DEP/DUA/1/14/08 (Transcript version)

Pratrich Trotter

(1777)

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Pratrich Trotter.

Respecting disease of this patient when first came under care must own was much at loss.

And although has now attended regull for above space of month opin respecting it little more settled than before

Here could be no doubt that [affect] under which he lab. to be consid as having seat in breast.

But a question of much diff to determ whether merely of catarrhal or phthis nature

Was willing if could to flattr myself that of no worse tenden than form

Yet must be acknowledged that many circum giving counten to latter suppos.

Cough & pain of breast are indeed by no means uncommon occurrences for some length of time without Phthis.

But with our patient had subsisted for months together before came under our care.

Farther to be observd that during that time had encreased in viol.

And for this encrease of severity no manif cause.

That is no evid of augmented secret of mucus acting as const irrit. cause.

Cough here said to be dry.

Or in othr words with very little expector.

This however very freq. the case when effect of that irritat to lungs attend Phthis

But besides all partic mentiond two othr still more unfav. than any yet mentiond.

These are state of pulse & dispos. to sweat which took place at time when came under care.

Pulse in general above 100 strokes in minute

Such quickness howevr an almost const sympt in phthis affections.

And although this condit may occurr with catarrh yet when wanting always consid as giving presumpt against Phthis.

While at same time happening to a patient affected in manner ours is gives presumpt of const. irrit cause support celerity

With this state of circulat also sweatings a very freq. [occur] in phthis affections.

And indeed one of those [event] attending advanced period of hectic fever from which patients partic exhausted.

In in general remarked also as in case before us that these sweatings partic occur in morning.

From all circum taken togethr then would appear that here ground at least for appreh. of Phthisis.

And here next occurrs as question what partic kind of Phthis princip to be suspectd

For hold that general wasting of syst with hectic fever may origin from diff morbid affect of the lungs.

Consider it in every inst to origin from absorpt. of purul. sanies.

This howevr may I appreh be [illegible] in three diff ways.

Either by separat from surface of lungs.

By being separated in form of vomicae conseq. of preceding inflammat.

Or by separat from a tubercle that is a hard [inducted] swelling probab in every case origin from a diseased lymph gland.

Of these the last viz tubercule perhaps [universall] to be consid as depending on scrophula

Second vomicae often conseq. of haemopt

Although this as well as first may freq. depend on catarrh.

And indeed am disposed to consider neglected catarrhal affections to be one of [chief] source of Phthis in this country.

Although however patient ascribd disease to cold yet if really Phthis presumpt was that dep. on tubercle.

For here nothing resembling expectorat of purul. mattr.

This howevr unif the case where separ from surface.

Pus indeed may be lodged in vomicae & give hectic fever where no purul [expect].

But then usually othr Phthis [sym] attended with diffic of breathing.

Which indeed must be necess conseq if vomicae of any consid size

And besides this patient seldom able to lie but on one side.

While at same time pain of breast fixed to partic spot.

Such appear however all here wanting.

Serves therfore to give presumpt of [affectd] depending on that irritat & separ [which] tubercle [furnishes]

But although from all partic mentiond presumpt. of tubercle yet by no means amount to certainty.

For as Phthis compl. often make remarkab progr. unobservd so cough from other causes will put on very exactly appear of Phthisis.

And here though quickness of pulse yet regul access of hectic fever wanting.

And even in sweating to be observd [does] not as is freq. case in Phth. occurr in partial manner.

To all this may add that no [appear] of scrophull in habit of our patient.

Nor as far as can learn has it existed in any of family.

And lastly patient in point of years already consid past the consumpt period

That usually included between 15 & 25.

Our patient however has arrived at 50^th year.

From these diff. circum then some probab. that disease may be of less fatal tenden. than phthisis.

On such a suppos howevr can hardly stile it catarrhal.

For see no evid that encreased secret by the lungs

Probab. therfore is that convuls [affec] of coughing depends not so much on pecul. stimul as on pecul. sensib.

And on such a suppos I [apprehend] sympt. of this patients affection may be explaind.

Yet though a possib cause reckon reality of exist. very doubtful.

And after all rather disp. to suppos of Phthisis.

In this situat then will naturally [concl] that appreh as to termin of disease

Do not indeed reckon recov. from Phth even dep. on tubercule to be imposs.

But at same time every species of phthis highly danger.

And of all others that from tubercle the most dangr.

Is farthr in affection in removal of which by medical aid can do very little.

Hence principle hopes of recovery to be founded on second suppos thrown out

That viz affection depends on pecul irrit. state of lungs.

And was cheifly on this supposition that practice hitherto followd with this patient has proceeded.

Will indeed occur to you that on idea mentiond might naturally have had recourse to use of sedatives.

For in these have most immed means of allaying irritab.

Many of them however although productive of immed dimin of irritab. yet augm. that state afterwards.

Wishd therefore to try a remedy which though product of [more] [slow] would [induce] more perman. affect.

And was with this intent that had recourse to Peruv. Bark.

To this the rather induced as in such a case as pres. appreh. may have even good effects in phthisis.

In this affect. in general objected to from tendency which has to dimin. expect.

For by this means often augm diffic of breathing

But in pres. inst nothing to be dreaded from this circum.

As evid that whatever cause of cough at least is not a mattr which can be [decr] by expector.

Even on suppos of tubercle therfore may as in other cases where purul. matter [observd], [counteract] inflam of [sanies] [entering] syst. from this source.

And thus mitig most urgent sympt febrile affection & sweating.

Was farther of opin that some chance of being of service in this last way whatever might be cause.

And that from tonic power might [restr] sweating as encreasing resist at surface.

These then reasons by which [induced] to make trial of it.

And on whatever princip has oper seems at least to have been so far prod of good effect.

While therfore appear this [promising] shall persist in use.

If howevr affection again increase [some] othr measure may be tried.

May have recourse to opiate on [suppos] of pecul. irritab.

May employ mercury on idea of tubercle

Or may direct use of epispas. as [promising] some good affect on either [suppos]

But of future plans of cure can speak with little confid. till have formd more decis opin as to nature of the disease.