DEP/DUA/1/11/09 (Transcript version)

William Walker

(1776-1777)

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William Walker.

Compl. distinctly markd.

One of sever. patients under our care affect with haemorrhag.

And may here remark that for so limited number of patient very consid variety under care.

In one already mentiond bloody vomiting.

In pres. bloody expectorat.

In next to be ment. Ferguss. bloody stools.

In case of Johan Scott. Menorrhagia or excessiv disch of menst. blood.

In case of Wm Knight probab Haematur or bloody urine.

And lastly in Jane Allen ex of bloody [disch] by gums & nose & may even say tendency to bloody disch by surface.

All these in some meas referab. to class of haemorrhagia.

And thus may be consid. as having gen affinit.

In many respects however do not agree

And not only give diseases to which differ. names affixd, but attended even with very diff. degr. of danger & requir diff [trea]

To disease of pres. patient can have no doubt in affix. name of Haemoptysis or Haemoptoe.

This affect. charact. by one sympt.

viz Discharge of blood from lungs.

Blood may be evac by spitting when comes from other parts as Gum fauces & even Stom

But then easily sensib that not from lungs.

And indeed when comes from breast, its arising from thence as in case with pres. patient can be sensib. felt.

For most part fixed pain in breast.

And if not as in pres. instance viol at least at commn. viol cough, most commonly some slight ticklish.

Besides these some nosol. have introd also into defin of this disease other symptoms. Partic Flushing & Dyspnea

Were these even essent. might observ that not wanting in pres. inst.

May remark however that do not consid them as necess constit of every case.

Latter cheifly attendant only where the haemorrhage consid.

And where blood accumul & coag. in breast.

Former a very common attend indeed where idiopath haemopty of active kind

Partic where affect of plethor.

But does not even gen. occur where haemorrh. passive.

Or where as in instance before us has been affect of accid.

For little doubt that with this patient first derivd origine from stroke in breast.

That vessels thus brought to diseased state have never again recov. former condit.

And that accordingly fresh rupture induced by agitat of coughing in conseq of catarrh. affection.

This then breif view of opin respecting name & nature of this disease.

As to probab. event must own that much at loss to speak with certainty.

Would fain hope that patient may get better of pres. attack

Or that rather that already in some measure termin.

Yet own suspic with regard to future conseq.

And disp to consider him as now very liable to future attacks from slight [acid]

Probab. is that these in end may prove fatal to him.

Where this disease not to such extent as to be fatal by itself usual. termin by phthisis.

And should not be aston to learn that this hereafter case with pr. patien

Such termin however do not imagine that any danger of witnessing at pres.

On contrary unless from some fresh accid may soon be dismissed.

And will even perhaps depend on [such] accident if has ever any such occurr in future

In treatment of this patients affect. first & great object is disch of blood.

And here would naturally occur that prev. to be expected on two princip.

By dimin force propelling blood.

And by encreas. resist. to passage.

Force propelling blood in such a case as pres. may be consid as of two kinds.

The const. impet of circul.

And accid occuren giving uncom. impet

Ex in pres. case cough.

This indeed in some degr. necess. for expul of accumul. blood in breast.

But at same time suspect it to have been first cause exciting the Haemor.

During contin therefore will always have tendency to support it.

And even after has ceased to renewal.

Other circum indeed which may also in some meas have same affect.

Ex. loud & much speaking viol exercis

While these however can be avoided cough will occurr contrary to every effort.

Hence is here princip. accid [claiming] attent.

In pres. case therefore princip. obj were

1 To dimin. moment. of blood.

2 To mitigate cough.

3 And to contract ruptured vessels.

These views will readily explain to you meaning of prescript.

Employd nitre here as a refrig.

And of all subst. taken into alim canal has perhaps greatest effect in dimin impet of blood.

Had recourse to blisters & paregor elix. with view of mitig cough.

And employd infus rosar as an astring.

Not so much indeed from virtue which suspect to be commun by roses.

As from vitriol acid.

Although not to be doubted that latter also of astring. quality.

From these remed patient already seems to have obtaind consid relief.

In so much that part of plan already discont.

And now reckon it cheifly necess. to guard against return.

Both by endeav. as far as possib to strengthen vessels.

And to mitig remaining cough.

Am hopeful that in pres. case will be necess to employ no other remed.

And as already observed that may soon dismiss patient from any future attendance.

If cough should remain obstin however may be necess. to do more than merely trust to paregor. Elix.

Besides mucil & demulcent med may be necess. to have recourse to [secnd] blister.

Or support drain from neighbourhood of breast for consid time by issue or setton.

This probab. treatmnt of case even on suppos of contin of cough provided the haemoptoe does not return.

If however is again attackd with that compl. will require other meas.

With this view may have recourse to use of lancet, & to cooling purgat.

At same time enjoining every other part of a refrig. plan.

With these may at same time employ even more powerful astring than form.

May employ other veget of this tribe as Tormentil & Bistort.

May have recourse to other min as alum

But upon whole should trust more to encreasd doses of vitriol acid.

May however be necess. for us to prosecute none of these meas.

And may soon even be led to other which do not at pres. forsee.

Yet what now suggested are the meas. which think there is greatest reason to appreh. may be necess.