DEP/DUA/1/40/58 (Normalised version)

Peggy Hislop

(1786-1787)

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Peggy Hislop. January 13.

In this case as formerly observed strong indication of Phthisis.

Have common & constant symptoms of affection in Cough Dyspnoea Pain of breast & wasting of habit.

Presumption from these strong corroboration by quickness of pulse & other hectic Symptoms

Pulse 160 in minute.

If farther proof wanted afforded in colliquative sweats & bloody expectoration.

But even without these little [doubt]

And from all circumstances taken together not only evidence of Phthisis, but of bad tendency.

For although may have begun as catarrhal, yet has at least so far degenerated into ulcerated state

For of some considerable ulcer at least presumption from bloody expectoration.

Here I own inclined even to consider it as of wasting tendency.

As example viz of tuberculous Phthisis.

At least of this presumption from appearance.

For very much of fair & delicate look with which scrofula often connected.

And of this species farther presumption from acute nature of hectic fever with remarkable quickness of pulse.

But still more from evidence of its being hereditary.

Would here therefore conclude [that] Phthisis of tuberculous kind.

That one or more of these tubercules has already degenerated into state of Suppuration.

And that thus ulceration giving at times mixture of blood.

From these circumstances then naturally led to unfavourable prognosis.

For Phthisis in every instance a dangerous disease.

And particularly when of tuberculous kind.

Not indeed here of long standing.

But this when consider rapid progress rather unfavourable than otherwise.

Hence formerly opinion that in no long time would prove fatal.

And have seen nothing to lead me particularly to alter opinion.

But at same time during attendance here progress has not at least been so rapid.

Whether effect of medicine or not may perhaps be matter of doubt.

But before conjecture on this subject necessary to observe that Phthisis not only disease to which patient subjected.

Is affected also with deafness of one ear.

And from this discharge of suppuration [material].

A circumstance evidently pointing out cause of deafness.

And such suppuration not uncommon.

While state of inflammation product of great [p.]

But after suppuration formed in general little uneasiness

And often of no long continuation.

In most instances healing as readily without any application, as with it.

And nothing farther necessary than attention to cleanliness.

Frequently even rather inconvenience from application than otherwise.

Hence therefore here resolved not to have recourse to any, till found necessary.

And entirely to direct Practice view to Phthisis.

Resolved in this case also to make trial of Gum Myrrh.

A remedy of which already have had oftener than once occasion to speak

And may refer those who wish for more full account to Dr Simmons Essay¹.

Shall only observe that much deceived if in my own practice have not seen it attended with advantage.

Nay manifest example in case always treated during course of winter [ Elizabeth [Jardine]

When came under care very evident symptoms of Phthisis.

But during employment entirely ceased.

In so much that now dismissed from farther attendance.

And though may return yet cure at least for present.

As much as by sea voyage, change of climate, country air or like

For well known that where from these recovers even for year or two, patient will yet fall victim from recurrence of affection.

Hence then whatever future event, consider it as having there succeeded.

But in case of present patient cannot expect so much from it.

For circumstances much more unfavourable.

Consider it however at least deserving trial

And if succeeds strong proof of power.

Here directed Myrrh in composite powder

United to equal quantity of Cream Tartar.

Two scruples² twice a day.

But small quantity.

Often ℥p of Myrrh alone ter de die

But necessary to give with small doses.

For sometimes disagrees with stomach [Vomiting]

More frequently from action on intestines [causes] looseness.

Here evidence of propriety of small doses.

For even to small quantity effective in both ways.

Did not indeed produce vomiting.

But some sickness from morning dose.

An effect most apt to take place with empty stomach.

For then medicine least easily borne.

Accordingly every day taken with care after though cannot be retained [farther].

But while some sickness, still more effective from action on intestinal canal.

For there several loose stools.

A circumstance occurring as strong objection to increase of dose.

For any considerable looseness [surface] as exhausting patient.

And thus adding to debility induced by disease

Was however unwilling from this circumstance to discontinue trial.

Hence chose rather to attempt counteracting looseness than [desire] use of Myrrh.

For this purpose had recourse to Infusion Japonica.

Made by pouring boiling water on Succus Japonica.

In different proportions.

In general ℥i in ℥vi

Most elegant form.

As frees from every impurity.

May be united with Aromatic as Cassia of nutmeg on Infusion.

And [occasionally] with Laudanum in any [proportion]

Here [grain] 60 to ℥VI. 10 to ℥i.

This though not sufficient for alleviating severe pain or inducing sleep yet sufficient for moderate diarrhoea.

Especially as often very sudden [checking] to be avoided.

Accordingly have frequently found this mixture very useful.

Here effects at first not very considerable.

But at same time at least no increase of looseness.

And from continuation some diminishment.

Hence hope that by persisting in use might be entirely overcome.

While at same time opportunity afforded for regularly persisting in use of Myrrh.

Has now persisted in this course for space of month.

And looseness so far gone that at present farther continuation of Infusion Japonica [unnecessary]

Cannot however say that in other respects better.

Cough indeed at times more moderate.

And no appearance of bloody expectoration.

But still as frequent as even in worst Phthisis

Attended with that cleanness of [tongue] indicating purulent expectoration.

Still remarkable quickness of pulse indicating acute hectic.

And profuse colliquative sweats, reduced strength & wasting habit.

Hence hopes still as faint as formerly

But at least nothing to discourage from continuing trial.

Mean therefore to persist in giving fair trial.

Occasionally employing such articles as may be indicated for obviating particular symptoms.

Example Infusion Japonica repeated if return of Diarrhoea

Perhaps Vitriolic acid for week

But even these only when circumstances required

And objective will be to try Myrrh by itself as much as easily can

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Explanatory notes:

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

2) A unit of weight equal to 20 grains, used by apothecaries and physicians.