DEP/DUA/1/40/50 (Normalised version)

James Scott

1786

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James Scott. December 16^th 1786.

Another case where suspicion of Phthisis.

Not so distinctly marked as Elizabeth Jardine.

But still sufficiently to give strong presumption.

Not indeed same marks of hectic fever.

Nor pulse uniformly quick.

Even slower than natural standing.

But at times cold fits alternating with heat.

And these followed by sweating.

Also lassitude & emaciation.

And to these superadded Cough Dyspnoea & pain of side, principal & common symptoms.

May add also appearance of tongue.

Not only clean but red towards point.

Almost universal attendant of purulent expectoration.

But above all profuse morning sweats.

These in every instance of [observing] cough alarming

Upon whole then strong presumption of Phthisis

At least many cases where long [exam] though less marked.

Cannot indeed say that certainly or decided marked.

For neither certain evidence of purulent [expectoration] nor hectic fever.

And hold those alone to be instances of Phthisis Pulmonalis where hectic fever from purulence of lungs.

But much more evidence both of one & other, than in majority of cases of such standing.

Hence stronger presumption of Phthisis than any other disease.

Supposing Phthisis next species.

Whether viz Catarrh Ulcer or Tuberculous.

This distinction of importance in practice.

And although not always easily determined yet of consequence where can.

In former case reason for supposing Catarrhal

Hence [different] species – think Ulcer.

This is vomica of considerable size.

To this led, not more from [absence] of symptoms of other [respects], than presence of those characterising this modification.

Did not begin under form of Catarrh

On contrary cough supervened only after some time.

Is not apparently of scrofulous habit.

And no reason to think hereditary.

These however if not pathognomonic [symptoms] at least common marks of Catarrh & Tuberculous.

While here again characteristics of ulcerous in fixed pain & considerable dyspnoea.

Cause also such as gives suspicion of this

Effect of accidental injury to breast from strong exertion.

Thought felt fail at time.

And though mistaken as to noise yet not improbable that some internal rupture.

And from such accident large vomica more frequent than from any other cause.

To these still another circumstance.

State of pulse.

In this [species] much more natural than other.

And by no means marked by same [quickness]

Probably as matter formed more ordinarily [mild] & bland pus.

Certain that less effect on circulation than ichor absorption.

Hence very acute heat in tuberculous cases

And hence long continuation without any hectic in some cases of ulcer.

For with discharge of pounds at time patient for years without any.

Indeed much case in ulceration at other parts where mild & bland pus without [feator].

But when change in appearance – bloody or ichor hectic very soon ensues.

State of pulse then among other particulars evidence of this species.

And upon whole inclined to look upon it as example of ulcerous Phthisis.

With this idea of disease no great hopes of recovery.

For great majority of instances of Phthisis fatal.

Can only say that less immediately dangerous than tuberculous.

And where in end fatal only so after long time

Some patients to certain degree at least subjected to it not for one or two merely but for 10 or 20 years.

Upon whole indeed more [dangerous] than catarrh.

Yet perhaps of longer duration which prove fatal.

For in catarrh in most instances either complete recovery or fatal conclusion in shorter time.

Hence often at least affords opportunity for fair trial of medicine.

And this may expect in present case of patient continuing attendance.

Hence different practices from former.

In that case trial of Gum Myrrh.

Might also have been used in present.

For in such often employed.

But wished first to give trial to Peruvian Bark & Vitriolic acid.

In this case as already said supposing ulceration of considerable size in lungs.

The healing of this must be entirely work of nature.

And case of [practice] to be chiefly employed in preventing & obviating symptoms

In this case as observed hectic fever at least moderate.

And no uncommon quickness of pulse.

This ascribed to pus of bland nature

Was with intention of [pres] [such] that employed bark.

While thought that might in some degree [form] adhesive inflammation.

Thus both preventing occurrence of more alarming symptoms, & promoting cure.

But besides this directed also Vitriolic Acid

This employed with view to astringent [power]

Chiefly meant for obviating a distressing symptom

Colliquative sweats to which patient subjected.

For to these chiefly attribute loss of [strength]

Infusion of Vitriolic acid in this way well known

And although inadequate for every case yet sometimes at least successful.

Never more so than in [simple] [state]

From taste however requires dilution.

And for this purpose added to Mucilaginous jul.

Under these medicines was intention to continue patient for some time.

And from last report in register¹, though no remarkable benefit yet no reason for deserting plan.

But for some time past has not attended

And probably may see nothing more of them

But if returns is intention to persist in plan, or rather to renew it.

At least unless affection then puts on different appearance.

In that case treatment [must] be accommodated to circumstance.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.