DEP/DUA/1/14/13 (Transcript version)

Adam Kirby

(1777)

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Adam Kirby.

Disease of this patient one with regard to which do not consider us as subj. to much diffic.

At same time do not look upon it to be simple or uncompl. affect.

Greater part of compl. such as have already oftener than once had occas. to mention

Consist of cough, diffic of breathing with expector. of viscid mucus.

With combin of these affect, occurs at least as most probab suppos that two formr to be referrd to latter as cause.

And that while stagnat viscid mucus accumul in breast cause of diffic of breathing at same time from acting as irrit cause gives rise to cough.

On these grounds then would consider pres. affect as princip depending on encr. secret. of mucus.

Or in other words to be catarrh.

And notwith state of patients pulse which consid quicker than nat. standard must pron. chronic catarrh.

Of this suff. evid not only in absence of other febrile sympt. heat, thirst, debilit &e but also from cont.

Before came under our care affect had subsisted for about 9 months.

True indeed that this not unfreq case where nearly same sympt from Phthis.

For from this also cough & diff. of breathing

But besides that affect characterized by condit of expectorat in viscid of which have suff. cause for sympt. almost no circum giving count. to suppos of Phth.

Though pulse quick yet nothing resem hectic accessions.

Patient not affected with any fixd pain in breast

Nor any circum in age habit or former condit of life giving counten to phthis

While far past age at which that affect almost alone takes origin has arrived at period when catarrhal comp of chronic nature by much most common

And in modif of cough here catarrh partic character.

Attacks in very severe fits which cont seldom less than 1/2 hour often two hours at time

Such fits almost never the concom of Phthis.

These cough in general rather freq than severe.

Nature indeed diff. modified according to cause of Phthisis.

But for most part under form of what calld short tickling cough.

While on other hand in chronic [stage] of catarrh fit of coughing cont. till expect takes place.

And where mucus very viscid this this not affected till fit of very long cont.

Is indeed in some measure in common to both to have cough aggrav. on first going to bed.

And indeed naturally follows that cough should be aggrav. by change in circulat prod by applic of cold bed [cloth] to surface.

But in some measure pecul to catarr to be severe in the morning.

Is necessarily consequence of stagnat & conseq. addit viscid acquired by mucus during night.

From this source howevr cannot look for aggrav of cough in phthisis.

And accordingly not in reality observd.

But while all these circum concur in leading us to pron. pres. case catarrh one circum mentiond in history which would natur. occur as pecul partic.

That is peculiar sense of suffoc occurring taking place during severe fits of coughing.

This indeed not unfreq. even from interrupt when coughing must give to action of respir.

Will also in some measure be affect of obstruct to larger branches of trachea while viscid mucus by success. agitat. brough grad higher

But that in pres. case not from either of these causes evid from mode in which releivd.

Patient we are told freed from it by eructat of wind.

From this then might I think concl. that diffic of breathing in some degree affect of distens of stomach by wind.

And that on disch of this more room afforded to lungs.

Thus then from first histor. of the disease may inferr also some affect of alim canal giving rise to uncommon extric of wind.

But of such an affect. have since had farther evid from after circum of affect compl.

While cough consid allev still continued to have various sympt evid the affect of wind.

And these not merely appearing during fits of coughing.

Nor confined solely to upper part of alim canal.

Compl. of being much & even const. affected with wind through whole tract of bowels.

Could therefore be little doubt that with catarrhal affect there was here united, that state of alim canal favour to extric of air from alim.

This then opin which entertaind respectin name & nature of affect to which this patient subj.

And with these sentim of his disease could not consid our patient as in any great [danger]

Would not indeed by understood to [effect] that might not be cut off by either.

And well known that both when to high degree not unfreq. mortal affection

But in pres. case had put on no such appear as could lead to dread of such conclus.

Although however from these consid was disp. to look upon affect as free from danger yet did not expect speedy termin.

For both one & other affect very obstin.

And often that medic aid partic at late period of life of little avail.

Then even stomach compl. remain with much greater obstin than at earlier periods.

Probab as cannot then employ to equal extent most effect modes of cure.

Partic free use of exercise in open air.

But if reason for doubt respecting affect from wind still greater with regard to catarrhal affect.

And this as already observed consider to be by much most consid part of disease

To patients far advanced in life this affect. partic common.

And when becomes so is very rarely that get rid of it.

For most part when gives even not great inconven is yet in effect contin during remaindr of life.

And often even observd that when cough absent are worse.

That is, cough stopt only in conseq. of some more matter. affect.

May indeed be consid as favour. circ [there] that since patient came under care cough consid mitig.

