DEP/DUA/1/16/03 (Transcript version)

William Kay

(1777-1778)

---

Wm Kay.

Princip part of affect to which this patient subj. by no means rare.

Yet is at least uncommon at so early a period of life.

Especially when attend to first comment.

Here although several sympt no quest. that most mattr. part of affect is bloody expectorat.

Of five nosol. syst. circum of expect of blood alone reckond suff. to const a diseas

And to this affect have univ. given the name of Haemoptysis.

Of these four two consider absence of acute fever as an essent [consit] of disease

And for this [restrict] at least some [founda]

For certain that in partic febrile affect ex. peripneum bloody sput occurs when not prop. haemoptys.

But on other hand in syst of Dr Cull. haemoptys as well indeed as all other haem ranked among febrile affect.

And for this arrangement also some appar. reason.

For in some inst of active haemorrh febrile affect distinctly markd.

And in others although all sympt not obvious yet often quick & hard pulse.

At same time can by no means consid pres. of fever as essent to Haemopt.

And that too even when haemorr. [occur] is of active kind.

Still less however when is merely passive

In inst before us an example of Haem where sympt of Pyrex. cannot by any means be said to take place.

Is then on these consid. that look upon disease as best defined where neither pres. nor absence of fev. consid as necess. constit

And in this light consid defin of Lin. & Vogel as having prefer to those of Sauv & [Sagar] on one hand, & Cullen on other.

Consider bloody expect as only essent constit of the affect. no hesit in [pronoun] exist here to consid degree.

For here not merely slight appear of blood in sputum which may come from vessels of Trachea.

But is we are told at times disch. even to extent of one or more pounds.

And seldom cont free from it for more than space of month.

Often even intermiss not more than week or two.

In these diff. partic of recurrence & quantity of disch. no great singul.

And with age at which patient is now arrived that viz of fourteen cannot be consid as great singul an uncommon affect

Although at same time much more freq. somewhat later in life.

But pres. patient who yet but 14 year of age has been sub. to it for space of 8 years.

With him then ex. of occurrence at [much] more early period of life than common.

And that too without having been origin affect of any partic accid.

From which may I think justly infer. that tendency to this affect partic strong.

And of all species enum by Mr Sauv most exactly resemb what directed under [title] of habitualis.

In which cannot be ascribed to any partic cause disease does not take rise from any partic accid as viol concuss. wound tubercle or like but where merely affec of pecul. state of pulm vessels & of cond of fluids in these

And this species of Haemopt. partic marked as attended with othr sympt ocuring in pres. case.

Our patient for example has to very high degree the florid complex attending that species of haemoptys.

With him even so strong as often to approach to purple hue.

Is affected also with pain of side, cough & dyspnea.

Circum in which certain indic of local determ to lungs giving irritat.

While at same time am disp to consider sickness at stomach & headach as conseq. of general plethor. state.

Thus then view all sympt to which patient subj. as constit only one disease

And to that would give name of haemoptysis.

As this affect not consider bloody disch as constit princip & most dangr part of his affect.

Yet view it ultim as being affect of pecul. plethor habit.

And of partic state of lungs in conseq of which disch by superab. quantity more readily affected by that outlet than any other

This then idea of nature of affect to which patient subj when came under care

And with which accord. to acct given us had been affected for sev. months before.

With this opin respecting nature of affec prognos. cannot be favourable.

Notwith contin of disease indeed has not hitherto induced those sequel which most to be dreaded.

Evac has not hitherto proceeded such length as to give rise to marks of inanit

Or at least if otherwise would have done so influ has been fully counteracted by dispos in syst to plethor state.

Neither on other hand does the freq. rupture seem, on any occas, to have [been] succeeded by purul. expect.

While at same time does not appear that hitherto many remed tried for [remov] of this affect.

Cannot therefore repres. it as having already obstin resist. diff. means of cure.

Yet must own do not consider all these circum as giving found for great hope

Haemoptys in every inst. to be consid as a danger affect.

Is especially so where occurrs at early period of life.

Much to be dreaded also when subjected to freq. returns.

And especially when these so much affect of constit as to take place even without exciting cause.

May also remark that during contin which has already had in place of mitig has encreased in viol

And from this great reason to believ that such a state of vessels of lungs indeed that even notwith use of med will prove obstin.

Hence then great reason to [apprehnd] that sequel already ment although yet no certain indic of them, will at last take place

Even some presumpt indeed that has already taken place But if not danger at least that will hereafter occurr

Should not then be surprizd here to find that haemorrhage extended to such length that patient at last cut off by inanit.

