DEP/DUA/1/45/30 (Normalised version)

David Ritchie

(1788-1789)

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N23. David Ritchie at 24

When formerly spoke of case of this patient expressed some doubts whether to be considered as Phthisis or Catarrhal.

Was however upon whole rather inclined to former opinion.

And very apprehensive that in end would prove fatal.

During time for which continued under care cannot say that this opinion either confirmed or refuted.

And when left us to go to country still remained in same state of doubt as before.

From practice employed no material change at least induced in nature of affection.

Began by directing application of blister to his breast.

To this practice led from several considerations.

For in first place may observe that often useful against cough whether phthisis or catarrhal.

But here more especially led to it by severe pain of breast with which patient affected.

For this, whether attendant of Phthisis or Catarrh, very generally consequence of some degree of inflammation.

As counteracting both pain & cough blisters probably operate on different footings.

But in my opinion principally from changing mode of circulation.

Hence advantage of continual discharge under form of issue as permanently supporting such a change.

And on this ground led to direct it in present case.

While however directed blister & issue, at same time ordered for patient [compound] powder of Gum Myrrh.

And article prepared of equal parts of Gum Myrrh & Cream of Tartar.

And of which as employed in case of Phthisis have already oftener than once has occasion to speak.

By some as Drs Griffith, Simmons & Saunders, represented as product of wonderful effects.

And although, can by no means, for my own part, subscribe to all they have said with regard to it, yet cannot help thinking, that have seen it in some instances product of good effects.

And as far as my own observation goes have never seen it product of any bad consequences.

Hence in most instances where a fair opportunity offers may be considered as well meriting trial.

Soon after these medicines begun, pain of breast at least as will observe from succeeding report, considerably diminished.

This was inclined to ascribe, to immediate operation of the blister.

For while often product of such effect, from other medicines could expect no benefit unless from long continuation.

Hence then, though cough & dyspnoea still continued as before, yet still hope for benefit from persisting in use.

And although in place of diminishment at succeeding report cough rather aggravated yet merely [directed] continuation

Soon after however appearance in several respects became rather more alarming.

For while coughs frequently & expectoration copious notwithstanding free discharge from issue had return of pain of breast.

And what still more alarming [became] frequently affected with cold & sweating fits.

These I need hardly remark the common symptoms of hectic fever.

And when latter allowed to run to great extent, tendency very much to debilitate & reduce patient.

Thus in remarkable degree forwards conclusion in death.

Is indeed true that all endeavours to check colliquative sweats often ineffective.

And only to be obviated by removal of cause an end very rarely to be accomplished.

Still however something may be done with view to [moderating] it.

And that not merely by avoiding causes tending to increase it as warmth of bed load of bed clothes or like, but also by employing such articles as tend to restore it.

And perhaps no astringent more powerful than vitriol acid.

To this accordingly had recourse in present instance.

And as most convenient mode of exhibiting, diffused it in Mucilaginous Mixture.

To this not merely led as a means of covering taste, but from hopes also of some benefit against cough.

For as appears from employment in catarrh, serves at least to diminish irritation at fauces.

And effect in this way nothing diminished from addition of vitriol acid.

From which even in consequence of astringent power, some alleviation of cough may be expected, as diminishing secretion of mucus.

Accordingly in this way seems to have had even more influence than in restoring sweat.

At least were informed at succeeding report that thought cough rather easier.

Still however sweating continued as before.

Which with continuation of other medicines a sufficient inducement to persist also in use of this.

At this period however an opportunity offered to patient of going to country.

And was I think with great propriety that he [embraced] it.

For although far from being certain or even general cure yet promotes at least some advantage.

And from such a change, patient not unfrequently obtains relief.

Indeed opinion of some, that in Phthisis, more to be expected from country air, gentle exercise, & milk diet, than from all medical practices put together.

Two former indeed can be had in towns as well as in country.

And no doubt that from both very considerable advantage.

The one as affording mild & at same time nutritious aliment.

The other both as leading to digestion of that aliment, & as to free circulation through system in general.

And hence to regulate support of every function.

But though these to be had in towns yet in several respects more readily & in greater [performance] in country

While at same time in most situations, there obtained, what not to be had in towns, the breathing a pure dephlogisticated atmosphere.

For no doubt that air of towns [consistency] much contaminated, by smoke of fires.

Pure air however, in many [illegible] salubrious to system.

And indeed, for my own part, am inclined to attribute benefit of sea voyages, as much to this, as either to sea air, or to change of [temperature].

To advantage of pure air, even benefit of watering places have of late been by some referred.

This particularly the opinion of Dr Pearson as will observe from treatise on Buxton waters¹.

But whether his observations well founded or not cannot be doubted that pure atmosphere always advisable to Phthisis patient.

Hence our present patient [with] propriety [preferred] it to any benefit which could expect from continuing attendance here.

And especially as same course of medicine with equal advantage continued in country.

Accordingly at [departure] advised him to persist in it.

But have now heard nothing of him for some time.

And what event of case shall probably never be able to learn.

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Explanatory notes:

1) George Pearson, Observations and experiments for investigating the chymical history of the tepid springs of Buxton (1784).