DEP/DUA/1/43/24 (Normalised version)

Alexander Ross

(1787-1788)

---

Alexander Ross at 31.

Formerly expressed doubts as to disease to which this patient subjected.

Could however consider it only as example either of Catarrh or Phthisis.

And when began treatment rather inclined to former of these opinions.

To this led from several different considerations. But particularly from long continuation of disease.

Had subsisted for five months without at least being distinctly marked as Phthisis.

From age of patient. Had passed 30^th year & consequently past common Consumptive period.

From cause to which attributed. Referred to cold & hard labour much more frequently cause of catarrh than Phthisis.

And lastly from regular severe attacks of coughing at all hours in morning.

An occurrence very common in catarrh while rare in Phthisis

And marking even chronic state of disease.

But notwithstanding all these particulars from what after saw of disease inclined to alter opinion.

From periodic attacks of shivering fits from loss of strength – From constant quickness of pulse – But above all From night sweats soon led to conclusion that disease really Phthisis.

And accordingly to alter opinion not more as to nature of affection than dangerous tendencies.

If furnishes therefore no other lesson is at least example of insidious nature of Phthisis.

Of this however was not [unavoidable] when last spoke of case

And accordingly then [illegible] that both in prognosis & practice danger of Phthisis to be had in view.

Began by directing for patient the use of an Emetic.

This both in instances of Catarrh & Phthisis a remedy of great use.

And accordingly very frequently employed. Cannot indeed do so much essential service in latter as in former affection.

But even in Phthisis of worst kind that is tubercule by some recommended as [illegible] of radical cure.

For my own part however cannot say that ever saw anything to [countenance] supposition of its producing resolution of tubercule.

But at least useful as mitigating cough for time & giving determination to surface.

Still more so in catarrh as unloading breast.

For little doubt that emetic the most powerful expectorant.

In expectation of benefit however in these ways altogether disappointed.

For Ipecacuanha though taken to quantity of ℈i did not operate as Emetic.

Produced merely several loose stools. An operation as cathartic a very common consequence of almost every emetic substance.

And among others of Ipecacuanha when given in small doses.

But perhaps more rarely than from any other emetic are disappointed in effects of exciting full vomit.

While [ordered] Emetic directed also simple mucilaginous mixture.

This likewise on idea either of catarrh or Phthisis equally applicable.

Could not indeed in either case expect much benefit from it.

And more fitted for catarrh in recent than in chronic state.

But in every case will at least have some effect in removing irritation at fauces.

And thus tends to mitigate frequency of cough.

Here however cannot say that in this way had much influence

For cough continued nearly as before Patient indeed thought that after use expectorated more freely than before.

This however could hardly [think] to be attributed to the medicine.

But state which disease now assumed, served to show that great secretion of mucus took place. Hence imagined that might be advantageous to diminish that secretion by giving determination to some other part.

This often accomplished by [increasing] [discharge] by kidney.

And to produce this effect had recourse to vinum nicotiana as a diuretic.

The introduction of Tobacco for this purpose but of late date.

[Indebted] to Dr Fowler.

Since his treatise¹ have frequently used it. In no complaint more useful than chronic catarrh.

Probably operates both as diuretic & sedative. For have found that even prior to increase of urine considerable effect in [illegible]

Cannot however say that in [either] way with present patient much benefit from it.

And under use belly became very bound.

This occurrence whether effect of medicine or not was necessary to obviate.

For no doubt that by bound state of belly pectoral complaints in general but particularly chronic catarrh much augmented.

Here as cathartic had recourse to an article from which also expected [some] diuretic affect.

I mean composite powder of Cream Tartar. This to extent of tea spoonful daily hoped might both have effect opening belly & aiding Nicotiana in producing diuresis.

For this also directed to be continued. In these expectations however were disappointed. And this probably in part at least effect of new occurrence of which [informed] at succeeding report.

His having very generally [vigorously] vomited his medicine.

This effect was I own disposed to attribute to mixture itself.

For with some very small proportions of Nicotiana has this effect

And when consider that even [scruple]² of Ipecacuanha had no influence shows how much variety in state of stomach as affected by different emetic substances.

While from this however led to discontinue former medicine, another occurrence still more alarming.

Profuse sweatings during night

From these conjoined with quickness of pulse loss of strength & other circumstances now inclined to adopt opinion of disease being Phthisis.

And accordingly while Nicotiana product of inconvenience little to be expected from continuation.

Omitting use therefore now ordered for patient another medicine more particularly [illegible] [illegible]

A powder viz consisting of equal parts of Gum Myrrh & Cream of Tartar

Of use of Gum Myrrh in Phthisis practitioners of late a good deal diverse in opinion.

While some extol use by others totally condemned.

And indeed this condemnation extended to whole of healing balsams as have been called among which Gum Myrrh may certainly be ranked.

Alleged that from all [circulation] [quickened] hectic paroxysms augmented.

This however attributed by others to [them] being used without any refrigerant conjoined.

But alleged that by such addition [incontinence] from action on stomach obviated while continually product of good effects in other respects.

Accordingly strong advise for use in Dr Saunders & Dr Griffith

But for most satisfying account yet published Dr Simmons

And from own experience inclined to think favourably of use.

Here therefore intent to have given fair trial

But since prescription nothing of patient. Desertion I am inclined to conject [consequence] of loss of strength & of progress of Phthisis.

But whether conjecture just or not prevented from any farther observations on [case]

---

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).

2) A unit of weight equal to 20 grains, used by apothecaries and physicians.