DEP/DUA/1/24/07 (Transcript version)

Alexander Hastie

(1780-1781)

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Alexr Hastie

With regard to disease of this patient not without diffic both as to name & nature.

At same time only distress. sympt in case both obv. & common.

Although some obvious evident swelling of legs yet princip compl. those of breast.

Consist of great dyspnea & severe cough.

After what said of last case Mary Ainslie will naturally occurr that here great simil.

And both unquest may be affect of mucus

This the rather prob when consid cause from which immed arose.

Expos viz to cold when body [prev.] much heated.

But while affect may be consid as catarrh & depend on mucus, other causes from which may also arise.

And here cheifly divided in opin whethr from mucus or watr.

While formr may be cause of sym many circum fav latter suppos.

Well known that from water either in cellul membr of lungs or in cavity of chest all these sympt. may arise.

And here unquest evid of dropsic affect to certain extent in obv. swelling of legs.

This, from appear. – from effect of press. – & from encrease by erect post manif of anasar. kind.

And gives at least some presumpt that anasar dropsic affect may exist also in other places.

But certain evid of dropsy not only presumpt of its being cause of cough & dyspnoea.

Here will observe that notwith severity of cough very little disch by expectorat

And from this want of evid of mucus presumpt of water

Presumpt heightned by encrease of dyspn in horiz post.

And still more by breathing being more diffic when lies on right than on left side.

As farther evid may add also state of urine.

For as is in gener. case in dropsy, both scanty & high coloured.

Lastly may add as addit circum appear of patient

For had as very much of pale leucophlegm look, as any patient as have ever seen which so common in Drops affections.

Upon whole then strongly disp to consider affect disease as dropsic affect of lungs.

But suppos it such, still another doubt.

Whether viz Anasarca of lungs or prop hydroth.

Is no evid partic of former that ana. of legs.

For this well known to be seldom wanting in hydrothor.

While again in anas. respir little affected by post. & equally diffic on both sides.

But may here be obj to supposit of Hydroth that some of those sympt wanting which pointd out by pract & nosol writers as charac of Hydrothor.

Partic no affect of pulse neither in way of interm, or irregul.

No sudden starting from sound sleep with palpit.

And no evid fluctuat within thorax.

That all these when occurring are strong sympt of hydrothor no one will deny.

Yet may with confid venture to assert that disease may occurr even to such degree as to prove fatal when entirely absent.

Of this lately mett with very [strick] inst

Lately Not long ago attended in conjunct with anoth Physic & Surgeon of this place a pat. in whose case no susp. of hydroth.

After a ted illness which put on diff appear. compl. of pain in breast.

But this without either dyspnoea or cough.

Pulse full strong & regul.

And no inconven from sleeping in horiz. posture.

While not smallest indic of drops sympt in any other part of syst.

In that case much more than in pres. what are reckond the [diag.] of the disease wanting.

Yet in situat I have mentiond patient died very suddenly.

And upon opening body very large collect of water found in left side of Thorax.

When related this case to a very able surgeon at this place Mr An Wood was informd that a simil inst had occurd to him.

At least none of common sympt of hydrothor. & no susp. before death

But on dissect. very large collect of water found in cav. of chest.

From all this would not deny that diagnost of hyrothor. prop.

Have no doubt that where pres. indc exist of the disease

Yet from absence cannot concl that patient free from the affect.

And from all circum of pres case taken together cannot help thinking that more reason to susp disease to be Hydroth than any other affect

With this opin of nature, progn. must at least be doubtful.

For in general ranked among the most danger. forms of dropsy.

And when consid funct. which must or at least may be [disturbd] from water in breast this by no means surpriz.

At same time even when exist as most distinct charact. do not look upon affect as incurab.

And am inclind to believe that often to cert. degree takes place & removed where not distinct markd.

In pres inst from want of most distress. sympt. may concl. that has not proceeded to very great height.

And on pres. occasion at least has not been of very long durat.

For when patient first applied here ailment had cont only a few weeks

Are indeed it is true informd that [durn] former winter subj to simil ailm sympt.

But even this also rather in fav of patient.

For recov at that time gives now some ground for hopes.

