DEP/DUA/1/47/49 (Normalised version)

Patrick McCulloch

(1790)

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N^o29 Patrick McCulloch.

In this case as well as in that of Robert Miln, a distinctly marked instance of Haemoptysis.

And here with circumstances still more unfavourable than in former.

For grounds even to apprehend, that Phthisis had already in some degree taken place.

At least of this, reason to be apprehensive from loss of strength & appetite of patient.

For while complains of great weakness, had very much that appearance of [illegible] [circumstance] red viz in cheek, which so common with hectic fever

And at same time, though no hot or cold fits, yet pulse often to 100 in minute.

Apprehension also somewhat increased from age of patient.

For at 22^d year was still in what called consumptive period.

So denominated from frequency of affection at that time.

But still more grounds for alarm from long continuation of cough prior to occurrence of bloody expectoration.

As indication that diseased condition of lungs, from which probably, cough here alone capable of inducing Haemoptysis, had been of considerable standing.

From all these particulars, my opinion I confess was, that in this case should soon probably have distinctly marked Phthisis.

And that in no long time would have fatal termination.

In this however, as well as in former case, fears also agreeably disappointed.

For patient at least for present, has had apparently a complete recovery.

Must however add, that still cannot help entertaining very great suspicion as to soundness of lungs.

And should by no means be surprised at his having soon again, a return of his affection.

And from every return of Haemoptysis danger of Phthisis is undeniably increased.

But for present at least, whether as consequence of remedy employed, or not, affection has certainly had a turn for the better.

Here as in case of Miln, remedy to which had recourse, was powder composite of Gum Tragacanth. Starch, & Sugar.

To this, as formerly took occasion more fully to state, had recourse on authority of Dr Odier of Geneva.

And although at a loss with respect to principle on which could be supposed to operate, yet wished to determine influence by observation & experience.

For must confess, that cannot adopt opinion of those, who imagine that haemoptysis stopped by [ agglut], as they have been called.

That is article giving greater [ visi] to mass of circulatory fluids.

This some have supposition, to be particularly the effect, of all mucilaginous & [ amylae] matters.

But though these, may show demulcent affect, as collected at excretion, yet no reason to believe, that produce change in mass of blood.

And even supposing such to occur, still less reason to think, that by [ agglut] power, would stop bleeding vessels.

If therefore has good effect must I think be expected on other principles.

And whether has or not, to be determined by experience alone.

Here however, must be allowed that many opportunities for deception.

For Haemoptysis stopping from other causes, may be unjustly attributed to this.

Cannot therefore, by any means, rely on one, or even few trials.

But is only by frequent & general observations, that a certain conclusion can be drawn

And present instance also as well as former, at least somewhat in favour of the medicine.

Haemoptysis did not indeed immediately stop after powders begun.

And when was observed to be diminished, imagine that this might be as much effect, of some sickness, which then took place, as of any other circumstance.

But afterwards found, that even [within] sickness, continued free from return.

And that too, notwithstanding severity of cough at time.

While severe cough continued however, were constantly exposed to danger of renewal.

For mitigation of this therefore, [superadded] to powder, the use of some Pill Thebaic.

And under those; for several weeks continued so well, that considered farther employment as unnecessary.

Had now also very much regained strength.

From which [apprehension] of Phthisis at least for present very much removed.

Still however wished, that patient had continued attendance for some time.

And with this [internally] directed for him the use of stomach pill.

As while might tend to restoration of strength, & [appearance], could at least have no bad effect.

But since that, patient has never again attended at this place.

This however, in all probability, solely consequence of finding that has no farther occasion for assistance.

For may be seen daily in streets following occupation of Hawker.

And as already observed this case as well as that of Miln, somewhat in favour of Gum Tragacanth.