DEP/DUA/1/45/22 (Normalised version)

Peter Paterson

(1788)

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N^o19 Peter Paterson. at 25.

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

And although continued under care for upwards of two months, now nearly in same state of uncertainty as before.

Was however evident that [most] [leading] symptom consisted in pectoral affection combined with hoarseness.

And was inclined to hope that might be merely an example of [ Parass] catarrhalis, as styled by Sauvages.

At same time from continuation & [complexity] of affection, some reason to be apprehensive of Phthisis.

A disease which while not unfrequently arises from [influence], well known to be of insidious nature.

And in many instances accompanied with loss of voice in [different] ways.

Reckoned it therefore necessary to have both in view in practice.

Began treatment by directing for this patient the use of an oily mixture.

This consists of olive oil diffused in water, by means of vegetable alkaline [Salt] of Tartar as commonly called.

Here need hardly observe that was from oil alone that looked for any benefit

And that alkaline employed only to promote union with water.

Nor need I add that such an [union] effected by saline substances of different kinds.

Most frequently perhaps a proportion of volatile alkaline spirit is employed.

But from this a pungency given to the mixture often disagreeable.

Which however few stomachs in this [constantly] at least able to bear

Hence for my own part, very generally prefer mild vegetable alkaline as giving more pleasing mixture

A union indeed with water may be affected by articles still more mild

Such for example as vegetable [mucilaginous], sugar syrup, or yolk of egg.

And accordingly with these oily [illegible] are frequently formed.

But with these [intermediary], union [when] merely mechanical much less [intimate].

And when separation takes place a fresh union less easily obtained.

Hence does not so readily answer intention, of producing diffusion of oil, which may easily sit upon stomach.

And in oily mixture this great objective in view

For otherwise more advantage may [certainly] be expected from oil in pure state.

But oil, when swallowed in any form, well known to be one of most powerful means of lubricating fauces.

Accordingly as a pectoral medicine, or rather as a remedy in catarrhal affections, is every day in use.

And particularly beneficial where much affection of voice in way of hoarseness.

Indeed often employed as remedy for affections of voice of different kinds.

And may even add, that where Aphonia or Paraphonia has occurred as curable disease, am for my own part unacquainted with any medicine from which greater benefit may be obtained.

At same time must allow, that greater part of these, which I have had opportunity of treating in practice have baffled all efforts I could employ.

And patients have left me in no better situation than came under care.

Hoping however that present might be of less obstinate nature here expected some benefit from this remedy.

Did not however find that soon product of any change for better.

For although cough rather easier yet hoarseness nothing [relieved].

Still however relief of cough no grounds for removing apprehension of Phthisis.

And when consider, that affection had commenced from influenza was even inclined to fear that of tuberculous kind.

By this consideration had here recourse to mixture of Cicuta & Bark.

A combination from which in some instances of scrofula have I think seen advantages.

And most if not every tuberculous Phthisis of this kind.

Here however considering affection as a [sequel] of Influenza had still another reason for employing it.

For reason to believe that after this as well as after some instances of Pertussis cough supported, by mere morbid irritation.

But as removing this the sedative [power] of Cicuta united with tonic power of Peruvian bark, may naturally be supposed to have considerable influence

And in actual practice have I think seen material benefit from it.

On both these grounds then had recourse to it in present instance.

And was at same a remedy which without smallest inconvenience might be continued in conjunction with other.

Cannot however say that from this any more flattering prospects of advantage.

On contrary not long after use begun symptoms of Phthisis even more alarming than before.

For although hoarseness somewhat diminished yet pulse became more quick.

In so much that in general exceeded 100 in minute.

While at same time much affected with sweatings.

And tongue also appears remarkably clean especially at point.

A circumstance always unfavourable in Phthisis.

And indeed very commonly the attendant of some degree of purulent expectoration.

Still however did not see that any measure could be prosecuted with greater advantage than those formerly directed.

But another occurrence now took place which seemed to claim some attention.

Became affected with flying pains in different parts of his body.

These from transitory nature did not consider as alarming.

But from severity were at least very distressing.

With view therefore to temporary alleviation directed friction with Anodyne Balsam.

And this seemed at least to be attended with desired effect.

For after friction became considerably [easier].

In this situation continuation of use seemed improper.

As might naturally expect greater benefit on renewal after intermittence.

Still however cough & other symptoms continued much as before.

Directed therefore continuation both of oily mixture, & of bark with Cicuta as formerly.

During time for which this course has now been continued, cannot say that suspicion of Phthisis either confirmed or removed.

But upon whole apprehensions by no means diminished.

I own my expectations from medicine are not great.

And after trial already made without success, am inclined to think that patient may look for more benefit from country air, milk diet, & gentle exercise than from any remedy which we can recommend.