DEP/DUA/1/41/32 (Normalised version)

James Thomson

(1786-1787)

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James Thomson April 14^th

Of disease of this patient no room for doubt.

When came under our care formerly observed that was distinctly marked instance of Catarrh.

And in that state has since continued.

Catarrh however during whole progress often not with same symptoms.

And particularly beginning as febrile often degenerates into a chronic disease.

This degeneration particularly apt to take place at late periods of life.

And besides this chronic catarrh one of most frequent diseases of old people.

At least in our climate.

Hence has in general got name of Catarrhus senilis.

Are not however from this circumstance to pronounce every catarrh of old people to be of that kind.

For with oldest as well as young people may appear in [foreign] form.

To be distinguished therefore not by period of life but by symptoms.

And accordingly better distinguished by names of acute & chronic.

Indeed unless with those long habitual to catarrh seldom that does not begin in first & afterwards pass to second state.

This particularly apt to be case with those advanced in life.

And such a transition has I apprehend occurred in present instance even since patient came under our care

Or rather perhaps, during whole period, disease in what may be called intermittent state

For at that time could by no means be considered as in chronic condition.

Was then only of ten days standing.

And although patient considerably past 60^th year, yet had by no means been formerly subjected to catarrh.

Was then obvious consequence of exposure to cold.

A cause from which well known that this affection almost universally if not solely originating.

In so much that in common language passes by name of cold.

And indeed anyone who pays slightest attention to facts, cannot possibly entertain any doubt respecting it.

From period of duration then no doubt that still in recent state.

And that therefore could not [with] any propriety be styled chronic

But on other hand not marked with distinctive symptoms of febrile catarrh.

Pulse indeed considerably quicker than natural.

For with a man even at earlier period of life 98 above natural standing.

And had also impaired appetite & considerable thirst.

But was at least without febrile heat or anxiety.

And pain of breast & side, could not be considered as consequence of inflamed state.

For at least chiefly felt [severity] from violence of cough.

But to this still farther to be added that expectoration copious.

A circumstance rarely occurring during febrile condition of catarrh.

For then in general there takes place what called dry cough

And is always considered as mark of progress if not to recovery at least to different state when expectoration considerable.

Upon whole then in this condition of progress was affection when this patient came under care.

And during continuation here progress still farther marked.

For now, even symptoms with which formerly affected of febrile kind [entirely] gone.

While considerable secretion continues, matter to be expectorated more viscid.

Hence greater difficulty in discharge occasions more violent fits of coughing & greater dyspnoea from want of free discharge.

Now therefore no less reason than before, to express apprehension as to obstinacy of case.

With this patient tendency to augment separation at lungs seems now to have taken place.

And when this has once occurred well known that by no means an easy matter to remove it.

Or at least that renewal from slightest accidental exposure to cold, giving constriction of surface.

Hence cure more to be expected from change of weather than anything else.

And accordingly observed with many habitual to this disease, that disappearance during steady warm weather in summer season but [recurs] again from cold in winter.

In case of present patient then recovery hardly to be expected, during prevalence of chilling easterly winds.

For from these more effect in aggravating the disease, than benefits in removing it from any remedy that we can employ.

Imagined however that might at least do something towards alleviating affection.

And if progress to recovery not prevented by unfavourable weather, might promote & forward natural termination.

Was with this intention that here directed for him what we call composite powder of Cream of Tartar.

A formula consisting of equal parts of Cream of Tartar & Flower of [illegible].

Of this powder need hardly remark that one of most common consequences is that of moving belly.

For both articles well known to be gently laxative.

And indeed are among best & most common of gentle cathartics.

But besides this in Cream of Tartar also a powerful diuretic.

And well known that from promoting discharge in both ways benefit often obtained in this affection.

For necessary consequence is some derivation from lungs.

In this way in particular often remarkably aided by diuretics.

And indeed may readily conceive that should have nearly same influence as increase of perspiration from mild weather

For well known that discharge by kidneys & surface [illegible] compensate each other.

In [obvious] effects of this powder were not disappointed.

For from beginning operated both as gentle cathartic & diuretic.

And seemed also to have some good effect on cough

For this according to patients account somewhat alleviated.

From persisting in use these good consequences rather increased.

For cough became still easier

And I own was not dissatisfied to observe, that had still farther effect in moving belly.

For notwithstanding age of patient no reason to apprehend consequences of several loose stools.

Afterwards found however, that even continuation of this, did not prevent recurrence of affection.

For while still great quantity of matter discharged by expectoration, dyspnoea became more severe

Seemed in this situation necessary to do something with view of unloading breast.

And with this intention, prescribed an emetic, to be repeated at short intervals.

Emetic as expected, perhaps to be [considered] indeed, as operating on mechanical principle.

But of all expectorants little doubt that most immediate & most powerful.

Accordingly no article more suddenly beneficial in instances of chronic catarrh.

But besides more discharge from lungs probably also useful on other principles.

And particularly as giving determination to surface.

Here also imagine that might at least moderate looseness.

For this often affect both of increasing discharge by surface & of evacuation by stomach.

In obviating operation of vomits were not disappointed.

But cannot say that in other respects attended with desired consequences.

For while Dyspnoea still continues looseness also frequent.

And now began to think that pushed as far as strength of an old man would [permit]

Have directed therefore at least for time that powder should be omitted.

And if again employ it will be only occasionally if bound state of belly should occur.

In mean time have again ordered repetition of emetics.

And if these have not effect of relieving dyspnoea shall not expect this by vomiting.

May probably in that case have recourse to blister, converted into issue.

But in this, & other practices, will be regulated by state in which find patient.

And as already said, hardly expect much benefit till steady [illegible] weather.

And from this probably more than from anything we can do for him