DEP/DUA/1/43/39 (Normalised version)

Donald Mathieson

(1787-1788)

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N31 Donald Mathieson at 34

Formerly observed that considered this patient as labouring under complication of affections.

And particularly that while subjected to dyspnoea affection to a very considerable degree, was at same time labouring under a disease much more alarming & dangerous viz Phthisis Pulmonalis.

Hence could entertain but very slight hopes of recovery.

For of all affections which object of practice very few more certainly fatal than Phthisis.

And what still more deplorable see patient as it were dying by inches when he himself no apprehension of danger.

But although conclusion of Phthisis generally fatal yet cannot be represented as universally so.

And in this as in other diseases danger in some degree connected with cause from [whence] originated

And particularly whether there exists tubercules in lungs, a large abscess, or mere separation of purulent matter from inflamed surface.

These may I think be distinguished from each other by titles of Tuberculous Ulcerous or Catarrhal Phthisis.

And of these as far as can speak comparatively, 1^st most dangerous last least so.

In case before us consider us as having example of middle kind or ulcerous.

Hence reason at least to hope that hectic fever less exquisite than if tuberculous.

This opinion of affection since patient came under care have had no reason to alter.

On contrary is I think confirmed both by progression of disease & by appearance which [has] since taken place.

Particularly the copious purulent expectoration as mentioned in report of 2^d of February.

But before this took place, symptoms by much most distressing to him were stomach ailments.

As these attended with much flatulence with view to free discharge downwards had recourse to Pill Foetid cum Aloe.

While with view to strengthening tone of stomach & thus alleviating nausea vomiting & cardialgia had recourse to a mixture with vegetable bitters & aromatic.

Soon after these medicines begun, his stomach ailment, particularly uneasiness from wind, very much diminished.

But an occurrence took place by which use soon interrupted.

During violence of cough in all probability a considerable vomica had burst in lungs.

And in consequence of this discharge took place of considerable quantity of purulent matter mixed with blood.

Foundation of this abscess probably laid at time of former bloody expectoration.

And have little doubt that at time case taken was cause of pain & heat about right Mamma.

That indeed chiefly observed when stomach full.

This however probably to be ascribed to distension of stomach then preventing free motion of lungs.

But whether this case or not, now no doubt that an abscess of considerable size existed in lungs.

And while after rupture had now taken place reason to think that cough would be means of discharging purulent matter, was objective to aid operation of nature, in forwarding healing of ulcer.

With this intention put patient on use of Gum Myrrh. united with Cream of Tartar

An article which have formerly had occasion to mention as of late strongly recommended in Phthisis.

And if can judge from own observations [illegible] far from [representing] it as useful in every Phthisis case yet think have seen it serviceable in some.

And particularly in cases of ulcerous phthisis. With this medicine wished also to conjoin another practice the motion viz given by swinging.

This of late represented by Dr Carmichael Smith as most efficacious mode of cure in Phthisis

Imagines that from motion are solely to account for benefit of sea voyages.

That motion employed with greatest advantage at [distance] from sea air.

And that while exercise a stimulating motion again a sedative power.

That while one accelerates [circulation] by other [rendered] slower.

Must own can by no means adopt all his reasoning on this subject.

Nor do any observations which I have had occasion to make confirm account he has given of efficacy of practice.

At same time consider it as well deserving trial & accordingly directed in present case.

With our patient however has not hitherto been carried into execution.

And when consider state of weather perhaps no loss, as would necessarily have led to exposure to a cold.

Has therefore gone on with the Myrrh alone.

Hitherto however no appearance of any considerable benefit from it.

[At] same time cannot say that progress of disease very rapid.

And as know nothing promising more benefit is intention still to persist in employment