DEP/DUA/1/19/14 (Transcript version)

William Bouchier

(1778-1779)

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Case of next patient Wm [Bouchie] in no long time favourable termin under our care.

From prin sympt of disease cough dyspnea & copious expect. could have no diffic in referring it to genus catarrh.

Especially as in appear of matter expector. nothing giving slightest count to suppos of mixt. of pus.

And no indicat of hectic fever or other circum giving counten to phthis affect

While however disease thus evid catar of catarh was without fever.

And although patient not at that period of life during which could get name of catarrhus senilis yet could have no diffic in giving it appellat of chron catarrh.

Especially as had now subsisted with patient to [some] degree for space of three years.

And applied for our [assist] only in [cons] of pecul aggrav of compl. from which rendered more distressing to him.

Circum of case during summer, of itself a strong evid of this affect.

For among other marks of disease may be reckond one of most charact that always aggrav by cold weather.

From all these partic then could entert no doubt. with respect to prin part of patients affect.

Yet affectd also with one other sympt respecting which some diffic whether belongs to this or not.

That is swelling of legs at night.

This we can have little doubt depended on water collectd in cellul memb of parts.

To be consid therefore as giving indic of the incip state of another disease dropsy [ansarca].

And well known that from [Anasa] as affect lungs, some of most distress. sympt in pres case, Cough & Dyspnoea arise.

Then however without that state of expector. which here occurrs.

Besides these sympt as arising from [anasarca] occurr only when the disease has arisen to a consid height.

Swellings however as here taking place to slight degree only.

And without other sympt attending incip state of anas. scarcit of urine, [thir] &e.

Can have little doubt then that cough & urine Dysp not the conseq of [anas]

But that from these togeth with debilit state of patient anasarca. affect has here derivd its origine.

This then opin as to nature of disease to which patient was subj.

Observat on Prognosis now precluded from being already brought to fav term.

Here may only observe that relief which patient obtaind occurrd sooner than I expected.

Did not indeed look upon disease as attended with any threatning sympt

But very freq happens that where compl. even much slighter than those of this patient contin with obstin notwith best instit plan of cure.

And when do yield is generally in more slow & grad manner than in this case.

But although case has had so far fav progr. that have dismissd patien yet must observe that by no means consid him as free from danger of relapse.

This partic apt to happen from even slightest expos to cold.

In this respect however pres [seas] has been pract favourable.

And in all probab. compl. would not have been so far allev in so short time, if weather had been more severe.

With this circum however am inclind to think that treatm here directed for patient, at least in some degree conspired.

Of this then come next to make some remarks.

In this affect consider what may be reckond proxim cause of the disease to consist in encreased mucous secret by the lungs.

From matter thus accum filling air vesicles [illegible] Dypsn arises.

And from irritat cough.

Great obj in cure then first to free lungs from this matter

And then to prev. fresh accumul.

With these intent remed here directd were employd

As means of evac mucus already accumul. had recourse to emet.

These indeed unquest operate most immed, as disch contents of stom.

But can be no doubt that few more exped or effect expect.

Prob conseq of concuss agitat & gener effort to which they give rise.

And in this way, well known that often prod of consid & immed benef when lungs oppressd.

But besides this hold that in such affect as pres, useful also on other prin.

Partic as giving determ to surface of body.

By this means often affect as remov that determ to breast by which disease supportd.

And thus have tend, not only to allev of sympt, but to radic cure.

Notwith these advant howevr very freq repet never perhaps advis.

For unavoid conseq. is that tone of stomach weakned.

Hence then even where seem prod of best affects, to be used with caut

And after first or second dose some interv to be allowed.

With pres patient two vomits taken during course of first week.

And obvious operat of both these as could have wishd.

Not however attendd with that relief of sympt which expected.

For after use of both cough & Dysp contin nearly in formr state

In this situat then less encour. for repetit of emet.

But had they been [even] more success. should have wishd to [intem] use at least for week

And was intent, if matters had cont. in same state to have directed repet.

But in mean time ordered for patien the use of Squill pills as much with intent of occup interm time as with hope of great benef.

Must however observe that hold squills to be in such affect both an active & useful med.

That these as acting entering circulat exert action on kidney no one will deny.

And for my own part am as fully satisf. that act also on other secret organs partic those by lungs.

From this circum however may seem ill adapted for such a case as pres.

For here suppose affect supported by encreased [illegible] secretion

But if in this way influ rather adverse is more than compens. by action as prom excret.

By this means mucus disch before acquires viscid & thus both cough & Dysp. mitig.

Hence then though no great tendency to radic cure while allev sympt allows better opport for syst. to recov itself.

That was prod of this affect in pres. case at least probab.

For from time that use begun expect more free & easy.

In this situat in place of returning to emet. thought it better to contin squills & augm use.

And from persist in this course patients compl. so far mitig that consid farther attend as unnecess.

As have some heard nothing of him am in hopes that cont free from return

Next case this day forthnight