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

Nelly Drummond

(1778-1779)

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Nelly Drummond.

Of case of this patient a great deal much might be said.

And that both with respect to nature of affect, probab. event & treatment.

As of late however has attended but little & probab. may not be see much more of her, reckon it less necess to say much.

Sympts such as to render it in good meas doubtful whether subj to Phthi or to Catarrh.

For in differ partic here in mentioned cough, dyspnoea, expector, state of pulse &e nothing giving certain evid of Phthis.

No doubt that appear in catarrh often nearly approach to those.

And but seldom at least that Phthis contin for so long period as pres. compl have already subs. without prov. fatal.

Yet on other hand greatest number of circum rather in fav of suppos of [Phth] as [otherwise]

Cause from which origin well known freq to lay found of Phthis.

As conseq. of small pox find often suppurat & inflam & suppurat in every diff part of body.

And not unfreq affects lungs

Such however are told was commen of pres. case.

While a cause readily giving rise to Phthis cannot easily suppose that should induce catarrh.

Although duration of affect against Phth. yet not less so with catarrh.

For patient has not arrivd at that period of life when reason to look for catarrh of chronic kind.

Nor are compl partic aggrav. by those circum known to encrease it. ex Cold

Is not observd partic severe during winter & to cease in colder weather.

This however is almost unif case with chronic catarrh.

Hence then no more reason from this circum still less reason for suppos of Catar than of Phthisis.

Might probab. be her [formentd] with certain test from nature of expect. matter.

Matter accord to descript given us in every respect a purul appear.

And if really found such must necess consid disease to be Phthis.

Need hardly howevr observe that common tests prop for disting matter from mucus, taste, smell [illegible] in water, effects of burning, &e subj to great falacy.

Have indeed but been furnishd with much more cert diagn by late ingen Mr Dar. from and one affect disting from other by having recourse either to vitriol acid or to Caust. alkali.

For some acct. of his method of distinct may referr you to a late Vol of med. Com.

These howevr merely result of Exper.

But the whole dissertat will soon I am told be pub. by his Father.

Here however unnecess to speak of it as patient never put it in powr to give trial to this diagnost

Where expect or purul. tongue almost in every inst clean & red.

This however partic case with our patient.

In as far however as can judge from other circum matter expect really purul. Besides Smell & Taste conf by Ton

Hence disp to consider her as subj to Phthis

Yet must concl with observ. that without farther test no absolute cert.

And if patient has not discontinued attendance shall be endeav to proc it employ such.

In pres. view of case disp to give an unfav prognos.

For if realy subj to Phthisis is a disease from which recov. at utmost but rare.

And that too even in most favour cases.

Of such [nature] indeed suppose pres. case to be

For always at least better chance where matter has free disch, than where retaind in vomica.

Or where hectic fever excited from sanies yeilded by tubercle without any proper purul expectorat.

Is also somewhat in favour of patient that disease for so great length of time has had so little effect in debilit.

For would argue that purul matter yeilded of mild & bland nature.

Hence then even although suppos. true patient may yet recover.

Still more so if in idea of disease are mistaken & affect really catarrhal.

Yet disposed to consider chance as being upon whole rather against her.

And from sympt having been of late much aggrav. should not even be surp. at fatal termin in short time.

In practice in such case as pres. great obj. to be aimd at is the healing ulcerat of lungs.

And till this can be affected the obviating effects of purul matter [absorbd] into circul system.

Healing of ulcer in this as in all other cases must princip at least be work of nature.

Yet diff partic by which may at least in some meas be aided.

Cheifly I imagine to be done in 2 ways.

By promoting viz free disch of purul matter from lungs.

And by endeav to bring on that degree of action of vessels which constit forwards adhes. or what has been calld adhes. inflam.

With view to accompl. any of those ends however have here had it in power to use very few med.

For although consid time since patien admitted on list yet has attended us very little.

And from absence of late not improb that shall see nothing farther of her.

Here neither hectic fever nor any other sympt very urgent.

Consid no meas. therefore as here necess for counteracting influ of purul. absorp.

And while dyspnea not very urgent copious expect shewd that purul. matter had already free disch.

Concl. therefore that with this intent also nothing at pres. requis.

And was willing to direct whole atten to inducing adhes. inflam.

Was with this view that put patient on use of G. Myrrh.

An artic of which have already had occas to give opin when speaking of case of J. Thomson.

And which notwith opin of Dr Foth am inclind to consid as an useful remed.

In this sentim confirmd not only on [auth] of some emmin practit but likewise on own observat.

Circum of pres. case such as suppose partic suited for this remed.

And if patient returns to attend will be endeav as far as circum will permit to give full & fair trial.

May probab. as has been recommendd by Dr Mos. Griffith unite it with small proport of salt of steel.

This plan which intended to prosec. if patient had contin attend, & which prob. shall follow if renews it.

But as chance that this may not be case hold it unnecess. to suggest any thing farther.