DEP/DUA/1/45/18 (Normalised version)

James Sinclair

(1788)

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N^o17. James Sinclair at 20^th

When formerly spoke of case of this patient expressed doubts with respect to it.

And represented it as matter of uncertainty whether merely catarrh or incipient Phthisis.

Of two however was I own inclined to latter supposition.

And of this presumption afforded from several circumstances.

Particularly from age & appearance of Patient. From profuse sweatings during night without relief.

From aggravation of cough at that time. And from nature of cough, being rather tussicula than tussis.

Have met with many cases of Phthisis subsisting for considerable time with less [alarming] appearance.

But at length proves fatal patient under most decided form.

Now however I own rather inclined to change opinion.

For all symptoms of most alarming nature entirely gone.

And those to which still subjected belong to very different & less dangerous disease.

Can hardly however suppose that if Phthisis, pectoral symptoms would so soon have left him.

Now conclude therefore that from beginning has only been catarrh.

But may probably at least be ranked among doubtful & suspicious cases, by [which] reputation given to the remedy here employed.

Began you will observe by directing for this patient the Pulveris Gum Myrrh [composition].

This consists of equal parts of Gum Myrrh & Cream of Tartar.

The chief article of this composition the Gum Myrrh of late very much employed in Phthisis by different practitioners.

And for most particular account of cure may refer you to late treatise on Consumption by Dr Simmons of London¹.

This indeed as well as various [other] vegetable balsams, employed in Phthisis at very early period.

But found that most of these of heating & stimulatory nature.

And by this means, often aggravate symptoms of hectic fever.

This led Dr Fothergill & other practitioners entirely to condemn employment.

And accordingly fell into disuse.

But again revived by observations of Dr Griffith Dr Saunds & others.

And found that any bad effects to be dreaded from stimulating power may entirely obviate by giving it in conjunction with some refrigerant.

For that purpose Nitre or Cream of Tartar most frequently employed.

And chiefly determined in choice by state of belly at time.

Of late years have in my own practice, employed this remedy, in great number of cases.

And from extensive experience can at least venture to assert that when given in manner here directed not product of any bad effects.

And may also add, that at least much deceived if have not seen it in several instances attended with considerable benefit.

Am very far indeed from representing it, as a certain, or even frequent cure of Phthisis.

Nay do not recollect one instance of decided tuberculous consumption falling under my own observation in which successful.

But in this respect, still at least equally powerful with any other remedy with which I am acquainted.

For recovery from that disease when does happen is at least very rare occurrence.

And then rather operation of nature than of any medicine.

But have met with several cases where strong suspicion of Phthisis, apparently yielding to Gum Myrrh.

Have also seen it I think employed with benefit in that catarrhal Phthisis

But still more than any in ulcerated Phthisis

There from large vomica in lungs copious discharge of purulent matter takes place.

And very apt to be continued in [consequence] of fresh separation of purulent matter.

Have often been inclined to think that in these cases, by use of Gum Myrrh, adhesive inflammation promoted.

And thus ulceration probably obliterated. Hence then while have recourse to it in every species of Phthisis have particular recourse to it in Ulcer.

[If] however case before us, in any degree Phthisis, was of tuberculous kind.

But whether Phthisis or not may at least venture to assert that Gum Myrrh product of no bad effect.

From commencement of use was product of no unease at stomach or other inconvenience.

And in no long time cough much diminished.

Soon also became much less affected with sweating than before.

Still however continued to be at times affected with pains of breast.

And although neither constant nor fixed to any particular part yet very distressing to him.

Became so to remarkable degree about end of December.

And at that time not only seated in breast but attended also with much dyspnoea.

I own became to this time to entertain some suspicion that an inflamed affection may have existed within [breast]

And had once thoughts of directing blood letting.

But to this length of time for which patient had continued under disease seemed to me to be objection.

And therefore chose rather to see whether would yield to a blister

This accordingly directed to be applied

And in consequence of operation became much easier.

Soon after however became again more severe.

And by this led to direct employment of an opiate.

This I need hardly observe one of most effective means of allaying pain with which are acquainted.

And even where no influence as tending to remove cause yet has affect of giving temporary ease.

In this in present instance were not disappointed.

For although pains not altogether gone yet no longer fixed in breast.

Now appeared only under flying pain affecting different parts of body.

And at same time almost entirely free from cough sweating or other symptoms giving apprehension of Phthisis.

In this situation considered farther continuation of Gum Myrrh as unnecessary.

Accordingly has now for space of some weeks been intermitted.

How far in this case of any real service to patient, cannot possibly pretend to say.

Certain that during its use got rid of those symptoms giving apprehension of Phthisis

And at least no reason to believe that did any harm

But now I own inclined to think notwithstanding various circumstances giving [supposition] of Phthisis his affection only catarrh.

And probably would have terminated as soon without Gum Myrrh as with it.

Since Gum myrrh intermitted still continues free from any affection of breast.

But by no means entirely free from pains.

And these with respect to situation at least have put on an appearance somewhat different from what did before.

For at last report found that chiefly affected joints of fingers.

And in joints most pained an obvious degree of swelling & inflammation.

That now therefore of Rheumatic kind can hardly I think be question.

And although seat which formerly occupied, breast viz & other parts of trunk, not that which Rheumatism commonly occupies, yet gives strong presumption that origin of same kind.

This however consider as no objection to use of opium.

On contrary in Rheumatism, in most acute form, as well as in other [influences], now every day used with greatest success.

Indeed an ingenious London practitioner, engaged in very extensive hospital practice, is inclined to think, that whole benefit of Dovers powder to be ascribed to Opium alone.

Accordingly now almost constantly employs it in simple & uncomplicated state.

+ Finds it thus equally effective both as inducing sweating & alleviating pain

And I own as far as my own experience goes tends very much to confirm his opinion.

Here therefore not only directed continuation of use internally but have also advised it externally.

At least have directed [application] of Anodyne Liniment, Opium with Camphor.

By these hopeful that mitigation or even removal of pains may be accompanied

And if this the case, is my intention to try preventing return, by means of Peruvian Bark.

Perhaps conjoining it with a proportion of Cicuta.

A combination from which in some modifications of Rheumatism, think I have seen very great advantage.

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Explanatory notes:

1) Samuel Foart Simmons, Practical observations on the treatment of consumptions (1780).