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

John Hook

(1776-1777)

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John Hook

In all probab. subj. to a disease of which too freq. examples in this country.

And which in by much greatest [numbr] of cases has fatal termin.

I mean Phthis pulmonal.

Phithis one of those affect in nature highly insid.

Seldom fails to deceive patient.

Even to very last stage entert hopes of speedy recov.

And has seldom least suspic of being subj to an affect vulgar. consid to be certainly fatal.

But not merely patient that deceived here

This freq. often likewise the case with Physic.

And disease of such insid nature that has often made very great progress before least suspic of it.

In some few instances circum the contrary of these.

as expect from the lungs.

And have appear. giving presumpt of Phthisis where in reality does not occurr.

Here think it pres necss to observe that pres. case not altog without doubt.

From merely catarrh affect greater part of sympt with which patient at pres. affectd will often arise.

And but rarely that Phthisis [subsist] for so long time without having made more prog.

Partic in those cases instances, where, as is prob case with pres. patient, it is not affect of tubercle but conseq. of catarrh.

Patient not affected with those feverish exacerb. which in advanced state of phthisis often so distinct as greatly to resemb. intermitt.

Nor does he seem to have const. quicken of pulse

May farther add that no certainty of matter expect. being purul.

And indeed probab. that large prop of it mucus

To be regreted that no certain test by which pus can be disting from [mucus]

Or by which can be determ where any propor of pus in matter expect.

Common marks from sinking in water from smell in burning, & from applic of acids all liab. to falacy.

If any certain mark could be fallen upon would often be very useful as affording a diag of this affect.

Not indeed that could inferr absence of phthisis where no evid of pus.

But might with confid conclude exist of pus Phthisis where pus discov.

And consider such a mark to be one of those [disid] not unattain.

In pres. instance however no such evid.

From all circum now mentiond consid pres. to be case where not entirely [with] grounds for doubt.

Yet from many other partic very strong presumpt

And in numberless instanc not [hath] the evid. where disease has even [appr] nearly to conclus.

Presumpt. even from cough alone.

Especially after contin for so many months

Greatly corrob. by fixed pain of side.

And by being of such nature as to be aggrav. by coughing.

Besides these presumpt at least of purul. expect.

And state of pulse with morning sweats shew even advanced condit of hect. fever

To these superadded all other comm although not essent sympt.

A transpar. of [albugin] hectic [flow] of counten & cleaness of tongue.

This last an almost const. attend of purul expect.

And indeed were not this the case would here probab. find tongue in diff state

Whole taken togeth therfore can leave very little room for doubt.

And not only look upon patient to be Phthis but consid disease as having already made very consid progress.

Although at same time must be allowd that retains more strength than common even after much shorter [cont]

This however by no means suffic to give any hopes of fav. termin

And own that in pres. case entert. very faint hopes.

Though progr. of disease hitherto but slow can by no means concl. that will contin so.

And even in space of very few weeks may termin fatally.

Perhaps even in shorter time

If goes on even at former rate hopes hardly more flattering.

And little probab. that patient will outlive commen of summer.

Would by no means however repres. his case as one where no possib of recov

Am even inclind to think that has better chance for it than if same sym without expector of pus.

For although many circum unfav to healing of any ulcerat in lungs yet certainly may happen & has happened.

And unquest. better chance where opport for free disch of pus than [when] lodged in Vomic

And perhaps of all phthisis these most incurab. where no prop. suppur.

But As for ex where cough & hectic fever the product of tubercle yielding merely sanies.

Should he even recov then may still be more effect of nature than of any med which we can employ.

But own that is even more than look for from conjoind influence of both.

While however able to attend us must still attempt something for recov.

In treatment of this disease attempts made to cure by aid of med.

Still more however by regimen.

But from treatment of this last kind patient in great meas. preclud by circum in life.

May indeed as easily reach a milk or vegetab diet as of other subst. less proper.

But here cannot think of propos. [chang] of climate sea voyage or the like.

Nor even of enjoining any exercise but on foot.

And that perhaps from bodily exert requird rather pernic as otherwise.

Whatever aid therfore can be afforded to this patient must be by means of med.

In begining of Phthisis before any propr local affect. much may be done by dimin gener. inflam. diath.

By occasion derivat from lungs to other parts partic surface.

And by mitig tickling cough.

With these views small bleeding at proper interv. repeated emet. & antiph regimen often very serviceable

Present patient howevr consid to be too far advanced for this treatment

And view him as having already open ulceration in breast.

