DEP/DUA/1/42/31 (Normalised version)

John Logan

(1787-1788)

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John Logan at 25.

In history of this patients case symptoms of different diseases.

But of these affection of hearing never so considerable as to become an object of attention.

Is therefore of pneumonic affection only that now intend to say anything.

And this also as will observe from our register¹ has already come to successful termination.

From this strong evidence afforded of opinion formerly given respecting case

That viz. merely a catarrhal affection.

Then indeed observed that some grounds of suspicion of Phthisis

For Phthisis at commencement often merely cough & pain of breast

Frequently for considerable time without any hectic fever.

Or at least without any other symptom of it than quickness of pulse.

And with our patient pulse you will observe nearly at 100.

Also additional grounds for suspicion of Phthisis from age of patient.

Was at that period of life when Phthisis most common.

But then also patients by no mean [illegible] from catarrh.

And with this at commencement in particular a degree of fever very common.

Was in favour of that supposition that patient here affected with no great loss of flesh.

For in Phthisis remarkable wasting of body a very constant symptom

And in general takes place even to greater degree than loss of strength.

Besides not that appearance of eye or tongue which common in Phthisis.

For while former [deprived] of all red vessels in [conjunction] latter in general acquires remarkable redness particularly at point.

And while these common appearances of Phthisis absent none present which are not strictly catarrh.

Hence led to conclude it an example of that affection.

Catarrh a very common disease often seen under two different forms.

viz its acute or its chronic state.

Former distinguished in some [measure] by period of duration.

Still more by some degree of febrile affection.

But most of all from not being attended with copious expectoration.

For at this period rather irritable than augmented secretion.

On these grounds then conclude present case to be of this kind.

But at same time, some appearance of its verging to chronic state.

Especially in cough occurring with uncommon severity at particular hour in the morning.

For this sometimes happening sooner sometimes later in morning one of most common occurrences in chronic catarrh.

And is as it were necessary consequence of mucus accumulated & acquiring viscidity during night.

Here however though thus [severe] periodic cough yet without that expectoration which in such a case should have expected.

And without the constant Dyspnoea the attendant of Chronic catarrh.

Hence expressed hope that might be able to remove affection without its degenerating into that state.

And this hope, event of case has now confirmed.

How far, favourable conclusion which has now taken place, effect of practices here employed, cannot positively pretend to say.

But am inclined to think that in this way had at least some influence.

In acute catarrh is sometimes necessary to take off inflammation, by bloodletting & other evacuants.

Sometimes to remove irritation, by demulcents.

But in present instance did not seem particularly necessary to aim at accomplishment of either of these objectives

What here seemed principally necessary was to discharge viscid matter already secreted acting as cause of irritation

And to prevent farther secretion by giving determination from lungs to other parts.

Was then with these intentions that remedies here employed were directed.

Began practice by prescribing for this patient the use of an Emetic.

An article from which in different modifications of catarrh often very great advantage.

And while of highest utility in chronic state often also beneficial in acute.

As an emetic have had recourse to Ipecacuanha

An article from which as already observed am inclined to think that full vomiting more readily obtained than from any other

From full vomiting here however very great advantage.

Not indeed that is particularly necessary to evacuate the stomach.

But as more [completely] evacuating lungs than perhaps any other remedy with which are acquainted.

For of all expectorants, excepting coughing the action of vomiting may be [considered] as most powerful.

And often even succeeds when cough for a long time exercised in vain.

Of this a remarkable example in instances of Pertussis.

And often also in other obstinate coughs where fit necessarily terminated by supervening vomiting.

Here cough of our patient of that kind, in which, on this principle from vomiting benefit might be expected.

For told that upon awaking from sleep, would often cough for upwards of quarter of hour without interruption.

A consequence in all probability of irritation induced by mucus thus accumulated.

And at same time, of viscid being such that not easily discharged.

But emetic besides being [thus] [illegible] often advantageous also as promotes discharge by surface.

For from free circulation on surface & free discharge there can be no doubt that catarrh, alleviated

Is from this circumstance that much less frequently a disease of warm than of cold climates.

Is from this that change of climate or passing winter where temperature moderate often of great benefit in relieving it

And from this that to account for benefit of wearing flannel shirt next the skin, or similar warm clothing.

Is indeed true that determination to surface produced by Emetic not permanent.

But no doubt that during action of vomit, at least gives very powerful determination there.

And cannot be questioned that circulating fluids pushed even to extreme vessels.

This abundantly apparent both from flushing of surface & even from sweating induced.

Hence little doubt, that circulation often renewed through vessels before [obstruction].

And by this means, opportunity afforded for its being afterwards continued.

Hence Emetic often advantageously paves way for introduction of other practices.

Or for powers of system itself afterwards supporting equable [circulation] on surface

While with these intentions ordered an Emetic directed also use of Pulveris Cream Tartar composite.

An article consisting of equal parts of Cream of Tartar & Flowers of Sulphur.

In this need hardly observe that powers of a refrigerant cathartic & gentle diuretic are united.

Nor need I add that from both in such cases very great advantage.

Certain that in febrile state of Catarrh nothing tends to aggravate affection more than bound belly.

And that in chronic, patient very generally easiest, when belly loose.

A consequence very naturally resulting from determination to intestinal canal [diminishing] that to lungs.

And thus diminishing secretion.

But if this effect from gentle cathartic still more from diuresis.

In what manner indeed this change of determination should have greater influence hard to say.

Perhaps in some degree effect of particular matter thrown off.

For certain that kidneys afford chief outlet for saline matter

And that this saline matter in cases of catarrh often highly impregnable mucus.

Of this incontestable proof not only from acrid taste, but from excoriation of lips & other parts.

By free discharge of urine then mucus secreted may be rendered less irritating.

But whatever explanation may be, no doubt that from increase of discharge of urine in such cases often great relief.

Was on these grounds then that expected benefit from medicine here directed.

In operation of Emetic were not disappointed.

And am inclined to look upon it as consequence of this that for some days cough considerably easier.

In operation of the powder our expectation not equally answered.

For although gently moved belly yet had no obvious affect as diuretic.

A circumstance not to be wondered at when consider uncertainty of operation of whole class.

Under use had recurrence of cough with as great severity as before.

And now attended even with more copious expectoration.

From relief formerly experienced from Emetic was again naturally led to repetition.

And hoped that by persisting in Cream of Tartar might at length be product of full effect.

For not unfrequently happens that articles failing at first to operate as diuretics, have yet that effect from continuation.

Is particularly case with those combining cathartic & diuretic power.

And with none more than Cream of Tartar.

Here however cannot pretend to say that this was case.

For on continuation of use no more effect than formerly.

But operation of Emetic not less advantageous than before.

For while induced brisk vomiting also followed by remarkable relief from cough

A circumstance affording additional proof that advantage before obtained to be attributed to same cause.

At succeeding report found patient almost entirely free from cough & other symptoms.

Hence considering farther attendance as unnecessary dismissed him

But at same time cannot with any confidence speak of permanency of recovery

For at this season of year very liable to recur.

And indeed, with those obliged to work for bread hardly possible to avoid cause.

Must also add that if disease does recur would by no means be astonished to see it assume different form.

And notwithstanding what have said could consider it as in no degree surprising or uncommon if patient yet fell victim to Phthisis

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.