This however perhaps as much affect of warm weather as of any remed empl.

And do not doubt, that whether from one or other cause severit will again be encreasd during winter.

But from season of the year alone may look at pres. for allev. of this part of affect.

Which also may be somewhat aided by use of proper. remed.

And if from these can also dimin affect from wind must own that is utmost that here to be expected.

And if patient cont. to enjoy same relief as for some time past shall think of dismissing him.

Since this patient came under care have not employd great variety of measures with view to releif.

Consid catarrh as most [matterial] part of affect. thought first of taking measures to allev it.

On opin deliv of affect. should look for radic cure from restor. augm disch to natural standard.

Hence might expect cure from use of astring & tonics.

But although quantity of secret. immed ultim cause yet ultim immed cause is reten of that quantit in breast.

And with our patient retent seemd not so much effect of very great secret. as of want of dispos in lungs to excret.

And when excret. not properly carried on, viscid acquired of course comes to be great.

Consid this therefore to be case in inst. before us looked on means of promot excr to be most essential.

For this purpose various med. long in use known by title of expect.

And although some modern practit disp. to deny exist of any such yet cannot help thinking that stimuli [entering] circ may be collect. at this as well as other [excr] organs.

From greater part of expect. indeed while propensit to excret augmented some influ. also as augm. secret.

A circum which may necess. suppose unfav. in such compl. as pres.

But influence in this way more than counterballanced by affect in prod disch.

Naturally occurrd therfore as most prop. remed to be here employd.

Of all the expect. of kind now mentiond gave prefer. to the Gum. Ammon.

To this led as hoped likewise might have some good effect on affect from air in stomach.

For while imagine it capab. of [action] as stimul. on collect at excret of [mucus] hold like wise that had in some meas effect of foetid gums in primae viae.

And that by antispasm & stimul influence there tends to expuls of wind.

On first employm of this med were not disappointed in expectat in either of these ways.

At least while had evid effect of prod freq. eructat. at same time cough was somewhat relieved.

At least I think For cannot help thinking that might reasonab. inferr that relief from this cause when consider that from farther contin state of expect. manif. changed.

Became according to observat of patien evid less viscid than formerly.

Not then surprizing that duration of fits of coughing at same time much shortned

Any may be consid even as addit proof that violence affect of pecul. viscid of musc

While therefore reckon it not improbab that relief of cough in some measure affect of warmth of weather would not consid med as of no affect.

But although cough became grad easier whethr from this or any other cause, affect from air in bowels not equally dimin.

And solut did not cont. to have power of prod such freq. eruct. as before

In this situat thought of employing a carmin stimul. still more powerful.

And was with this intent that had recourse to Pil. Gumos.

A formul of which already oftener than once occas to speak.

Consists of several [Gums] as Galb & Myrrh nearly resemb. the Ammon.

And what more near affin & still more powerful than either the Assafoetid.

On this imagine princip effic of remedy to depend.

And hoped that by addit of these pills to former mixt. affects might be more powerful.

In this howevr disappointed.

For while cough cont. easier other [affect] nothing mitigated.

In this situat then thought it unnecs to contin meas. with view to cough.

And omitting both former med. gave a praescript to patient solely with view to cough wind in bowels.

In this employd as a stimul more immed acting upon stomach, a med in which greater part of compos. peppermint water.

Need not observe that activ of this depends on diffus of a warm essent. veget oil in water

Effect of this from stimul. to stomach when wind lodged there is almost immed [expul]

In this way affect even as instant as ardent spt.

While at same time not in other respec prod of equally bad affects.

And probab. is that if some of fair sex who have recourse to cordial spts water for stom. compl. would employ simple peppermint water would never become [illegible].

But although look on effic to be [cons] & immed. did not here trust to it alone.

From addit of syrup indeed expected no effic.

But was princip intended to diffuse & susp in watery menst. the other addit viz. Tinct. Fulig.

This hold to be remed of same nature with pil foetid.

And here used with same intent.

Consider this although derives name from the Fulligo to be prin a Tinct of the assafoetid.

And in gener. give it even prefer to Tinct. Foetid strictly so calld from menst which is employd.

In one case menst. [merely] weak spt of wine with which can venture to use [illegible]

But in other is Spt. Sal. Amm. Vin.

Which although caustic vol. alkal. somewhat diluted yet must be exhib. with [sparing] hand.

From formul. here directed then expect more immed & more powerful affect than from those before used.

And hope that will so far relieve compl. that may soon dismiss patient.

If howevr does not may have recourse to other stimul & tonics to stomach.

But as already observd at utmost here expect allev. only.