DEP/DUA/1/19/02 (Transcript version)

Robert Hunter

(1778-1779)

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Robert Hunter.

Sympt occurring with this patient by no means uncommon at his period of life or at this season of year.

Severe cough attended with Dyspnea so freq with old people that in many of best syst. of pract. even has got name of catarrh Senilis.

And such with great prop. such very properly applic in case of pres. patient who is nearly arrived at 70 year of age.

But although most freq with old peop. yet not conf. to these.

And imagine therefore that with greatr prop. may obt name of chron. catarrh.

Sympt of this affect in diff. cases very little varied.

Princip variety what respects state of expectorat.

Almost always thick viscid mucus.

Sometimes to great degree, sometimes more scanty

When latter of these circum case as happened with our patient breathing in general the most affected.

For depends not on scanty secret. but on matter accumul in air vesic of lungs & small branches of aspora arteria Trachea.

Such accumul. of secreted mucus then consid as having been princip cause both of cough & Dysp. with pres. patient.

At same time some reason to susp. that was not sole cause.

Is indeed true that patient not subj to any of those sympt consid as most cert. charact of Hydrothor.

But of this some presumpt from dropsic swelling of legs.

And well known that the disease often subs. when no mark by which can be [disting]

Hence then when Dyspn. very great with other dropsic appear. reason alway for susp. either anas of lungs or [affec] into cavit of Thorax.

This then foundat of susp. in pres. case

And not imposs. that either in progress of disease shall have stronger evid of it or after death of patient more certain proof from dissect.

For here must own am by no means without appreh respecting termin of affect

Chron Catarrh indeed in uncomplic state will often cont. for many years & to high degree without proving fatal cutting off patient

Yet in end partic when patients far advan in life often even of itself prov fatal.

Still more however to be appreh where reason to think that conj with others.

Part. when these of still more danger [nat]

And such dropsic affect. will unquest be allowed to be.

If opin therefore not a mistaken one pres. case rather unfav as otherwise.

At same time recovery would be by no means surpr.

And if on pres attack does prove fatal am inclind to hope that will not be for consid time.

During that period meas may be tried both with view of allev. & remov. compl.

And here accord to idea given of affect. allev cheifly to be expectd by remov of matter accumul. in lungs or cavit of breast

While what prop speaking to be calld cure must be affect of prev of fresh accumul.

In this inst suppose dyspnea in part in effect of water in part of mucus.

Former may be carried off in diff ways but partic by the Lymph. absorb.

While latter in as far as already [secreted] to be carried off only by expect.

But with respect to both of much more conseq. to prev. farther depos.

And this to be done by giving due vigour to affected parts but still more by deriv of fluids from these

And is partic on this latter princip that many patients regul affectd with chron catarh during winter as regul free from it during summer.

For during latter period temperat of weather gives determ to surface during former determin from surf to intern parts.

These then what I take to be prin obj to be aimd at in treatm of this affect.

Some varieties indeed will occurr in partic cases depend on circum.

Such for ex as removal of irritat from fauces by matter lubric there.

But what now stated will explain inten with respect to most of pract directed in pres. inst.

And on these shall next offer some remarks.

First meas with this patient was applic of blister to side.

From this meas expected advant. both with view to catarrh & dropsic part of affect.

Cannot indeed be supposed to have any influen as abstr. from lungs mucus already depos. there.

For probab. is that thicker parts can in no case be taken up by absorb

But in as far as fresh [secret] depends on determ of fluids to breast must have tenden to dimin it.

And according few pract found more affect in this disease than epispast vesic & even [suppurant].

That is purul. disch induced & supported either by issue ointm or [illegible] contriv.

Here however expected more from [illegible] blisters than from contin of purul disch.

For if some advant to be lookd for as counteracting catarrh still more to be hoped for on suppos of water depos in breast.

Of all modes of evac in cases even of hydroth blisters one of most effect.

And not less so where water in place of being lodged in cav of Thor in [illegible] [illegible] of lungs

From blister therefore with both these views entert high expectat. of benef.

And by effects at first prod meant to regul cond as to repet.

But even suppos blister prod of greatest advant yet did not think that cure to be trusted to this alone

And accord directed also at same time another med. a combin viz of equal parts of Crem of Tart & Nitr.

Of these articles former, when taken at least to certain extent, has very consid affect as acting on [alimin] canal

In this way now in very common use as a cathart.

And freq given both with intent of emptying intest & of evac from system.

When employd howevr with latter of these intent, & meant to operate as purgat must be given to great extent.

Here utmost that wishd from action on intest was merely effect of gently moving belly.

And from this hoped that while determ to breast somewhat dimin, stim of arising from irrit fauces as affecting circul. [through] whole syst. might also be removed.

