DEP/DUA/1/39/36 (Normalised version)

Charles Riddell

(1785-1786)

---

Charles Riddell April 15.

Formerly pronounced case an instance of Phthisis.

And that consequence of Vomica [illegible] Haemoptysis

During course of attendance have had no reason to alter opinion.

On contrary every circumstance which has since occurred not only confirmed idea of disease but also of prognosis.

That viz affection in end will prove fatal.

Here indeed would not consider all chance of recovery as [precluded].

For even in worst cases recovery sometimes takes place.

And do not consider present as being equally dangerous with the tuberculous kind.

But on other hand even [slightest] [where] disease distinctly marked always highly dangerous.

And utmost that can say is that not altogether incurable.

Even in few instances in which this happens however much more by operation of nature than of art.

And in present instance saw no [mark] of this.

On contrary during course of patients attendance here affection constantly increased.

And if formerly apprehensive of fatal conclusion now reason to be still more so.

After having already spoken during present course of several other instances of Phthisis need not now resume any general remarks.

And in this case, so little benefit from medicine that few remarks with regard to these will be sufficient.

When came first under our care had but short time before been subjected to Haemoptysis.

And from hardness of pulse had reason to suspect there still remained disposition to return

In this situation might perhaps as means of prevention, had recourse with advantage to small bleeding.

But to this, debilitated state of patient exhausted by complaint occurred as objection.

And indeed must confess have often been disposed to think, that in such situations bleeding pushed too far.

And at that time too, patient at least free from pain of side.

Resolved therefore at least to reserve it till should be more strongly [indicated]

And to attempt rather diminishment of impetus & prevention of return, by gently refrigerant cathartic.

For this purpose directed combination of Nitre, with Cream of Tartar.

Need hardly observe that these every day used, in such cases, & not unfrequently with considerable advantage.

And where, with diminishment of heat, have affect also of gently opening belly principle of operation obvious.

Here however though taken to considerable extent not attended with that consequence.

For belly still rather bound than otherwise

Was however unwilling to push them to such extent, as to induce any [consequential] looseness.

Thought it sufficient therefore, merely to direct continuation.

But at this time, another circumstance requiring, more attention, viz severe cough.

From continuation, had reason to fear, that fresh rupture would be induced.

As means therefore of relieving it, had recourse to application of blisters.

And to obtain more permanent determination from lungs, directed that discharge should be supported, from blistered part, under form of issue.

But although not disappointed in obvious operation, yet not attended, with desired affect on cough

And was even subjected to some slight return of Haemoptysis.

This however, consider as entirely of passive kind.

And as means of alleviating tendency to inordinate action, resolved to have recourse to Laudanum.

Here however exception from [great] disposition which patient had, to very profuse & exhausting sweats.

To prevent bad affect, in this way, thought of conjoining, it with vitriolic acid.

From which imagined also some benefit might be obtained in preventing farther haemorrhage, from influence as astringent.

These then reasons which led me to prescribe for patient, a Mucilaginous mixture with portion of Spirit Vitriol ten, & Tincture Thebaic.

When first began this mixture thought that diminished both sweating & cough.

While at same time belly at least kept regular during use of powders.

Continued also free from pain of side.

But from issue, had so much unease that obliged to heal it up.

Under other medicine, continued for space of some weeks.

But during that time, had again frequent returns, both of severe cough, & sweating.

And almost daily, lost both flesh & strength.

In this situation was not displeased to find that was his own wish & intention to return to his natural country of Zetland by sea.

Accordingly dismissed from attendance here with view to his departure.

And if anything of service to him may expect it from Sea voyage Country air & milk diet.

Yet reckon it probable that will have ordinary termination of Phthisis. Death