DEP/DUA/1/11/18 (Transcript version)

Robert Robertson

(1776-1777)

---

Towards close of last Clin Lect. enterd upon case of Robt Robertson.

Observed that although many circum of this patients disease evid

Yet that not altog without ground for doubt

No ground for suspect any mistake with regard to bloody disch.

This told has freq. happened to to very consid extent partic in mornings.

Giving presumpt therefore of accumul in stomach during night.

Besides this great probab at least of very consid purul. disch.

That realy discharges pus by the mouth may be inferrd both from colour taste & smell.

Still more from quantity at once disch

Are told, that even since came under care has vomited up a matter with every appear of pus even to extent of lb. at a time.

Matter to such extent with strong [foetid] & disagreeab. taste could hardly be supp any thing else but pus.

May with certainty inferr then that here purul & bloody disch on vomiting

But disch of these matters not merely in way of vomiting.

Certain that blood also disch by expec on coughing.

That is that comes from cavity of chest.

Strong presumpt also that from same source disch. of pus.

For on coughing expect a matter with usual appear of pus in colour smell & taste

And has farther been found to answr to common test that viz of sinking in water.

All these marks howevr must be allowd do not amount to certainty

And have already oftener than once had occas in these lecturs to regret that an easy & certain test for disting pus from mucus as expect from lungs had not been discov.

The rather regret this as am persuaded that by a little indust & attent, with no great degree of chemic knowledge such a test may be discov.

Am in hopes that in short time this question may be prop as subj. on which any stud at this place may exert his ingenuity.

And if that ingen excited with success may be the means of obtaining to him if not adequate at least honourable compensation.

Although howevr diffic in disting when pus, when mucus expect in many othr cases can be very little in pres.

For besides ordin marks strong probab from its being accomp. with bloody disch

Still stronger from suddenness & extent of the disch on vomiting.

From these diff. partic then led at least to one conclus respecting nature of the disease.

Strong presumpt that somewhere a large abscess

Diffic however respecting situat.

May naturally conclude it in neighb of part where complains of fixd pain.

That is about lower extrem of Sternum.

Would therefore give presumpt that [suppur] in Lungs.

And of all the viscera there perhaps most freq. seat of suppurat.

While at same time on such a suppos see why blood & purul matter disch by expector.

This suppos however not altogether without diffic

Unquest some object to it from [quant] at once disch.

Seldom that any vomica in Lungs cont at once to extent of pound.

At least if this the case might expect to find before rupture much greater diffic of breathing than in pres. inst.

But if diffic from quantity not less from mode of discharge.

Are told that evacuated to greatest extent by vomiting.

This howevr means of disch more immed the contents of stomach.

At least presumpt therefore of coming from thence.

Natural to think therefore of some other suppos than that solely confind to lungs

Diffic may be [sold] on suppos that more than one abscess.

One may exist entirely in thorax, anoth commun with stomach.

Yet if this in reality case a rare occurr.

With great probab. may be supposed that one abscess so situated as in conseq of adhes & eros. to have commun both with lungs & stomach.

Perhaps still more probab. explan of diffic from supposing mistake on part of patient.

Not improb that matter seeming to be disch from stomach by vomiting in [realit] expect from lungs during act of vomiting

And that comput of patient respecting quantity higher than ought to be.

Or mistake may even be of an oppos natr

And notwith seat of pain all matter seeming to be disch by expect may realy be wrought up from stomach by aesoph.

And merly disch during forcib effects by coughing.

Yet must own reckon this conject less probab. than formr

But at same time where so many possib suppos. will at least be allowd that ground for doubt.

Thus far of nature of affect.

Of Prognos. must observe that am [affec] less ground for uncertainty respecting termin.

Great reason I think to apprhend that will termin fatally.

Few instances of intern suppurat ending in any other mannr.

Those in lungs partic fatal.

And here every reason for presum that affect by no means inconsid.

Would not however from this mean to repres. case as totally irrecov.

Have already often remarkd that some [chance] from free disch of pus.

And disease in proport to contin does not hitherto seem to have much affected constit of patient.

Gives therefore presumpt that not here ready absorpt

Besides from descript of matter every reason to think that what here disch well digest pus.

Certain however that from this as lodgd in diff part of system no remarkab. [inconv]

Either is not capab. of being absorbd or if absorbd not same tenden to prod hectic fever as putrid sanies.

Need not surprize us therefore that here no great degree of hectic fever.

And that patient still contin to possess vigour which from occurr of this would soon be lost.

Yet many circum in internal [suppur] even of mildest kind very unfav to healing

Partic where extent of affection such as great reason to fear in pres. case.

Must therefore own that fav conclus of pres case is more than expect

And from prog. being hitherto slow cannot inferr that will cont. so.

Hard to say how soon pus formd may degen. from pres. to more vitiated state.

In that event progress of affect may afterwards be as rapid as has hitherto been slow.

Yet better chance of slow progr than if from begining evid appear of vitiated pus

May hope therefore that better oppr of trying what can be done by [aid] of [med]

Yet must own that in pres case much at loss even respecting gener. plan of cure

And partic divided in opin whether best chance of success by what would call trusting to natural or attempting artif cure.

Healing of ulcers work rathr of [natu] than art.

Is probab conseq. of pecul. inflammat. to which unless in partic diseased state greatest tendency.

Where purul. mattr formd however & has no exist this cannot take place.

But after rupt of abscess & disch. have at least all that chance of healing which power of system can give.

To this have hitherto trusted in pres case.

And during time that patient has been under care have done little else but lookd [on].

Had indeed recourse here to a blister since converted into an issue.

But of princip on which expectd benef from it need hardly not say any thing after what have already obs of other [phthis] cases.

Had recourse to cream of Tart. on presumpt that purul. matter in alim canal.

And By gently moving belly wishd to disch downwards what not eva by vomiting.

And ordered vomit with view of [suppor] & promot. expector.

But trusted cure of ulcerat to natural progress of adhes. inflammat.

In this plan will yet probab. persist for some time.

Cont. issue & purgat & repeating [emet] at due intervals.

If under this manag. hectic sympt do not appear may entert some hope of natural tend to cure.

But if these superveening purul disch contin. will be prop at least to make some trial towards giving dispos. to [heal].

And pres. a case in which may I imagine have some expect from Per Bark

While at same time may make trial without much hazard.

If this fails have thoughts of putting patient on use of G. Myrr.

A remed of which can say nothing from my own exper.

But which am told Dr F. of London thinks he has found very serviceabl in Phth compl.

By time these trials made probab. more distinct idea of patient compl.

And may perhaps be thence induced to alter plan in manner which do not expect.