DEP/DUA/1/41/34 (Normalised version)

Thomas Aitken

(1786-1787)

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Thomas Aitken

Of this case after what said of former now unnecessary to add much

For here also a manifest example of catarrh.

But in this instance much more distinctly marked of chronic kind.

For here no symptoms of febrile nature

Disease had already continued not for few days, but even for several months.

And what served to mark it still more distinctly, for several winters past had regularly been subjected to it during cold weather.

Thus not only manifest example of Chronic catarrh but of that occurring as periodic disease.

These circumstances might upon whole be considered as unfavourable.

But at same time nothing in his case portending at least imminent danger.

For although of long continuation, yet had not much exhausted vigour.

In former seasons on appearance of warm weather, had spontaneously disappeared.

And although on this occasion more severe than formerly observed yet even when came under our care had marked it, as being rather on decline.

Had therefore reason to hope that even without interposition of art, would of itself soon decline.

At least if weather favourable.

For on this, as already had occasion to observe more than any other circumstance, recovery from catarrhal affection depends

And even where apparently recovered, on slightest change of weather, aggravation of affection.

In treatment of this case, considering both cough & dyspnoea as effect of mucus deposited in breast, first objective to unload it.

And was for this purpose that directed an emetic to be repeated at interval of few days.

For of all expectorants emetics most immediate, & most powerful.

Besides this considered effective also as renewing circulation on surface.

And thus giving chance at least of change in balance.

Thus in some degree product of benefit of warm weather.

Or at least as paving way for its influence.

Cannot however say that in these particulars expectations here answered.

May indeed have had effect of unloading breast.

And of this presumption, both from having operated well, & likewise from finding that at succeeding report less affected with Dyspnoea.

Now also little discharged by expectoration.

Which might also consider as consequence of their being little, to discharge

But cough even rather more severe than before.

A proof that still some irritation at lungs.

And probably still tendency to [augment] secretion

In this situation, had recourse to Vinum Nicotiana.

Which hold to be one of best forms for exhibiting this article.

As by vinous menstruum both saline & oily parts most readily [extracted]

And highly probable that both very considerable influence on system.

Nicotiana long known to possess very active powers.

And long in some degree [used] in medicine.

But not hitherto perhaps so extensively as it deserves.

Of late however has become more common.

And for its introduction are indebted to that very accurate practitioner Dr Fowler.

Particularly has pointed out its strong powers as a diuretic.

This indeed not an effect uniformly resulting from use.

Nor indeed certainly arising from any one medicine whatever.

Even [illegible] in some cases entirely discharged by other [illegible].

And this uncertainty not surprising when consider situation of organ.

For so placed as to be very much out reach.

While however no diuretic [certain] yet undeniable that often [considerably] different from Nicotiana.

And while reason to presume, that narcotic powers effect of oil which it contains am inclined to conjecture, that diuretic effect from saline [impregnation]

This however I throw out merely as conjecture.

But may at same time add, that may admit of being determined by experience.

And am not without hopes that the Harveian Society¹ having proposed Nicotiana as subject of prize dissertation for 1788, may perhaps in some degree lead to useful investigation of that question.

But whether diuretic powers from resinous part or not certain that oil highly narcotic.

This apparent from accurate experiments of the Albe Fontana.

For according to his trials, with some animals at least, even by slight application as by small quantity on toothpick to wound on breast of pigeon, most remarkable affect of nervous system produced.

And what he has done, points out a variety of future trials by which circumstances of importance may be determined.

Among others whether diuretic power in any degree effect of oil or not, a circumstance well deserving to be ascribed.

From diuretic power which certainly does possess first employed in dropsical cases.

And from advantage derived from other diuretics in chronic catarrh as well as in dropsy was but natural to employ it in that affection.

And here besides diuresis reason to hope that might also be useful even by narcotic power.

As taking off or at least diminishing affects of irritation in exciting cough.

But on whatever principle may operate have no doubt that in such cases often highly beneficial.

And this am well convinced have often found in my own practice.

Here directed Vinum Nicotiana to extent of [gt.] XX ter de die.

This consider as moderate dose for beginning use.

And appears that with our patient at least could not have been [borne] to greater extent.

For as at first taken especially with empty stomach in morning, excited vomiting.

But not to such extent as to lead to discontinue use.

In effect however of obtaining diuretic expectoration were not answered.

For was not at least sensible of any considerable discharge.

But whether effect of drops or not felt breast considerably relieved

From this then naturally led to continue.

But after persisting in use for another week still found that cough frequent.

And that no more diuretic effect observed than before.

From this led to try conjoining with another diuretic.

And while directed continuation as before ordered also ten grains of Squill pill at bed time.

Still however no obvious change on quantity of urine.

An evident proof that with him augmented discharge by kidney not easily effected.

But at same time now so far free from cough, while in other respects in good health that reckoned farther attendance unnecessary.

When thus discharged however can hardly with and confidence say that favourable change on his disease, effect of medicine employed.

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Explanatory notes:

1) The Harveian Society was founded 12th April 1782. The idea came from Andrew Duncan senior who had also been behind the setting up of the Aesculapian Club and the Edinburgh Medico-Chirurgical Society.  Duncan envisioned a larger club than the restricted Aesculapian to take over the running of the prize essay competition which had started in 1777 and to run an annual festival to commemorate renowned medical figures.