DEP/DUA/1/14/15 (Transcript version)

James Hutton

(1777)

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James Hutton.

Compl. of this patient That this patient subjected to disease evid from [sligh] at attent even to [appar].

In emaciated habit had evid indic of some cause giving exhaust of gen. system

And from appar. mode of respirat little doubt in fixing this cause to be in breast.

Although at same time descript of patien would seem to lead to diff suppos.

For according to his acct was affected about forthnight before came under care with severe vomiting of blood.

Might therefore lead to suspicion then cause of affect. rather in stom than lungs.

That is that princip part of affection rather Haematom. than Haemoptys

Here however to be observd that between these two, patients not always very accurate in distinct.

Are apt to [compreh] under term of [vomitin] almost every praeternat disch by mouth.

And here partic room for decept. when by action of vomiting expect of blood promoted.

That blood here in reality disch by expector evid from mixt still appear in what spit up from lungs by coughing.

Presumpt therefore that suppos of patient as to disch by vomiting a mist.

Especially when consider that [Haematm] a very rare affect.

And very generally occurrs only as sym of other compl.

Would here then be disp. to consider evac of blood as wholy Haemoptysis.

And this the rather probab. from other compl. with which here conjoind.

Partic from cough.

Cough may indeed be conj. with Haematemis as well as with any other affec.

But by no means a sympt pecul or charact of it.

On contrary is an univ concomit of Haemoptysis.

And must indeed be an univ sympt of every disease, where matter lodged in breast.

To be observed however that cough occurring in Haemoptys. takes place in very diff. state.

Sometimes mere short tickling cough without any severity.

And to be consid as proceeding from no other cause than irrit. which blood occas in air vesicles.

This perhaps most common state of cough.

And hence in some of best definit is character by title of tussicula.

Where haemoptys. with this state of cough disease may be consid as affect either of pecul. determin to lungs or of gener plethor habit.

And haemorrhage occurring always to be viewd as of active kind.

That is as depending on action of blod vessels themselves, being augm & giving rupture. Not on rupture proceeding from other causes & conseq. disch from ordin. action.

In that case besides state of cough this affect also disting. by other marks of plethoric habit.

Partic by flushing of counten. general florid state of compl. sense of weight & [oppress.] & espec. by what may be calld haemorrhag. dispos.

That is tenden to evac of blood by other places as well as by vessels of lungs.

All such appear. however whatever may have formerly been case at pres at least wanting in inst before us.

And cough disting here both by freq. & severity.

To be rememb. however that disch of blood may take place by lungs from active as well as passive haemorrh.

And that among other causes inducing rupture of vessels viol. cough to be justly enum.

Occurrs therefore as quest of some import. whether haemorr. of this or former kind.

And must own that from state of cough together with pres. condit of habit am disp. to view it now at least, whatever may have formerly been case as of [passive] kind.

True indeed that besides Dyspnoea, [which] may be consid as conseq. of air vesic being filld with other matters, patient compl. also of pain of breast.

Which perhaps to be consid as one of strongest marks of encreased action or what has been calld haemorrhag. affect giving rise to encreased disch.

But to be rememb. that pain as well as cough of diff. kinds.

And not improbab. that pain here occurring merely conseq. of oppress & gener uneasiness.

Partic as not remarked that attended with heat, an almost const attend [concom] of pecul encreased action.

But although from these consid would view haemorr. as at pres. of passive kind yet would not inferr that has been always so.

For with begining in diff. state may have given rise to debilit cond. of vessels.

And may have even been origin of fixed cause prod cough.

Of this some presumpt from cont of affection

And from extent of haemorrhage giving appear of vomiting.

Yet when consider cause of affect as far as that obvious may perhaps conclu that from begining of same nature as at pres.

But inquiry respecting origin state now perhaps immat.

As treatment unquest to be accomod to pres. condit.

And respecting this another question of greater import. claiming attent.

Whether viz can consider pres. patient as subj. to Phthisis.

Have formerly had occas to point out these diff. causes as giving origin to Phthisis.

Catarh. Tubercle & [Haemmorage].

Wherever therefore haemopt. exists reason to dread Phthisis as conseq.

And in a disease which makes progrss so imperceptib sympt giving any indic of it partic to be attended to.

In case before us some partic perhaps to be consid as fav. suppos of Phthisis.

And may be imagind that is in conseq. of ulcerat or vomica origin from this cause that cough supported for so long time & with such severity.

State of expect also may be consid as giving some counten to suppos.

And may be imagind that yellow viscid matter expector is of purul. nature

Here must be ownd that subj. to diff. from want of prop diagnos. between pus & mucus.

Well known howevr that both partic mentiond as describ pus in pres. inst yellowness & viscid, are strictly prop of mucus.

Latter even more the prop of purul than of mucus than of purul matter.

And here some at least of more common marks of pus wanting.