Reckon it however still more probab. that from freq. rupture of vessels of lungs ulcerat will in end occurr.

>

And, that from purul. absorpt. patn patient may at last fall victim to [hect] fever.

But although look upon this to be most probab termin am far from consid it as certain.

Disease may admit even of complete cure.

Or even if this cannot be affected may yet be so far mitig as not at least to be attended with fatal conseq.

And some inst at least, although [indeed] but rare ones, are to be met with, of patient subj to this disease to consid degree even for greatest part of long life.

A Gent. who lives in this neighb & who is very consid advanced in life affords perhaps one of most stricking exampl of case now mentioned.

From this then may at least inferr that case not altog desperate.

And that while patient inclind to cont under care may even try other meas. than with mere view of mitig. sympt.

Treatment of this & simil cases [naturale] referable to two heads.

Meas. viz to be taken while disch pres.

And meas. during interv. with view of prev. return.

Where excess. evac. and of long contin. reason to appreh. that may prove even suddenly fatal.

For in same manner as other haemorrh may give rise to convuls or [deliq] term even in death.

In such cases then must attempt to restrain flow either by dimin cause giving impet by which expelld.

Or by encrease resist. to passage [have] rupt. vessels.

When however as suspect to be case with pres patient disch in effect of pleth. such meas. totally inadvis.

For then evac to be consid as [salut.]

And by giving check to course worse conseq. may be induced.

Hence [then] nothing farther to be aimd at than follows in conseq. of means of prev. return.

Or at utmost can venture only to restrain disch by removal of causes supporting it.

Hence then consider great obj. of cure in pres. inst. to rest on prev. of return.

And where as suppose to be case with our patient haemorrhage of active kind depending on pleth. diff obj. to be aimd at

Must endeav as far as able

1 To prev. recur of plethor state

2 To avoid causes encreasing [amount] of blood in general.

4 To avoid circum giving uncommon momentum at lungs.

And to support free circulat on surface

Is cheifly on these grounds that would explain prin part of pract already [empl] or hereafter to be empl. with this patient.

Although at same time some meas also taken from appreh. that already tendency to Phthis affect.

And not impossib that if freq. returns of bloody expect. may afterwards have recour to others as means of encreas. resist to passage of blood by lungs.

Especially if, which at least highly presum., from contin of disease indicat of gener. pleth. entirely removed.

When patient first came under care had been free from bloody expect for space of ten days only.

Had reason to hope therefore that [still] [some] interval for trial of means with view of prev. return.

Might with this view have had recours to various means of prev. plethor.

Partic to diff. evac.

And from none more certain or immed affect than from blood letting

But although influence powerful yet but temporary

And in end often occas even afterwards greater dispos. to renewal of same state

From this circum then unless where appear. urgent seldom consider it as being an advis remed.

Same obj. does not indeed in gener. occurr to cathart.

And hold cathart of refrig. kind to be among most powerful means of counter counteracting tendency to plethor.

But here natural catharsis had occurrd without aid of med.

And while this at least cont, use of these superseded.

Was then from such consider that at commen of treatment had recourse to nitrous powders alone.

This employd princip with view of obt. from it consid affects as [disting] impetus momentum of circul.

And by this means prevent. impet by which fresh rupt of vessels in lungs prod.

Among neutral salts many which have what may be called refrig. quality.

That is from solut in mouth a sense of cold is excited.

While from action on stomach & other parts of alim canal prod general sensat of cold over whole system.

And at same time prod gives rise general affect of sedatives to [sanguin] syst. very manif dimin moment of blood.

Such then would naturally occurr as [app] in pres. case.

Especially as besides indicat of augm impet at extreme vessels from gener [fluid] here also very consid quickness of pulse.

Never [remained] below [100] sometimes even at 120.

Of all neutrals howevr none from which have ever observd more powerful affects in this way than from nitre

And accord. in such cases is in very freq. use among pract. in general

In my own pract have I think in such inst found it prod even of best effects.

Was intent therefore to cont. it to consid extent at least for some length of time.

And if Haemopt. did not return at usual period to go on with it till [that] period past.

Is a med which in common pract is exhib in diff forms.

Not unfreq. given in way of mixture

And in this [rate] action most immed.

Yet has at least most remarkab. affect as exciting cold when solut takes place in syst itself.

On this acct therefore consider it in such circum prefer. to give it in [sub].

Here directed in form of powder comb. with G. Arab.

