DEP/DUA/1/11/14 (Transcript version)

James Bruce

(1776-1777)

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James Bruce

Symptoms of case not numerous

And one respecting which do not imag that foundat for much diffic.

Princip compl cough & diffic expect.

These have already observd may arise from diff. causes

Partic of from every cause which has any tenden to irrit lungs or to occup space which should be allottd to [atm] air entering breast.

Such for ex. as water, blood, mucus purul matter in thorax itself.

Have seen that may be prod even by causes without abdom. as enlarge. of liver.

In pres. instance however no room for suspecting any but one of these.

Water in breast seldom without oedem swelling elsewhere.

Blood would either give const diffic of breathing or be disch by expect.

And if purul. matter besides pain of breast & various other sympt should have hectic fever.

No affection without thorax on which can suppose it to depend

Naturally led therefore to ascribe both cough & diffic of breathing to effects of mucus accum in lungs.

And that suppos. corrob. by mucus expectorated.

Vomiting with which affected consider to be a circum of very little conseq.

And affect only of viol fits of coughing when stomach at same time distended.

For to be observd that affected him princip if not only after full meal.

From all these circum then no diffic in conclud. disease to be catarrh.

And from contin with absence of fever would pronounce it of that kind which have formerly disting by title of chronic catarrh.

From all that have seen cannot pronounce either cough or diffic of breathing here to be very severe.

Patient has not suffered from it any great loss of strength.

Nor can be disease compar. [speak] be consid as of long standing.

From all these circum then cannot help thinking that here grounds to hope for complete cure.

Not however to be expected that will soon be brought about.

Nor can it be lookd for during contin of pres. weather.

May reason. expect even that will now be much aggrav.

At least if patient does not guard carefully against inclem of weather by keeping much within doors & by prop. [cloth]

Hope however that upon whole, [alth] progr. to cure not unif. may get grad better under care.

And as weather becomes warmer compl may at least be much mitig.

After what already observd of case of [Brymnr] less necess. for being partic as to gen plan of cure with pres. patient.

Chief indicans in cure is morbid state of secret. from mucus glands of lungs.

And endeav cheifly to be directed to restor of this to natural state.

Both by avoiding circum encreasing determin to breast & by promoting more free circulat in other parts.

With first intent partic necess. to guard against expos. to cold

With last various med may be employd

Among these, emetics from influence as prod free circul on surface by no means the least effec.

And repeated at propr intervals often attended with very consid effects.

Was intent therefore to employ [this] in pres. case.

And to conjoin use with squils.

These indeed am inclind to believe from collect at excret of mucus have affect [rather] as encreas than dimin secret.

But to [compen.] this as affording addit stim have affect likewise as promoting excret.

Thus tend to unload breast & dimin viol of cough.

While at same time have also chance of being serviceable as proving diuret.

When these med first begun seemd to have good effect

And was intent to have persisted in this course for some time.

But cough becoming more freq. & seeming in some meas to depend on tickling in fauces a demul was judged necess

And with this intent had Sperm [Ceti] in form of [tinctur].

As from this imag. that reapt consid benef. resolvd on cont. it alone at least for week or two

With resolut however of afterwards returning to former plan if should be found necess.

That this will be case reckon highly probab.

Reason to appreh. even that both may be insuff.

And that may be obliged to superadd to these still other means of cure.

Among these one of first to which will probab. have recourse will be a blister.

And for obtaining more perman. affects to be kept open by epispast. ointment.

Besides these still anoth med which have often been led to imag. might be useful in this affect.

That is Peruv. Bark.

Of effic of this can say nothing from my own exper.

Nor indeed do I recollect to have heard it recommended by others.

Expectat proceeds totally on idea of nature of the disease.

And on effic of bark as restraining mucous disch in other cases.

Thus for ex. consider it to be very useful med in Gonner after virul of disease overcome

And with those who are averse to inject have often I think seen from it very remarkab. affects as checking running.

On same ground have been disp. to think that might sometimes be useful in chron. catarrh.

And in case of fail of med already [sug] may perhaps try it here.

May however remark that is a med not altog without ambig.

And while has tenden to dimin secret may also have affect as dimin excret.

And thus may encrease both diffic of breathing & aggrav. sever. of cough.

May be necess. therefore during use to contin former drain. issue

And to conjoin even use of vomits at due intervals.

While point out these however as meas which have in view with pres. case would hope that sympt will not require them.

And that patient by meas before [ment] may be dismissd if not cured at least consid relievd