Partic foetid smell & taste.

Would then consider this mark of Phthis affect at least to be wanting.

And from circum of viscid of [mucus] alone may perhaps expl. sever. & cont of cough.

Farther to be observed that other [character] of Phthisis here wanting.

Though breathing affected yet not [observd] partic labor on either side.

Though pain of breast yet not fixd to any partic spot.

And although pulse quick yet not with those regul access. which disting hectic fever.

Besides even circum of contin may be consid as an obj. to phthis.

Had now been liable to Haemorrhage for space of three years.

If however phthis affect had occurd when haemorrhage greatest, may conclude that ere this time patient would have been cut off.

And well known that haemorrhage may very freq. occur from lungs without inducing phthisis.

For this last conseq. of ulcerat & suppurat. succeeding rupture of vessels

And is rather to be consid as proceedg from deprav. habit of lungs than follow as necess. conseq.

For when such habit does not exist rupture naturally heald up by first [intm]

From all these circum then disp to consider pres. patient as not yet at least subj. to Phthis.

And on this suppos. chance of recov unquest better than should otherwise supp

Must however upon whole view pres case as of very danger. tendency.

Is so in every inst. even the slightes

But partic so where has cont. for so long a time.

After this has been case can hardly [exp] to prev return even from slight accid.

And utmost to be lookd for is I appreh to give tempor. releif to patient.

Am much affraid that by this affect or conseq. patient will yet be cut off.

And even suppos at pres free from Phthis may yet soon occurr.

Is however our obj. here to take such meas as may serve to remove pres comp.

Gen. princip on which this to be affected must in great measure turn on condit of [pat]

Even where haemorr of passive kind & quantity of blood in system not morbidly augmented is yet sometimes necess to dimin impet. of circulat.

For even in ordin impet. have a [cause] capab of supporting haemorr.

And from [reduct] below natural [standard] other remed will operate with greater success

Where however state of gener. impet such as to preclude any meas. with this view may yet be necess partic to dimin [impet] at lungs.

And that either by restraining action of vessels there or by promoting determin to other parts.

With diff intent now mentiond, blood letting refriger. cathartics, blisters, issues, sedative emetics & various other articles, are according to circum employd with advant.

In some cases howevr none of these practices admissib.

Partic case where patient as in inst before us much exhausted.

Then farther dimin of impet even [allow] augm circulat of it should be indic demonst. by [encreas] quickness of pulse, not to be attempted by evacuants

Utmost then to be done, is to endeav to moderate it by use of refrigar.

Great object of cure must then be the constrict of bleeding vessels.

And the removal of every circum which can give rise to fresh rupture.

Was on these princip then that chiely expected to afford tempor. relief to this patient.

Put cheif depend here on such a med as thought would have some chance of prod constrict of vessels.

With this intent might have employd many diff. astring.

But consid none as preferable to Infus Rosar.

Not indeed from any great effic which it derives from Roses.

Although these it must be allowed do posses an astring quality.

And enter this formul. to such extent [that] may expect utmost affects which capab of producing.

But must be allowed that posses other vegetab. astring still more powerful.

And consider cheif effic of this med as arising from Vitriol acid entering compos.

While however exhib an astring [wished] also to employ in same formula a means of allev cough.

And was with this intent that here united Infus. Rosar. with Mucil of G. Arab. Simple Syr. & Hy. water.

These articles of themselves would have formed mucil. mixt.

And although conjoind with astring. yet do not think that power would be dimin as lubric & sheathing parts against irrit stim

Hoped therefore that by this means [sev] cough which consid as cheif [cause] giving [form] rupt. might be mitig.

But while these expectat from this [praescrip] did not think it advis. to trust to it alone.

And although could not here venture on evac as means of restr. impet of [circulat] yet with pulse at 100 consid something as necess. with this intent.

With this intent view then had recourse to nitre as a refrigerant.

And that might sit more easily on stom combind it with G. Arab.

From which also expected some good effect as demulcent.

Former of these med seems in great [measure] to have been attended with desird affect

For aftr use for some time cough not only mitig but had no return of bloody expec

Latter prescrip howevr did not seem to have had much affect on state of circul.

And as patient imagind that had affect of prod. gripes thought it advis to limit it

During cont of mixt for about forthnigh lungs remaind perfectly free from spitting of blood.

Still however cough at times severe & part so at bed time.

While therefore saw no farther immed occas for [pushing] astring reckond means of mitig cough still more necess.

And was with this intent that throwing out Infus. Rosar. subst. a prop. of an op. viz Tinct Thebiaca

What affect of this praescrip howevr have not yet learnd.

But hope may have had some influ as dimin cough.

And if this the case at least bettr chance that will not be sub. to return

This however can hardly I imagine be expected.

But if does return unless circum changed shall probab have again recourse to same measures as formerly.