DEP/DUA/1/11/10 (Transcript version)

John Fergusson

(1776-1777)

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John Fergusson.

Case of this patient one with regard to which am not altog without diffic.

And expect to have still more in conduct of cure than in ascert. nature of the disease.

Sympt. with which at pres. affected few.

And of these greater part obvious to senses.

Here naturally first & most import. [ques] respecting swelling in abdomen.

From equab. nature may conclude that is some of abdom. viscer.

And can suspect [none] more probab than liver.

A viscus affection of which known to be very common.

And although on some occas. continue for life without inconven. yet on other occas attended with most serious conseq.

This then would consider as most essent part of patients pres. compl.

And may even be question how far is not to be consid as cause of all.

Only other compl. at pres. distressing to him are diffic respir & cough.

May I think be question whether these propr catarrh affection or whether dep. on disease of the liver.

In othr instances have had occas to speak of what call chron. catarrh.

And may occurr that have here pres. those sympt. which consid as necess to character. it.

May observe however that cough in some respects differ. from that of chron. [Catr]

As expressed in case is a const tickling cough.

Would lead therefore to presumpt that does not depend on stimul. from great quant. of viscid mucus.

For then fits of coughing not so freq. as they are severe.

And very rarely that a fit termin [withou] expector of very consid quant of mucus.

Hence to pres. cough being of this nature still farther obj. from scanty [disc.]

Must own therefore that consid it to be most probab. that both cough & diffic respir. of diseased state of liver.

On what princip swelling & tumour of liver should prod latter of these sufficiently obvious.

Must necess, partic while body in recumb. post., prev. free action of diaph

The organ by means of which highly probab. that ordin respirat cheifly performd.

Nor diffic to conceive how should produce cough.

From this very circum will necess. act as giving irrit to lungs.

And thus freq. cough with little or no expector.

In some parts of country liver consid as cause of almost every disease.

Most emmin phys. at pres. in Bath that great [recept] of invalids disp. to ascribe much to it.

Hence nothing more common among those who have been his patients, than to hear not only of compl. of stomach & bowels proceeding from the liver but of liver coughs, liver consumpt. & the like.

In so much that have freq. been told, partic by very humane pract in med of female sex that in this part of Country we know as little of diseases of liver as in Bath they do of the Nerv.

Am I own far from being disp. to imag that liver so freq. a cause of disease.

Would however be equally groundless to refuse that may often act as such.

And where as in pres. case high probab of its being diseased would even occurr as most probab. cause.

Thus far then respecting pres. symp

But besides these patient also since compl. first began has been affect with others

These although not constant return at certain intervals.

And may resonab. appreh. that will again be subj. to them.

What I allude to is disch. of blood by vomiting & stool.

With regard to this sympt also ground for doubt.

May or may not be connectd with fixd affect. of liver.

Certain that tumour & schirrus of liver very freq. without any such appear.

And equally certain that blood may be disch from alim canal derivd from other sources.

Most commonly indeed happens from its own vessels.

Besides these circum anoth partic [here] also giving doubt.

Swelling of liver said to be only of two years durat.

While are told that at intervals has been affected with bloody stools for near three years.

In these circumstances cannot posit. assum that are connected.

Yet must own that still disp. to think it not improb.

Liver may very readily have been [diseas] for consid time without any obv. swelling

And even now gives little or rather no pain.

At pres. however can be little doubt that in diseased state

Hence would rather suspect it to be cause of sympt. than ascribe them to a cause of exist of which are not certain.

Besides blood disch from vessels of liver ready access into alim. canal.

And from this way source greater [chance] of disch. both upwards & downwards than from any other.

Well known to happen with regard to fluid secreted by liver

And if bilious vomiting & purging a common occur. bloody ones disch may also happen from same origine.

Upon whole then disp. to look on pres. as what may be calld liver case

Respecting cause first inducing it are here entirely in dark.

Patient himself does not ascribe comp. to any partic occurr.

From this source therefore no light thrown on nature of disease.

And any conject from circum of patient employment must be very uncertain.

Yet when reflect on busin. that viz of Chairman must conclude that exp. to very strong occas. causes of disease.

Perhaps no employm. subj. to greater viscisit of heat & cold.

And accordingly life of Chairmen very bad.

In London none undertake this business but those of stoutest & most robust habit.

