DEP/DUA/1/40/46 (Normalised version)

Elizabeth Jardine

1786

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No5 Elizabeth Jardine 9^th December 1786.

In symptoms many particulars highly alarming.

If not certain at least strong suspicion of Phthisis

Has chief symptoms cough dyspnoea & pain of breast.

These it is true in common to Phthisis with Catarrh.

But here many symptoms generally attendant of former seldom of latter affection.

Loss of strength & faintness.

Hot fits & flushing with headaches.

Profuse sweatings particularly in morning.

Remarkable quickness of pulse.

Here then characteristic both of pneumonia affection & hectic fever.

In general not even occurring in incipient state

But taking place only after disease farther advanced.

And considered as decidedly marked affection.

This judgement corroborated also by age.

Is at period when Phthisis most frequent.

Corroborated also by shape & appearance.

Light hair & eyes. Tall & delicate make.

Presumption also from family disposition.

For brother we are told died of Phthisis.

Presumption even of infection.

For attended brother at time of death.

Idea [indeed] of disease being [induced] by infection one with regard to which doubts.

And has I believe often origin from two of same family falling victim.

Where in both effects of hereditary or perhaps rather scrofula taint

But several [practitioners] of accurate observation who hold Phthisis to be contagious.

And particularly often communicated from husband to wife or contrary.

And that where in latter neither family disease, nor any other cause to induce it.

Of late in own practice some observations corroborating this opinion.

Gentleman of fortune in neighbourhood at present abroad whose wife died of Phthisis.

In what manner infection does take place cannot pretend to say.

But no less inclined to deny it than [former]

Not impossible that from habit of [breathing].

Not impossible that from sweat [absorbed] where sleeps with [one] labouring under disease.

Shall only say that if infectious, this cause may have operated in present instance.

But where cause or not from symptoms disease sufficiently marked.

Phthisis however of different kinds.

In practical course these modifications Catarrh. Ulcerous. Tuberculous.

Differ both in degree of danger & mode of treatment.

Into particular history of each cannot enter

But formerly gave it as opinion & still think an example of least danger.

That case viz of Catarrhal Phthisis.

To this lead from copious expectoration want of fixed pain & lying with equal ease on both sides.

In tuberculous cough from irritation which tubercule gives.

Hence of what called dry kind.

In ulcer constant fixed pain [whence] large vomica seated.

And patient can lie only on affected side requiring free motion of other for respiration.

Here then marks peculiar to both these wanting.

While copious expectoration of matter principally at least mucous.

A circumstance always case when purulent matter from surface of lung.

And [constant] discharge from thence as from inflamed surface produced by blister converted into issue.

From these considerations then conclude it case of Catarrhal Phthisis.

And on this ground, prognosis more favourable than if either of other species.

For no doubt that of all these this least dangerous.

Or rather admits of most frequent recovery.

Some indeed hold that Phthisis in every instance fatal.

Contend that where recovery catarrh merely mistaken for Phthisis

But see no reason whatever for adopting this opinion.

Phthisis indeed a very insidious affection.

And in many cases for considerable period diagnosis between catarrh & Phthisis very difficult.

Nay in all probability has made very considerable progress before distinctly marked.

But when distinctly marked no reason to infer that merely Catarrh.

For these, all same symptoms, as in progress to fatal termination.

And such recovery where even every reason to conclude that Phthisis of [tuberculous].

Nay even where at after period patient falls victim to it.

Probably from inflammation & suppuration of future tubercules.

From this however mean only to infer that not to be considered as altogether an irrecoverable disease

And at least, most ground for hopes in catarrhal.

But every instance of Phthisis highly dangerous.

Present not only distinctly marked but far advanced.

Before came under our care had subsisted for twelve months

During that time gradually increased.

On these grounds then express apprehension of fatal conclusion

And still I own of same opinion.

Yet since came under care appearance somewhat flattering.

At least less alarming than at that time.

And she herself now sanguine hope of speedy recovery.

For not only diminishment of cough & spitting but considerable recovery, both of strength & [appetite].

While at same time, one great cause of exhaustion colliquative morning sweats have almost entirely left her.

These favourable appearances however I must own consider as being only deceitful.

For not uncommon to have in Phthisis temporary remission.

And this am afraid will prove to be case in present instance.

At same time present appearance [illegible] after uniform progress for worse at least a desirable occurrence.

And if no other benefit gives better opportunity for trial.

Perhaps even some proof of good effect from practices already employed.

But before speaking of [particular] practices may not be improper to state general principles on which here chiefly [expect] cure

Suppuration separating entirely from surface

Hence chief objective.

1. Alteration in state of separation

2. Restoration of natural condition to superficial vessels.

With these intentions success.

To diminishing impetus of circulation both in system in general & lungs in particular.

And to give such condition to vessels that state of action may be altered.

But besides this necessary also to [support] exhausted & debilitated system.

And to obviate such other urgent [symptoms] as occur.

On these grounds some explanation of common practices.

Particularly use of bloodletting. Refrigerant blisters, demulcents, milk diet change of climate etc.

And from these in some instances at least recovery.

Yet all frequently employed without success

At same time often at least aid [operation] of others.

Here you will observe different remedies.

At loss to say in what manner operate.

Directed Pulveris Gum Myrrh. composite.

Consisting of p. ae. Myrrh & Cream Tartar

This have now for good many years employed

And deceived if not frequently with advantage.

At one period this as well as other vegetable balsams in frequent use.

But all fell into disrepute.

By best practitioners entirely rejected.

[Passage] by Dr Foster. London Medical Observations

But since that Gum Myrrh introduced by other practitioners.

And even more used than ever.

For most particular account Dr Simmons.

Especially records use at Guys Hospital

Employed in some 100 of cases with advantage.

Sometimes given purely by itself.

Sometimes united with [Sal.] Chalybeate.

But oftener with some refrigerant as Nitre.

In formula somewhat directed by state of belly.

Where tendency to looseness rarely fails to increase it

Hence not unfrequently conjoined with opiates or astringents as Gum Kino.

Where tendency to bound belly with Cathartic.

And none preferable to Cream of Tartar.

Indeed consider formula here used as best.

Directed to extent of tea spoonful a day.

Each containing about grain X of Myrrh.

Considered as medium dose.

For larger effect either in giving uneasiness at stomach or moving belly.

From this quantity more regular [continuation] & thus more benefit.

Soon after begin use some diminishment of cough.

And after longer continuation all symptoms much mitigated.

While cough easier [appetite] also increased.

And not wonderful that with this [diminishment] of weakness.

Became also less affected with morning sweats

And pulse from above 140, under 100.

That these changes altogether effect of medicine will not positively affirm.

Yet somewhat probable as here [occurred] [during] use

And as besides authority of others have myself observed good effects in other cases.

Must however own that few [which] so considerable in so short time

And where no [share] to be attributed to any other practice.

For this only medicine directed.

Supposing thus beneficial would not readily think either of change or addition.

Hence intention merely to persist in employment.

And shall not be disposed to any other practice.

Even allowing however that sole cause of favourable change does not follow that will be permanent.

On accidental cold or similar circumstance may expect aggravation.

And notwithstanding present favourable appearance shall not be surprised if yet victim to disease.

If however on contrary uniform progress to recovery under Myrrh, shall not less consider present complaint of patient as distinctly marked case of Phthisis.

And even view it as already [experiencing] benefit from employment of Myrrh