DEP/DUA/1/24/05 (Transcript version)

James Ingram

(1780-1781)

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James Ingram.

Disease to which subj consists of but few sympt.

And these of such nature that can leave no room for doubt as to disease complaint.

That in affect of this patient an example of Haemoptys. evid from bloody expect.

To be observd however that [mere] bloody disch from lungs may [arise] from very diff causes.

And partic that may depend upon haemorh. either of active or passive kind.

Determ of this question of conseq both in progn & practice

And although sometimes very easy matter yet others where cannot arrive at certainty.

This I think some reason for presume pronoun. to be case in pres. inst.

For though pulse affected, not such encrease of velocity or force as is the common attend of active haem

While again if fever at all [existed] but very inconsid.

For appetite natur & free from thirst

But on other hand passive haem seldom commen without obv. cause

And in inst before us patient unacquainted with any accid which could induce it.

Had receivd no external injury

And all the cough which was affected no more than tussicula which attends every inst of activ.

If therefore of passive kind must have depended on some local eros. of vessels at some part of lungs.

And this by no means imposs.

At same time consider suppos of its being of active kind as more probab.

Patient not past that age when such might be expected.

Pulse evid that pecul. [hard] feel which so much the concom of encreased impetus.

Heat of skin above natur. stand

And if other febrile sympt less consid than might have been exp. to be rememb. that Haem but to slight degree.

While then consid affect as Haemop look upon Haemorr. to be of active kind.

Any farther inquiry resp. species reckon unnecess.

For although many by Sauv. Sagar &c yet merely of same [essent] nature, proceeding from diff. causes.

As to prognosis in this case may be thought, from begining haemorrh very slight.

And that now appear have almost entirely vanishd.

Yet even on these grounds cannot venture to give fav progn.

For to be observd that haemopty, not so much indeed from itself, as from conseq, a very dangr. disease

Well known that often termin in Phthisis pulmon.

And this more freq. the case when haemorrh very slight than when very severe.

Though sometimes yet seldom death from mere disch of blood in this disease.

Hold therefore that even triffling disch when long contin the most danger.

And although with our patient has been but of short contin yet not free from alarm while any pain of breast.

Would not therefore be surp. at recurrence.

And although does not at pres happen, may afterwards take place.

At same time if no threatning appear soon, may consider farther attend as now at least unnecss.

And may dismiss pat. as cured at least for the time.

This however cannot I think with any great degree of confid attrib to meas. here employd.

For some reason to think that would not have proceed to any greater extent although no meas had recourse to

At least farther than avoid accid by which might have been aggrav

Here however proceeded on same plan that should have done had haemorrh. been much more consid.

First object to be aimd at in all [such] cases the prevent of farther disch by the lungs.

For although Active haemmor. often it is true occurrs with state of syst. in which disch of blood [requis] & [healin]

Thus in some cases epistax rather to be encour as otherwise.

But though may be prop to dimin quant of blood, yet never I appreh prop that dimin should take place by lungs.

For from such always danger of suppurat & conseq Phithis.

Hence therefore always obj to stop & prev as soon as possib.

This however not to be attemptd by encreas resist to passage of blood by lungs but by

For from this merely worst conseq might arise.

Must be obj. therefore to prevent it by remov of cause.

And partic by dimin of impet of blood, by which rupt prod & disch contin.

From situat of lungs however have it not in power to dimin impetus at vessels there in partic.

Must endeav to effect it therefore by dimin of impetus in gener.

On this footing will readily unders meaning in diff pract to which had here recourse.

Although no manif signs of plethor state, yet began by direct blood letting.

For plethora may excit although not strongly indic by any mark.

And in this affect reduct to natur standard essent. necessary

As means of dimin impetus [nothin] more effect than reduc below natur quantity, the induc of state of [inan]

For well known that quantity of blood prin if not only stim to action of vessels.

Here however no necessit for large bleeding, as in sympt nothing urgent.

And if large evac necessary more benef to be had from repet of blood letting at short intervals.

From this then limited quantity to eight ounces.

And was intent if circum requird to have again recourse to repet

Meanwhile howver had recourse also to anoth med.

The use viz of Nitre.

Well known that nitre excites sense of cold both in mouth & in stomach

But besides this influence in same way extended over whole syst.

And sense of cold accomp with consid dimin of impetus of circul.

Here therefore useful as answer same end with blood letting.

But as with former remedy also here no necessit for being precip.

Employd therefore only in small doses.

And comb. with G. Arab. rather to give prop. form than with any other intent.

On this course although no return of bloody spitting, at least for some time past, patient still contin.

Rather indeed that attend might be contin, & that might thus be able to judge how far in reality [rem] than with any other intent.

And had in view the dismiss him at last weekly visit.

But at that time informd of [circum] from which led to alter resolut.

That affected viz with local pain in breast.

This may indeed proceed from [var] cause & may be totally unconn. with Haemopt.

Yet where such sympt had taken place some ground for alarm.

For although not urgent might be prelude to another haemorrh.

Reckond it therefore prop that attend should be cont. till saw [conc]

And on whatever cause might depend, whether connected with Haem or not, thought some benef. migh be obt. from blister

To this meas. therfore had recourse

And am in hopes that by next report may be informed has had affect of complete removal.

If this the case without return of bloody spitting shall rekon farther attend unnecss.

But if pain cont. may accord to circum in which find it have recourse to meas for obv. it.

If Haemoptys. returns shall prosecute plan already begun.

And unless attended with new occurrences shall put more depend on blood letting than any other meas

At same time however enjoin the carefully avoiding all causes which can tend to augm [quantiy] of impetus of blood.

Partic recomm low diet & the shunning stimuli whether extern or internal.

Am in hopes that except such regim no farther meas will be necessary