But besides action on intest, Crem of Tart in many inst at least exerts affect also as entering circulat.

And like many other artic of saline tribe is especially thrown off by kidneys, where operat as stimul, encr. action & augm secret.

But if Crem of Tart often employd as Diuret. Nitre no less so.

And among artic of this class has been very long & very common in use

Of late in sever. inst have employd cream of Tart & Nitre in conjunct.

And am inclind to think that thus obt more effect [diuret] than from either separ.

Do not indeed by any means repres. as a remed med which will cert operate by Diures.

And am inclind to think that no artic of whole class on which depend can be put.

Princip advant of this combin that sits more easily on stomach, than equal quantit of Nitre by itself.

And that less apt to run off by stool than if consisted wholy of Cr. Tart.

To these as well as to either used by itself diff correct. might be added.

But even without any addit have found it in many cases not only not prod of inconven, but followed by best affects.

Was in hopes therfore that from this med should derive some good effect as moving belly, still more as prom diures.

For by this means expectd that water depos. about organs of [respir] would be absorbd & disch from syst.

[illegible] myself that from this conj with blister dropsic affect might be removed.

And that might even allev. catarrh compl by determ from breast to kidney.

In answering these expect howevr med here used but of little avail.

In obvious operat of blister indeed were not disappointed.

For not only rose well, but copious disch of [seros.] afterwards [ensued].

Nitrous powder also not followed by any effect which would have wishd should not occurr.

That is neither occas. sickness at stom, inclin to vomit, nor those fits of chilliness with which very freq followd

But with respect to obvious operat were disappoint of effect in both ways.

For had neither influ as moving belly nor as encreas quantity of urine

Not surpriz then that by use of these no allev. either of cough, dysp. or swelling of legs should be obt.

On latter of these sympt could hardly expect that blister to chest should have any influ.

But was somewhat disappointd that had no effect in giving any relief to two former compl.

Although however had thus faild did not from this concl. that repet would be prod of no advant.

But before taking this meas [illegible] with a patient so far advancd in life as pres. that interv space of a week or two should interv.

During that period was intent to persist in med before prescribd.

And to increase as far as possib chance of obt effects by augm dose.

With this view in place of ℥i of Cream Tart ordered each dose to be prep with [ Jii].

But besides this thought it advis also to make anoth addit.

And both with view to diures Dropsic & catarrh affect ordered Pil. Scillit.

Of this formul. consider activ as entire depending on artic from whence derives name.

That is the Squills.

Look upon root of Squills to be one of most certain & effect diuret with which are yet acquainted.

But besides acting as stimul to kidney when enters circul syst. exerts also simil influence on other parts.

And partic on excretories of mucus by lungs.

From influence indeed as encreas secret there might be imag. that in pres. case would have rather bad affect as otherwise.

But while augm secret, by fluid being thus of thinner consist, renders excret. more easy.

And thus gives appear at least of a prop. often ascribd to it, that viz of attenuating mucus.

A prop. however which after secret has already taken place, cannot [come] to be [possesed] by any med.

But while Squills give this appear at least from prom new secret. serve still farther to be of service in catarh on another prin.

For in conseq of reaching [excretories] promote efforts for excret.

And thus also mucus disch in [more] fluid state.

From influ as prom expect often useful in freeing lungs from load with which before [oppressd].

Cannot howevr say that from use in pres inst derivd much benef.

For though cough somewhat mitig yet pills no influ in encreas expect.

While at same time no obvious effect at least as encreasing quantity of urine.

Nor did this in any degree result from use of former med the Crem Tart with Nitre in encreasd dose

While at same time still faild in effect of moving belly.

While in this situat Dysp. encreasd besides contin of these med. thought it advis to have again recourse to repet of blister.

And with view to encreasing influ directed that should for some time be kept open by Epispast. ointmnt.

But even under this administ. patient derivd from it no manif advant.

While at same time urgen of cough led me to susp. that some benef migh arise from articles of lubr. nature.

With this view therefore [omitting] powder & contin issue conj with pil Scillit the use of Mist. Oleos.

But these pract not more success than former.

And while from issue very little disch was at same time prod of very great uneas to patient.

Led therfore to discont. it.

And as still disapp. both of influ of squill pill in promot expect & in exciting Diures. thought of subst. to these another med. viz Spt. Nit. dulc.

This consider when does operate to be one of most exped Diuret. which can possess.

And as evac of Seros. have in many inst seen best affects from it.

What however was influ with pres patient have not been informd.

For since first prescr. have seen nothing more of him at this place.

And as probab. may not visit us again unnecss. to say any thing with respect to future plans of cure.

May only observe that after all [attemp] already made have provd fruitless, opin of case more unfav. than when began [treatm]