And yet computed that at medium do not live above five years after entering [illegible] it

This therefore may conceive to have had some share as inducing pres. affect.

Not impossib that aided also by too [free] use of spirit liquors.

For while proffess. naturally leads to this, is at same time known to be very powerful cause inducing affect of liver.

Whatever may have been origin cause however will now but little affect prog.

And must own that in pres. case can form no very favour. opin.

As yet indeed compl. not very urgent.

And what appears most so is perhaps in reality the least consid. viz Cough.

May indeed distress him but do not consider it as danger.

And even while cause of complaint contin although not perhaps entirely to be removed may yet admit of consid [allev]

Swelling in abdom howevr will probab. be more obstin.

May not merely resist all attempts but even encrease

And as suggested with respect to case of Janet Brown may yet termin in suppurat.

And patient be at last cutt off with tabes hepatica.

See no reason to imagine however that progress in pres case will be rapid

And hope that may at least allow opport. for trial of diff. med.

Am even not altogether without [expec] that from these may be overcome.

Upon whole however reckon it most probab. that this prin. part of compl. even after long attend here will rather if any thing encrease.

While however contin attend here is our busin. to try whatever measures we can with view to cure.

And with this view many diff. med. may at least be tried.

Here great [object.] is to remove [obstr.] in liver & restore due circul. [through] it.

Not to be imagind that even by obtaining these ends swelling would be entirely removd.

For probab. that solids even in some degree encreased.

Yet little doubt that greatr part of swelling depends on impacted fluids.

And that by free circul. these would be removd.

While at same by restorat of this any farther bad conseq. avoided.

Of all med known by name of discut or deobstr. none longer fashion. than Mercury.

And indeed incontest evid of its action as a pecul. yet powerful stimul to partic parts after introd into system.

Hence as prop in case of Jan. Brown to make trial of Cicut. wishd in pres. case to try affects of Merc.

And with this view put patient on use of it both extern & internally.

First meant in some meas as topic applic.

And with this intent conjoind Mercur ointment with small prepar of Camph.

Hoped that influence even when [rubd] upon integ might in some degree extend to viscera.

And cannot help thinking that have seen instances of benef. from it where equally little connex.

But even suppos that in this way no effect still equal powerful means of introd into syst. as by frict on any other part.

With this however wishd also to compar intern use.

As by this means greater certainty.

And could sooner, with safety, charge system with Mercur. than if trusted to one mode only.

Or if employd that to great degree.

Here directed Mercury merely rendered [act] by triture

As being state in which greatest chance of being retaind for some time in system.

And on such retent hopes of success cheifly founded.

Here directed triture with Confect Cynos.

A subst which some imagine has very powerful effect as killing Men

And hence a fashion formul with some of Lond practit partic Sir J. Pringle

By these and other Mercur. is inten to keep patient for some time on verge of salivat.

Not that imagine any benef to be reapt from that disch.

But that consider it as only certain evid of Mercury having fully ent. syst.

In prosecut of this plan howevr will be somewhat restraind from pres. state of weather.

But if has any influence in dimin tumour will be induced to cont. it for longer time.

Should it in end fail may be induced to try here some of med so highly recommend as deobst by Dr Stork.

Such for ex. as Stram. Dulcam or Cicut.

Am far from thinking that these will succeed in every case.

Yet have no doubt that are med possess. active powers.

And on some occas have had very wonderful affects.

Should not howevr be much disappn even at failure of all of them.

In that event may perhaps try electric.

Partic if find that has any good effect in case to which lately ordered.

But should even entirely fail there will be no sufficient reason why may not give trial in others.

And pres. may perhaps be one.

But before even trials already prop. not improbab. that disease may so far change appear as to lead to very diff. pract from what at pres. suspect.

And while prosecuting radic cure allev. of sympt. not to be neglected.

With that view indeed have hitherto done little

As except cough nothing in this way urgent

Is however as means of allev this that have ordered the pil. Thebaicae.

While these afford relief may be occas. cont.

Or may have recourse to other remed as demulcents or blisters.

While however is merely tickling cough in pres. state should I own expect more from opiate.

And take pres. to be one of these cough in which trochissci [Bechie] nigri a new formul of Ednr Pharm may be used with advantage.

May probab. therefore in pres. case give these a trial.