminished increased discharge also takes off, both gripes & tenesmus.

To employment however in present case one circumstance in pectoral complaint, occurred as an objection.

As diminishing frequency of cough indeed nothing more powerful.

Successfully allays this, as well as other inordinate actions.

But here, cough, at times at least, attended with copious viscid expectoration.

And no doubt that in such cases, greatest distress from accumulation.

Hence then previous to employment of opium, here thought it necessary, to unload breast, by free expectoration.

And with this intention premised to use of Pill Thebaic a dose of Ipecacuanha.

In obviating operation of this not disappointed.

And under subsequent use of pills, looseness at least somewhat diminished

Still however cough continued to be very distressing to him.

And with great quickness of pulse, though morning sweats rather [diminished] yet upon whole still very considerable.

In this situation, while directed continuation of pills, for looseness, thought it advisable also, to do something for cough & sweatings.

And thought that at least some chance of alleviation from Mucilaginous Julep, with diluted Vitriol acid.

But since this prescribed, have seen nothing more of patient.

Hence may at least conclude that has not given it fair trial.

But had that been case, still I own, had by no means high expectation from it.

What circumstance, led him to give up attendance, do not know.

But confess suspect it may at least in part have arisen, from progress of disease, & inability to attend.

But whatever cause renders any farther observation unnecessary.