DEP/DUA/1/47/51 (Normalised version)

John Miller

(1790)

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John Miller at 32. N^o30.

When formerly spoke of this case, stated sentiments with respect to it, at some length.

And although pointed out several singularities, with which attended, yet had little doubt, in considering it as being an example of Asthma, of spasmodic kind.

On this idea of the disease, was not disposed to give favourable prognosis.

Had not indeed any apprehension of fatal conclusion.

For upon whole but rarely terminates in death, merely of itself.

And will frequently subsist for many years, to much higher degree, without any such conclusion.

But very generally, when once distinctly marked, proves an obstinate affection.

And will often continue notwithstanding [every] remedy, to distress patient during whole remainder of life.

Hence formerly mentioned, that did not expect to bring about radical cure.

Yet entertain some hopes, that by proper remedy, should be able to diminish both frequency & severity of fits.

Cannot however pretend to say, that even in this respect, expectations have been answered.

At least, benefit received, neither so considerable as looked for, nor so decidedly the effect of remedies employed.

In treatment of this case, as formerly observed, had chiefly following objectives in view.

In first place on threatening of apparent fits, to endeavour to anticipate occurrence.

In the second place, when fit has already taken place, to endeavour to obtain speedy termination, by forwarding resolution of spasm.

But above all, during interval between fits, to endeavour to remove that morbid irritability, from which by very slight causes, inordinate action giving fits induced.

Was with view of answering two first of these intentions, that here directed mixture, which had for basis the Vitriolic Aether.

This I need hardly observe one of most powerful antispasmodics, with which are acquainted.

And often employed with success, both in allaying spasm, when already exists & in anticipating occurrence.

Hoped therefore, that might both be useful as preventing fits, & as bringing about termination, when had already taken place.

Directed therefore, that should not only be regularly taken every morning & evening, but also repeatedly employed when an urgent fit came on.

But in conjunction with the aether mixture, directed also, you will observe another medicine.

A combination viz of Zincum praecipitate, with powder of Valerian.

In both these have articles frequently employed with advantage, against diseases of spasmodic kind.

And not unfrequently product of benefit, in instances not only of Convulsivo & Hysteria, but even of Epilepsy.

On what principles they operate indeed, is I think very doubtful.

But seems at least highly probable that somehow diminished that morbid irritability, giving tendency to inordinate action.

This particularly to be expected, from the Zinc.

An article from which in cases of Hysteria in particular, have often I think seen best effect.

This article, in such affections, first introduced internally, under form of flower or calx.

Has often also been employed in saline state, that viz of White Vitriol.

But while former, with many stomachs inactive, latter very apt to excite sickness & vomiting.

And am I own disposed to prefer to either, the formula here used.

A precipitate from a solution of White Vitriol by means of Volatile Alkaline.

From these different medicines, no inconvenience.

And after continuing for some weeks, seemed to have obtained, at least temporary relief.

In so much, that from 13^th to 30 February was free from any fit.

In this situation, thought continuation of Aether mixture unnecessary.

And particularly led to omit it, that influence might not be diminished from long habit.

Directed therefore continuation of Zinc alone.

But soon after this subjected to several severe returns of Asthmatic fits.

This patient himself ascribed, & probably with justice, to some foggy weather which then happened to occur.

But whether this the case or not, could be little hesitation in [advising] repetition of Aether.

After this, though fits still severe, were for a short time at least, less frequent.

But about end of last month, probably from cold weather, & previous easterly winds, had a severe fit almost every night.

In this situation, became tired of medicine & expressed desire of making trial of St Bernards well¹.

A spring in neighbourhood of city at present used as an almost universal panacea.

But however useful may be in some instances, have no reason I think to expect benefit from it.

For is merely simple water slightly impregnated with [hepatic] air & with small proportion of common salt.

Reckoned it however most prudent to comply with his request.

For if had not done so, medicine although ordered, would not probably have been taken.

With omission of medicine therefore, gave consent to this trial.

And at last report found that for space of week had taken it daily to extent of two bottles.

Only obvious effect that of increasing quantity of water.

Fits of Asthma however according to his account both less frequent & less severe.

From this naturally led to persist in course.

And effects to be determined only by trial.

But may conclude with observation that if under use patient obtains any material benefit should ascribe it more to air & exercise conjoined with drinking cold water, than to any mineral impregnation.

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Explanatory notes:

1) St Bernard’s Well can be found on the Water of Leith, between Dean Village and Stockbridge. This natural spring was discovered in 1760 and rapidly became popular with citizens of Edinburgh suffering from a variety of medical conditions. The building in the form of an Ancient Greek temple that now sits over the well was built in 1789. It surrounds a statue of Hygeia, the Greek goddess of health.