DEP/DUA/1/22/13 (Transcript version)

William Gray

(1779-1780)

---

Wm Gray.

Have already hinted that consider this patient, as well as last Archd Campb to be subj to Phthisis.

Of this however have not at least same degree of certainty.

Yet from sever circum consider it as more probab than any other suppos.

And if really the case exhib very diff example of Phthis from last mentiond.

While referrd formr to vomica [am] inclind to think that this again prod of tubercle.

Here indeed may among other circum remark, stricking disparity in progr of two cases

One brought to fatal period even in space of few months

Other has sub already for years.

And patient still in such a state that cannot be said to threaten immed danger.

+ And little doubt that dyspn affect of this matter loading air vesic of lungs & small branches of Bronchia

In both cases with dyspnoea consid degree of expectorat

>+

But great reason to presume that matter expect very differ.

Have already had occasion to point out circum from which led to concl. former to be purul.

Here again from diff of circum, would conclude this to be mucus.

Patient not affected with that fixd pain at any part of thorax which commonly case in vomica.

Matter neither foetid, smell, disagreable taste, nor appear of mixt of blood.

And although tongue moist, yet without that pecul cleaness & rawness, which the attend of purul expector.

But besides all these tests another & perhaps still stronger mark afforded

Have had opport of trying the matter expect by this patient with test prop by late ingen Mr Darwin in treatise mentiond last lect.

And have found that this expect matter by aid of a little agit. comp. & entirely dissolvd in caust. alkali.

While this however univ allowd to be case with mucus, will find from Mr Darwins 32 Expt. that by no means holds of pus.

Found latter fluid incap of being dissolvd by caustic alk. lixiv of ordin or even of double strength.

And that too although much agitat empl. with view to forward solut.

This experim he observes, he repeatd five diff times, with same event.

Must therefore concl. that very little room for decept.

And on this ground, corrob other circ would concl. that matter here expect entirely mucus.

From this may naturally be susp. that compl. in place of being phthis, entirely catarrhal.

And that susp strength by two other circum.

Contin viz of disease, & aggrav. during winter.

Although sometimes happens yet but rarely that patients subj to Phth for years.

While again aggrav during partic [seas] especially winter much more common with catarh when in chronic state.

To these may also perhaps add age of patient.

Already in 34^th year, past period when phthis most common.

And at same time verging to that when patients most affected with chron catarrh

These circum it must be allowed are all in favour of suppos of catarh

And as here expect not purul. are necess led to concl. that catarrh in some degree takes place.

Yet at same time other circum which would lead to belief that [Phth] also occurrs.

At an early period of life long cont cough always a susp. circum.

This [suspect] here corrob by quickness of pulse.

Still more by hectic flushings, night sweats & exhausted habit.

But to all these, anoth circum to be added, giving still stronger ground for suspic.

That is evid marks of scroph, appear in [scars] under chin.

From every circum of case reason here to presume that Phthis [from] [tubercle].

And well known that of this the most freq. if not indeed only origin is scroph habit.

From all these circum taken togeth then too much reason to appreh. that this patient subj to tuberc consumpt.

And although consider Phthis as here complic with catarrh yet look upon former as by much most import & danger part of affect.

Is obj. therefore princip to be regarded both in prognos & in meas for cure.

Here indeed if affect only catarrh patient may either have complete [recov] or may not at least fall victim to the affect although subj to it for many years.

But if really Phthis chance much against him.

And although may hang out for pres & even anoth winter, yet if not in end cut off by disease notwith all remed which we can employ, is more than I expect.

Here, suppos affect to proceed from tubercle, most import obj in cure would be, remov of that morbid cond

What calld tubercles, appear from dissect to be small indur tumours usually of whitish colour, which may have seat at any part of lungs.

And often even to be found there in great numbers.

Evid from situat that cannot possib admit of remov by operat.

Alone to be expected by action of absorb, & renewal of circulat.

Well known that in this way many obstin indol tumours at length [disolvd].

And as long as circul. through them contin this at least possib.

But not unfreq., that vessels being entirely oblit, these become as it were an inorgan mass.

And if sometimes happens, in other cases, is a freq occurr in Scroph tum in general, but partic in tub. of lungs.

Here then not surpriz that the obt. removal by resolut always diffic, often perhaps imposs.

Where cannot be accompl. next object as far as able, to counteract effect [also] remain.

