DEP/DUA/1/47/31 (Normalised version)

Alexander Kerr

(1789)

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N^o20 Alexander Kerr at 43.

When this patient came under care considered his case as not altogether without doubt

Even then however was disposed to consider it as an example of Phthisis.

And from everything that have had opportunity of learning during progress of affection this suspicion confirmed.

While at same time, as indeed in general happens in that disease cannot say that derived any material benefit from practice here employed.

With view of relieving dyspnoea & giving determination from breast had here recourse to a blister

And as means of supporting change of circulation thus induced, directed that should be kept open by issue ointment.

With blister & issue, conjoined also what we call composite powder of Gum Myrrh.

That is p. [ae] of Gum Myrrh & Cream of Tartar.

An article which since strong recommendation of it by Dr Saunders Simmons & others have often employed with Phthisis patients.

And I think in some cases even decidedly marked not without benefits.

From blister & issue a free discharge took place.

And upon this thought his dyspnoea at least somewhat relieved.

Although therefore other symptoms still as before this sufficient inducement to continuation

But in this particular patient did not long comply with directions given him.

For from issue as indeed in general happens at commencement was subjected to considerable pain.

While at same time imagined that had considerable effect in inducing weakness.

And although probably mere consequence of the disease yet not altogether [without] foundation.

But whether opinion well founded or not learnt at succeeding report that had allowed it to heal.

And in this situation would probably have served very little purpose to direct [renewal].

Resolved therefore to continue with Gum Myrrh alone.

But now found that had some influence in moving belly.

Or at least had two stools daily.

And by continuing to considerable extent had reason to imagine that would be augmented.

Directed therefore that a dose should be taken only twice daily.

Seemed however necessary to do something farther with view of obviating urgent cough.

For this purpose, directed a mucilaginous mixture with proportion of Tincture Thebaic.

And to prevent operation by sweating as well indeed, as to counteract sweating which had already taken place, added a proportion of diluted vitriolic acid.

From use of this mixture imagine that both cough & dyspnoea much relieved.

And so far from augmenting sweating that thought this also considerably diminished.

Cannot however say that benefit thus reaped was permanent.

For notwithstanding continuation of medicine cough became again more severe.

And although looseness not increased was yet much distressed with tenesmus.

This imagine might be supported & increased by Gum Myrrh.

And as after trial for some weeks found product of no advantage thought it inadvisable to push it farther.

On this account therefore deserted use.

And as means of counteracting Tenesmus with continuation of mixture directed addition of proportion of Confection Japonica.

Whether from this addition or not tenesmus soon after became less distressing.

And for a few days somewhat easier.

But this relief only of short continuation.

For soon after recurrence of symptoms with addition even of sickness at stomach & vertigo.

Circumstance probably indicative of progress of disease.

In this situation however saw no benefit to be expected from change of medicine.

Thought it sufficient therefore to [desist] continuation

But since that have seen [nothing] more of patient.

And what has been termination of his case cannot pretend to say.

Reckon it however not improbable that disease still continues progression if has not even already terminated fatally