Attempts to heal this therfore must now be great object.

Evid therefore that if is to be effected princip part of work must be operat of nature.

All that can expect from art merely to aid this.

Or to prev bad effects of it on system while contin

Have no doubt that hectic fever in phthisis is the prod of absorbd pus.

And that purul. disch at partic part may be dimin by determ to other parts.

Partic if from these also disch occurs.

Such for example as issues or settons

How far these afford any outlett from mass of circul fluids, for absorbd purul. mattr will not pretend to say.

Certain however that such a matter though may be thrown off by some excret.

Often evid marks of it in sedim of urine.

Should therefore reckon it as probab. [that] may find exit by purul disch. as any other.

These were consid. which in this case directed me to use of issue.

And whether on these grounds or not appreh will not be doubted that often afterw consid relief.

Pres. patient even observes that all his compl. aggrav. when the running dimin.

Can be no doubt therefore that while strength will bear it ought to be cont.

Is accordingly intent to do so.

This however rather palliative than any thing else.

And with same intent also prescribed a mucil. mixture.

By which hoped to dimin freq. of cough & in some meas. promote expect.

But remed which was princip desirous of trying in pres. case was the Mercury.

Mercury a remedy which as far as I know has not been much used in Phthisis

Nor can I say any thing of it from my own exper.

While at same time doubtful respect princip on which may be of service

Is however a med of which some of first practit in Kingdom have high opin in Phthis. Partic Sr. J. Pringle.

Cannot help thinking that on such author deserves trial.

Not improb. that may have good effect from action as deob.

And if can thus resolve tubercle may be radic cure to disease.

May also conceive it in such a case as suppos. pres. to be, to be useful on other princip.

Well known that freq. serviceable in [treating] obstin ulcerat., besides those of Ven. kind.

Probab. from acting as pecul. stimul & inducing prop. suppur. inflam.

But whatever princip, effect to be determ by exper.

And if under use of it pres. patient recov. will I own have much higher opin of it, than at pres. have from any thing that have yet heard.

Should it even fail in pres. case will not reckon it unworthy of trial in other.

And must own that even doubtful, how far will in pres. instance have it in powr to give fair trial.

Have here put patient on same formul which have known Sir J. Pringle use in some cases.

And which I beleive he commonly [empl] in Phthisis.

Although at same time should I own have greater confid in common Merc. pill.

As there while Merc rendered active by same means are more secure of [compt] [tri]

But whatever may do in other cases, wish as have already said to contin formul already prescribd with pres. patient.

Partic if see any evid of its prod affects of mercur as introd into syst.

Cannot from use of this med expect any sudden or immed benef.

And should reckon it very unsafe to charge system with Merc to great extent.

Is therefore from consid contin that have any reason to look for benefite

If therefore no evid prejud wish to [persis] in use for some length of time, even [allw] that shall not be able to discov. from it any good effects.

May indeed soon be obliged to desist from it in conseq. of superven. looseness or such other sympt.

But if this does not happen more than probab. that pres. case will not afford opport. for trial of any other med.

If should have thoughts of making trial here of inspir of resin smoke.

From some late cases pub. in diff news papers has been recommended as having had very wonderful affect.

And do not I own consider it as [imposs] that applic of such subst in form of vap. may have prod that inflam which is accomp. with dispos. to heal

Have myself known it tried in one instance only.

There however had evid bad effect

And from prod great encrease of cough was soon obliged to be discont.

Have heard also same acct of this pract. from others.

And am I own very suspic that were we to give it trial would soon be obliged to discont. it

At same time must observe that consid it to be in some respects no unprom. med.

By no means unreas. to suppose that from from applic to ulcer in lungs some tenden to healing may be prod.

And unless that of smoke or vapour no other manner in which applic can be made.

If patient benef by neither of these & if state of sympt will allow of it have some thoughts of trying cicuta in this case.

On no other princip however than merly to give some chance in what reckon a desp case.

And as has certainly affect in giving [disp] to heal to other ulcers of very bad tendency may perhaps likewise to those of lungs.

On this foundat also have sometimes been disp to think that Mezer. might be tried in some Phthis cases.

But appreh that have already suggest more than shall have any opport. of putting in practice in pres. case.

And not improbab. that soon shall have no other view here but to obviate sym.

Such for example as colliq. Diarrhea or like often known to occur towards close of such affections.

And indeed will find that by much greatr part of Practit, in phthisis once confirmd make no attempts to [radic] cure.

But confine attent solely to mitig of urgent sympt.