From which as demul. hoped for some good effect as mitig cough.

And probab. that this operated at [leas] [as] excit cause [recovery] haemoptys

On use of this med patient cont for space of two weeks.

And during that period appear rathr favourable as otherwise.

Cont. at least free from any return of spitting of blood.

And although [celerit] of pulse but little dimin. yet skin at least [cooler] than before

While at same time less appear of that florid complex. indic augm impet at extreme vessels.

Thus far then seemd to have [effec]

But while in this respect relief of sympts. in other partic where nothing [diminished].

And both cough & Dyspnea if any thing rather augm.

By this led to suspect that [dimn] repeated haemorrh. there might have taken place effus. inflam or even local suppurat in breast.

Imagined therfore that some advant might be derived from determ circul to neighb parts.

And was with this intent that directed applic of blister to be converted into issue.

This imagined might without any incon. be conjoined with nitrous powders.

And that upon whole affects would rather [cooper.] than obst. each other.

While howevr with copious & free disch from blister come relief of cough & dyspnea appetite much impaired.

And this he suspected to be affect of powders.

As therefore no return of expector of blood, & as cont seemd less necess. [though] of intermitting use.

And to this the rather induced from another circum.

State viz of expectorat which now took place.

From this some presumpt. that ulcer in breast had already in reality taken place.

For although abatement of cough & dyspnea yet still consid quickness of pulse

And matter expect. to consid extent which in some respects at least resemb. to pus.

Had at least appear of pus in consist & colour.

And was something in fav of suppos. that cont. slight mixt of blood.

From all these taken together [indeed] am far from thinking that have evid of purul. expector.

And must own that still rather disp to be of contrary opin.

Yet here thought it not improper to have recourse to remed. of which have already spoken as [aid] in other Phthis [cases]

Use viz of G. Myrrh.

A remedy of good effects of which in [cases] of ulcerat of breast, inclined to have good favour opin.

And that both from some trials [which] have made on other occas. & still more from observat of a pract on whose observ am disp. to lay great stress

Yet of effects wish to be more fully satisf. by future exper.

If therefore in pres. inst should afterwards have evid that ulcerat really existed, would I thought afford opport of trying effect.

And if had at least better chance of doing good from having been begun early

If on contr. expect although with mixt of blood merely mucous would at least do no harm.

These then the consid by which first induced to use of Myrrh & still [prop] to cont it.

Since begun use found sympt so much relieved that did not bestow prop. attent to support disch by issue

And indeed this a pract to contin of which from pain occas. pract patients can seldom be induced.

During contin however with Myrrh alone although cough & dysp much mitig has had some return of the [Ham]

By this induced again to return to use of nitre.

And now intent to give both Myrrh & nitre in conjunct

In this course if no partic reason for altering it shall wish to persist for some length of time.

And during this shall endeav to pay attent to all circum by which can ascertain real nature of [expect] matter.

If evid of purul. & at same time patien under our manag. this course gets rid of distemper may I think be consid as ex of effic of myrrh.

But from what already said of prog. will readily conclude that whether purul or not, recov by means of this is more than expect.

At same time future treatment which may be necess. must be much regul by circum.

If bloody expect shall again return in excess. degree may have recourse be said besides refrig. to evac. partic cooling cathart & blood letting.

And at same time enjoining, the [avoid] with utmost care every circum acceler circulat as stim diet, bodily motion or like

While by these endeav to dimin [force] by which blood expelld may also consider it even as exped to take some meas. for encreas. resist.

And with this intent may have recourse to astring either from Veg or Min. Kingdom.

As belonging to first may employ roses, succus japon or g. Kino.

And as belonging to last may have recourse to Alum or to Vitriol acid in more pure state.

Of these veget & min astring diff conjunct combinat in the Phar of Coll of Ednr.

Partic in Pulv. [Styptic] & Inf. Ros.

In one Alum united with G. Kino

In other Roses with Vitriol acid.

But besides this other combin also might be suggest.

And cannot help thinking that infus. of suc. japon as well as of roses might be advant united with Vitriol acid.

If any astring here employed shall prob first have recourse to this formula

Reckon it however less probab. that will be necess to alter meas with view of checking excess. haemorrh. than of counter influ of suppurat.

And If this shall seem necess. some circum in pres. case which might lead to trial under caut manag. of Per. Bark.

At same time with regard to meas to be taken in conseq. of future occur. can at pres. form only vague conject.

And shall be better satisf if can [dismiss] patient without trial of any othr med than already prop. begun.