And either to prevent separat of [illegible ] sanies giving hectic fever, or although separated to prev action on syst.

More freq happens however that none of these intent can be accompl

And that must content ourselves merely with endeav to obvi sympt.

Where however circum of the case will admit of it, something at least to be attemptd in first way.

And is with view to resolut of tubercles, that have here had [recourse] to repeated Emet.

These, have long with diff intent, been advised against Phthisis

And sever prin, on which may I imagine expect benef from them.

In case before us hoped, for some effect from them, as unload lungs & determ to surface.

But cheifly determ, to persist in use, from accounts which have latly heard, of use now made, by some pract in London of Emet, in other cases of Scroph

Have been told that by freq empl even largest & most indol scroph tumour happily resolvd.

Not indeed suited for this during inflammat stage.

But after inflam gone while indol tum remains often of great serv in removal.

For this And that pract, some analogy at least, in use that has long been made of them in a partic gland swelling that of testic

>+

On what princip there operate hard to say.

But probab. that affect in part at least dep. on giving increasd action to whole vascul syst, both sanguif & absorbent.

But whatever princip of operat, success in certain states of that affect, conf by exper.

And analogy alone a circum suff to encourage to use, in simil cases.

On this foundat then, consid pres as an inst where merit fair trial.

And with this intent, patient has now for space of month taken sometimes one, but in gener. two vomits every day week.

Cannot however say that from these have derivd any manif advant.

On contrary affect rather more distressing to him.

And whatever may be influ in other cases now begin to be appreh, that shall not find it, adeq to cure in pres.

Hitherto have empl. this pract almost alone

Princip that might be able to judge how far by itself, had effects

Of late indeed, with view to dyspn, have ordered applic of blister to breast

But although disp to place some confid in issues, in such cases, this merely empl as tempor meas.

And if do not find some change at next report, neither intendd to support drain nor to push use of emet any farther

Here prop next, to try a pract which for my own part at least, have not hitherto used in Phthisis.

Nor do I observe it mentiond by any of latest writer - viz Cicuta.

Need not observe that has of late been highly celeb. against schirr & even cancer. tum.

Has been extolld also as highly adv. in cases of open cancer.

And for my own part, although do not consider it as univ success, yet have good opin of it, even in these.

Of late also have used it much in cases, both of scroph tum & ulcerat & I think with advant.

On these grounds is I think natur suggested in such a case of Phth as pres.

But here do not prop to employ it alone.

Have thought, that power as discut, in many inst encreased, from combin with Calomel.

To Merc indeed objected in cases of scroph that induc suppurat.

But still doubtful whether this a good or bad affect.

And Of discut power of mercury in such cases however, some pract, partic Sir J. Pringle very high opin.

After finish with Emet therefore next prop to give this fair trial.

And if find it success. shall be disp to consider it as strong proof of effic.

Perhaps however even should recov. occur., credit may be given it without [reas]

And that not merely as may be mist respect disease.

For may observe, that patient will naturally at this season of year, be put in way of anoth remed. of late extolld.

What I allude to, a Span pract. extold by Dr Simmon. in treatise on consup

The Banos de Tierra or Earth Bath.

This pract consists in burying patient up to chin in fresh earth, or in pitt dug for that purpose.

In this situat contin for

& repeated at intervals.

Is partic celeb in cases of consumpt

Dr Simmons mentions sever inst of efficacy.

And imag, that good effects to be acct for from effluv of Earth absorbd

And from being carried into circul correct. morbid state of fluids on which hectic depends.

Recomm., therefore that trial should be made of it during warm months in the country.

How far pract realy advant, future exper must determ.

May only observe that very analog. with what long empl, with delic & weakly child in this country following the plow.

And not even uncommon to lay them in new made furrow.

Have not at pres in view a trial of this pract with pres. patient.

But may obs. that is by occupat a Gardner.

At this season therefore as far as heat will permit will be empl. in digging up ground.

And therefore hard to say, how far if recov. should take place may not be attrib to that cause.

Here however must observe that although can say nothing either for or against virtues, yet should not expect any great benef from it in such a case as pres.

Although may be useful in reliev hectic fever yet should not expect from it the remov. of tubercle.

Still therefore in as far as advant may be obt. presumpt at least in fav of Cicuta with Mercury.

Besides this might sugg also other meas to be employd if what now ment. unsuccess.

But as no opport of trying these at least during pres course hold it to be unnecss.