DEP/DUA/1/41/16 (Normalised version)

John Sutherland

1787

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John Sutherland March 3^d. 1787.

In case of this patient a very distinctly marked instance of Phthisis Pulmonalis.

An affection of which in present course have already oftener than once had occasion to treat.

Particularly in cases of Elizabeth Jardine & Peggy Hislop.

Formerly observed however that [considered] as affording modification of disease different from both these.

For state of purulency in lungs giving hectic fever, & therefore [strictly] Phthisis admits of different cause.

In particular comprehend I think three different species which though not always yet often readily distinguished from each other.

Catarrhal Tuberculous & Ulcerous

Of first an example in case of Jardine.

Of second in that of Hislop.

While consider present case as example of ulcerous.

For that here vomica of considerable size in lungs may be inferred from various circumstances.

Rendered probable by origin, a copious spitting of blood in general prelude to considerable ulceration.

By fixed pain of breast.

But above all by copious expectoration of a matter evidently purulent.

This species of Phthisis considered as in point of danger intermitting between other two.

Less so that tuberculous more than catarrhal.

At same time no modification of Phthisis without imminent danger.

And particularly to be apprehended while hectic fever so acute as in present instance.

Accordingly now promises worse than either of others.

For while one already dismissed other has had considerable alleviation of symptoms.

And reason to hope that for present at least may get better of affection.

But of this little ground for expectation in case before us.

For disease has made such progress & loss of strength such that has not been able to attend us for some time past.

And much I think to be dreaded that this progression will continue till fatal conclusion takes place

In treatment of this case had recourse to same remedy employed in other two

Use viz of Gum Myrrh.

And in instances of ulcerous phthisis have I think observed more benefit from it, than any other.

This however cannot say of present.

For while in two other instances apparent benefit there no good effect.

From severity of cough, dyspnoea & pain of breast soon led to application of blister

And to convert this blister into an issue.

But notwithstanding both, affection continued to be aggravated.

And from severe colliquative diarrhoea supervening soon led entirely to [directing] use of Myrrh.

And now I own but little prospect of returning to this or any other mode of cure, from which much prospect of success.

Probably chiefly attention employed merely in attempting to obviate some symptoms.

Is with this view that have directed Infusion Japonica combined with a proportion of Tincture Thebaic.

One of most useful articles with which am acquainted as checking diarrhoea.

And accordingly in present instance seems to have had good effect.

At least were at last report informed that looseness considerably [moderated].

Still however all more alarming symptoms continued as before.

And this mitigation probably merely temporary.

Hence have directed continuation.

To what other practices may here think it necessary to have recourse will very much depend on circumstances for the time.

If however sufficient strength to admit of it, may here try a practice of late highly recommended in [Pharmacy]

I mean exercise or rather motion given by swinging.

For introduction of this are indebted to Dr Carmichael Smyth of London Physician to Middlesex Hospital.

Has lately published treatise [professedly] on this subject¹ & has done me the honour to send me a copy of it.

In this treatise fourteen different cases are related, all of which Dr Carmichael considered as decided examples of Phthisis

In 13 of these during this practice patients got well.

And in 14^th though disease in end fatal, yet swinging seemed product of good effects.

To this practice Dr Carmichael led from analogy to motion in sailing.

For whole benefit derived from sailing is he thinks to be ascribed to motion.

Endeavoured even to show that sea air is pernicious.

Motion, that is [where] merely quick passage through air, he [considers] as having very different effect from all exercise.

That is from all cases where exertion of voluntary muscles.

Contends while one stimuli quick pulse, the other sedative diminishing its velocity.

And this he holds to be of great advantage in Phthisis.

Respecting his theory here out of place to enter into any inquiry.

With regard to his facts, can place greatest confidence both in his integrity & in his accuracy.

But must at same time confess that my faith somewhat [staggered] from greatness of success.

For no idea that any species of motion whatever capable either of removing tubercle from lungs, of preventing termination in suppuration or of curing that suppuration when has taken place

At same time cannot help considering it as mode of cure which in this, & also in some other affections deserves at least fair trial.

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Explanatory notes:

1) James Carmichael Smyth, An account of the effects of swinging, employed as a remedy in the pulmonary consumption and hectic fever (1787).