DEP/DUA/1/43/14 (Normalised version)

Jean Robertson

(1787-1788)

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Jean Robertson. At 36. N^o18

Of case of this patient reckon it now necessary to say but little.

For can hardly be said to have been subject of practice here.

Has never returned since first prescription.

Shall merely therefore state in few words intention in view in practice proposed.

Will readily observe from history of case that subjected to complication of affections.

And matter of doubt how far these were to be considered as connected.

And also matter of doubt whether some particular sets were idiopathic or symptomatic.

[Two] however which considered as chiefly deserving attention were Pneumonic & Dyspeptic

To first were to be referred pain of side & breast, cough, dyspnoea & difficult expectoration of viscid mucus.

To the second distention of stomach cardialgia, nausea, vomiting, perhaps also headache, vertigo & even [ sup]

These therefore considered as first & principle objectives of attention.

Was with view to these that begun by directing for patient the use of an Emetic.

This I need hardly observe a very common practice both in Dyspeptic & Catarrhal affections.

For here consider pneumonic complaint of patient as entirely of Catarrhal kind.

In this affection most urgent symptoms of the disease immediate consequences of viscid mucus collecting in air vesicles of lungs.

Hence though permanent relief only to be expected from reducing secretion to natural standing, yet most immediate ease from discharging mucus already accumulated.

And nothing by which this purpose more effectively answered than Emetic.

For although cannot agree with those who consider actions of coughing & vomiting as only [expectorations] yet allow that are most powerful.

Accordingly where fruitless efforts to expectorate by coughing; vomiting often as it were spontaneously excited.

A remarkable example of its expectorant power in instances of pertussis.

And every day successfully used as producing large discharge of mucus.

But besides answering this purpose often also useful in catarrh on [another] ground

Well known that by action of vomiting very powerful determination given to surface.

And that circulation previously obstructed [thus] renewed through small vessels.

When thus renewed however often continued afterwards by powers of system itself.

And from free circulation on surface great benefit may be expected in Catarrh.

Is from producing this effect, that to account for benefit which those subjected to the disease derive from wearing flannel shirts

Is from this, that to explain benefits which derive from keeping house during winter.

And to this, are to ascribe advantage of passing winter in a steady & warm climate.

From free circulation on surface that at internal parts, particularly lungs often diminished.

And thus secretion restored to natural standing.

Hence with catarrhal patients different grounds on which benefits may be expected from emetics.

Accordingly not merely employed for a single time, but frequently repeated.

And as circumstances may require given at end of six, eight, or ten days with advantage.

But while thus useful in catarrh are also in Dyspepsia.

In that disease from slow & difficult digestion there naturally occurs [collection] of viscid mucus in stomach.

And from state of [fermentation] which goes on, collection of acid or of acrid & [putrescent] matter.

Hence relief derived [from] spontaneous vomiting, one indeed of most common symptoms of the disease.

Thus as well as in cases of catarrh naturally indicated in this affection.

And principal upon which they operate that viz of unloading stomach is very evident.

Here however much more than in catarrh benefit temporary merely.

And from frequent repetition even with this intention, have reason to [dread] [rather] bad consequences.

For no doubt that by action of vomiting tone of stomach weakened.

And of course all the symptoms of Dyspepsia augmented.

Accordingly have met with cases, in which I think have seen them manifestly prejudicial.

This however no objection to use for single time.

Nor even to repetition when symptoms urgent.

While however with these intentions directed the Emetic, had also recourse you will observe to another medicine.

A six ounce mixture viz consisting of equal parts of Bitter & Aromatic Tincture.

And to these directed that these should be added. Vinum Nicotiana ℥ i.

In two former, the bitter & aromatic Tinctures, have, need hardly observe what considered among best of stomach medicines.

And can be no doubt that often useful both as promoting digestion, expelling wind & strengthening tone of stomach.

Latter however Vinum Nicotiana meant with a view to Catarrh.

This article in that disease at [least] but lately introduced into practice.

For its introduction indebted to Dr Fowler of Stafford.

Has written a treatise [professedly] on subject medical reports on use of Tobacco ¹.

Has there from [number] facts demonstrated its diuretic power.

And accordingly recommend its employment in Dropsy Dysuria & other affections where these indicated.

Since that publication have myself [fully] employed it.

And from my own experience consider it as one of the best diuretics with which acquainted.

And am inclined to think that [employment] on this principle, to account for advantage from it in Catarrh of chronic kind.

An affection in which have often employed it with advantage.

Great objection to use is sickness which excites.

But as in case of Digitalis this probably not essential to Diuretic power.

And accordingly with view of counteracting it here conjoined it with Bitter & Aromatic Tincture.

But of effects have heard [nothing]

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Explanatory notes:

1) Thomas Fowler, Medical reports, of the effects of tobacco, principally with regard to its diuretic quality, in the cure of dropsies and dysuries (1785).