DEP/DUA/1/41/22 (Normalised version)

Kath Sutherland

(1786-1787)

---

Kath Sutherland March 24

One of many instances of pulmonary affections which have had occasion to treat during present course.

But still at least appears under different form.

For while in these examples of different modifications of Phthisis have only what will probably [land] in Phthisis.

And in present state to be considered as complication of Haemoptysis & Catarrh.

Evidently here a considerable haemorrhage from lungs as apparent from state of expectoration.

For when came under our care coughed up blood daily to extent of three or four ounces

Could not however be considered as a haemorrhage of active kind.

For discharge only in consequence of severe cough.

Was not, on other hand that very slight haemorrhage arising from diseased state of lungs.

Such for example as slight tinge of blood, occurring in tubercle.

For that in general accompanied merely with tussicula, or slight efforts to cough.

Consider instances, such as present as being less dangerous than either of these.

For on cessation of cough may expect also termination of Haemorrhage.

And accordingly had subsisted with this patient, for more than 12 months before came under our care

At same time even from continuing for this length of time grounds for alarm.

For reason to fear that diseased state induced in lungs.

And no doubt that haemorrhage & cough would tend mutually to support each other.

Hence I own apprehension is, that notwithstanding anything we can do, affection of this patient will terminate in Phthisis.

And particularly if continues in present occupation, by which much exposed both to exertion & cold.

From these more mischief than any good from all practices we can direct.

Or at least if from these remission at any time obtained will soon again be thrown into former state by accidental [means]

And this accordingly appears to have been already case since came under our care

Began treatment by directing for patient a mixture consisting of equal parts of Cream of Tartar & Gum Arabic united with proportion of Nitre.

This need hardly observe intended to operate as refrigerant & demulcent.

Did not here as already said consider haemorrhage as of active kind.

And both continuation of disease & state of pulse objections to blood letting.

But conclude that by diminished impetus of circulation tendency to haemorrhage would be less.

And that from employment of demulcent taking off irritation less frequent repetition of that action by which immediately excited

In these [efforts] not altogether disappointed.

From first doses indeed some sickness & vomiting.

Consequences neither expected nor wished for

But after continuing for some time haemorrhage ceased.

But though this the case still both cough & pain of breast severe.

And unless mitigation of these every reason to dread that haemorrhage would return.

From this therefore led to direct application of blister to breast.

And with view of continuing [determination] from lungs to support discharge by means of issue ointment.

Effects of this practice seemed so far favourable.

For while continued free from any return of Haemoptysis cough also mitigated.

This however when consider length of time for which disease had already continued reason rather for persisting in use of medicines than relinquish them.

Directed therefore that both powder & issue should be continued.

Patient however probably of different opinion.

And while hoped that disease overcome, was unwilling to continue a practice so painful as an issue.

Which particularly distressing to those obliged to work.

And accordingly both healed up this & gave over powder.

But consequence was that in no long time severe return of Haemoptysis

Which while probably in part the consequence of want of medicine, no less of exposure to cold.

Hence not surprising that did not immediately yield to repetition of [former] medicine.

And indeed could hardly expect her to be free from haemoptysis while cough very severe.

With view to mitigation of this, when directed continuation of issue and refrigerant powder [advised] also a mucilaginous [mixture]

And with view to sedative & astringent effect added to it proportion of Thebaic Tincture & [weak] Vitriolic Acid.

Under use of these medicines bloody expectoration has again ceased & at least some slight mitigation of cough

And again from unease & inconvenience arising from issue has allowed it to dry up.

This second remission must own hardly expect that will be more permanent than first.

In present situation difficult or rather impossible for her to avoid accidental exposure to cold.

And from every aggravation of cough, immediate danger of renewal of haemorrhage.

By continuing remedy however already [directed] may I hope at least be mitigated.

And if cough continues severe may still mitigate by increasing opiate.

But at same time as already observed think principal chance of recovery from leaving situation which must expose to renewal.

And going to country where can enjoy [free] air, gentle exercise & milk diet