DEP/DUA/1/47/13 (Normalised version)

Robert Miln

(1789)

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N^o25. Robert Miln at 42.

Most alarming [appearance] in complaint of this patient is bloody expectoration.

And can have no hesitation in [confirming] it as a case of Haemoptysis.

Here however room for some doubt as to relative connection which different parts of complaint have with each other.

And particularly whether cough the cause of bloody expectoration or bloody expectoration the cause of cough.

For no doubt that may mutually produce each other.

At same time vessels of lungs in every respect in sound state, will bear very great concussion without haemorrhage.

And when more effect of violence, is for most part rather from trachea than from lungs.

On other hand often very copious bloody discharge with but very little cough.

And blood brought to mouth in great quantity rather by tussic than tussis.

Blood [effused] in consequence of active haemorrhage.

And quantity such as to give free & easy expectoration with but very little effort.

Case of present patient therefore would seem to be different from both

For here severe cough preceded bloody expectoration for some time.

And yet bloody expectoration when indeed took place to considerable extent.

Would therefore infer that while haemorrhage in some degree at least of passive kind, was yet consequence of a morbid condition of lungs.

And that thus concussion which otherwise no effect, had given rise, even to considerable discharge.

This case I hold to be by no means rare.

Perhaps even no less frequently, than where haemorrhage entirely of active kind.

And may also add more dangerous.

For in haemoptysis can by no means estimate danger from quantity of discharge.

Where merely profuse active haemorrhage vessels of lungs heal as readily by first intent as those of nose.

And cases generally remarked most fatal where [much] tinge of blood with Sputum

Probably as then afforded from tubercle.

And perhaps in every instance danger to be estimated only by diseased condition of lungs.

On this view of present case then by no means the most favourable.

And am inclined to think the probability is that will at last terminate in Phthisis.

Of tendency to this state already even some presumption, from sweatings during the night.

But at same time with pulse at 76 can consider him as having but little of hectic fever.

And not without hopes of recovery.

With view to this have here had recourse to what will perhaps be disposed to consider as a very inactive medicine.

Mixture viz of Gum Tragacanth & Starch with a proportion of Sugar.

To this have had recourse on [advice] of an ingenious friend Dr Odier of Geneva

And when again speak of case, shall state at more length information which have received with respect to it.