DEP/DUA/1/47/41 (Normalised version)

Robert Milln

(1790)

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N^o25 Robert Milln at 42.

In case of this patient as formerly remarked had evident example of Haemoptysis.

And could neither be considered as [entirely] of active or passive kind.

This evidently apparent from blood not rising spontaneously to mouth, or being evacuated by mere tussicula.

And at same time from severity of cough not being such as could of [itself] induce haemorrhage.

From this then led to think that cough had considerable influence as immediately inducing it.

But that product of this effect only in consequence of diseased state previously existing in lungs.

This case of Haemoptysis, am inclined to think by no means rare.

And during future attendance of patient no reason to alter conjecture with respect to it.

Cannot however same as [illegible] respect prognosis.

For on view now given was disposed to look upon it as very dangerous.

As laying foundation viz for Phthisis.

For may remark that Haemoptysis rarely fatal from mere loss of blood.

And is chiefly from preventing morbid condition of lungs that degenerated into Phthisis

In this respect however apprehensions with respect to present patient agreeably disappointed.

At least have been able to see no tendency to Phthisis

And when dismissed from farther attendance here, not only free from bloody expectoration, but also from some other alarming symptoms particularly night sweats.

How far however this recovery the affect of medicine here employed perhaps matter of doubt.

At least will occur to you that remedy here chiefly employed by no means an active one.

A mixture viz of equal parts of Gum Tragacanth Starch & Sugar.

And these taken only to quantity of a tea spoonful thrice a day.

This remedy had not before employed in any similar case.

And had here recourse to it not on information of any regular practitioner but on that of particular friend of mine, who was some time ago obliged to visit continent of Europe with view to recovery of health.

Among other alarming symptoms had frequently been subjected to Haemoptysis.

And having suffered attack of it at Geneva consulted Dr Odier an ingenious & learned physician of that City.

Dr Odier advised him to try this medicine.

At same time adding however that recommended it not on any knowledge of principle of characteristics but merely on footing of [experience].

He added even that had begun use of it with trepidation.

Imagining that very little benefit could be derived from article apparently so inactive.

But that in repeated instances had experienced what he thought best [effects] from use.

On this ground then Gentleman to whom I allude had no hesitation in giving trial to a remedy from which at least nothing to be dreaded.

And upon his return to Britain informed me that in his own case had found it product of best effects.

Did not indeed give defence against any future return of Haemoptysis.

But upon repeated occasions found that Haemoptysis very soon stopped after began use of it.

His case as I have already observed consider as in some respects similar to that of present patient.

Thought this therefore no improper opportunity for giving trial to the practice.

And have at least no reason to [repent] it.

For not only taken without inconvenience but after use begun haemoptysis very soon stopped

This however was more probably effect of mitigation of cough, than of remedy.

For will observe that it this time became much easier.

Did not however obtain mitigation of all symptoms.

For now more affected with pains in different parts of body particularly cramps in legs.

These however could not at least consider as alarming symptoms.

And hoped would prove only temporary.

Accordingly without any practice against [this] directed merely continuation of former medicines.

Now however had farther confirmation of opinion that cessation of haemoptysis was principal affect of diminishment of cough.

For on accidental aggravation of it some slight bloody expectoration again appeared.

This however only for single day.

And would be wrong from [thence] to infer that powders no influence.

That had effect presumption from severe return of cough as mentioned in after report without any haemoptysis.

Even allowing powder however to have had considerable effect yet still from severe cough were always exposed to danger of return.

Here therefore with view of mitigation of cough had recourse to an opiate.

Which of all medicines we yet possess unquestionably most powerful as allaying [mode] action.

Directed under form of Pill Thebaic.

These in conjunction with powder taken to extent of grain V bis indies.

Under these while cough mitigated at same time continued free from any return of Haemoptysis.

Considered farther attendance then as unnecessary.

And although can by no means consider this case as decided evidence of benefit of Tragacanth & Starch, yet event at least such as to encourage to future trials.