Upon whole then though consid affect as danger. yet not without prosp of recov.

At same time must observe that patient now in worse situat than at last report.

And dyspn. in partic so far encreasd that for two weeks past unable to attend us.

Is also not in fav of patient that not very attent in following direct given him.

Hence then at least less chance of benef. from what we can direct.

And should not be surprizd were affect to have fatal termin & that too in sudden manner.

In treatm of this case on suppos that conject as to cause of affect well founded, indicat obv.

Here could expect only can only look for cure of disease from removal of water

And indeed could hardly from any other meas. expect perm relief of symp

Even by this however could not expect what may be calld radic cure.

For after water removed often tenden. to fresh deposit.

In such inst therefore measure also requis for prevent of farther affect.

But of these few at least of such nature that any tenden to prod immed evac.

And hence before any attemps in this way in gener. at least becom necess. that evac first prod.

With view to this intent meas empl in this case almost solely directed

First meas. to which had here [recour] was applic of blister.

And this may obs. a meas. on which in cases of hydrocephthorax more depend than almost any other.

Need not observe that affords artif outlett for the water.

True indeed that from applic in such case as pres. disch not direct.

But while gives vent for disch at same time encreas action of absorb.

And by this means not only artif disch. but chance also of uncommn evac by natur. emunct.

Accord. blisters a very common remedy in this affect.

And from repetit to diff parts of chest at short interv. often very surp. cures.

Was intent therefore with pres patn to have recourse to such repet as occas might require.

Fromm first blister as much [benef] derivd as could reason have expected.

For while prod of free disch both cough & dyspnoea consid relievd.

And notwith distance of situat reckon it also not improb. that ought in some meas to ascr. to it remov. of swellings of legs.

Is indeed true that had here recourse to anoth meas. from which such conseq. might have been expectd.

I mean Spt. Nitri Dulc.

This in my opin, one of the easiest & most exped diuret. which has yet place in Mat. Med.

Do not indeed repres as powerful or certain in operat where other fail.

Nor as prod in conseq of operat very cop disch.

But in gener at least to extent of twenty drops for dose once or twice a day very consid affect.

And although not to be ranked among most powerful yet will sometimes succeed where others gener. reckond more active have faild.

Besides seldom distress to patient as inducing nausea, sickness at stom &e.

Hence then a remedy to which where diuret indic am very much disp to have recourse.

And in pres inst expected benef. from it on sever. footings.

Hoped that while blister prom absorpt of water, would tend to disch

Expected that by copious diures. absorpt. would be still farther prom.

And imagind that might have influence as counteract [strangur] affect sometimes arising from blister.

How far was of any use with latter of these intent perhaps mattr of doubt.

Patient however not affected with [strang]

An occurr howver which might very readily have happ. without Spt. Nit.

But if any influ in this way were at least disapp. of effects in other.

For in conseq. of use no obv. encr of urine.

At this however, after trial for space of eight days, neither surp. nor disap.

And although inclind to consider both remov of swelling of legs & allev of dysp. as affect of blister, yet necss to delay repet for few days.

And in mean while thought could not do better than contin Spt. Nitr.

Now however directed augm of dose from 20 to 30 drops.

And as means of still farther aiding operat advised also anoth diuret.

Use viz of Squills in form of pills.

Diuret. power of squills is I may say univ admitted.

And by many held as most cert & powerful artic referrd to class.

Hoped therefore that in conj. with former artic might prod desired effect.

But besides this exp. benef. also on anoth footing

Am persuaded that secret. organs of urine not only ones on which squils act after entering circul.

Have I think unden evid of exert same influ on those of lungs.

And imagind that might here tend to relieve pneum sympt. from prom disch by expectorat.

Hoped then that should soon see good affects of this course.

Since Nitre encreasd howver & squils prescribd, patient has never been pres at [reports] here

Am sorry to say that this has proceeded from inabilit to attend

And from visit him at his own house have had mortif to learn that neither Squils nor Spt of Nitre any influ as encreas. urine.

This however am inclind to susp has in some meas proceeded from inattent or avers to med on his own part.

But whether regul taken or not most distress sympt of patient aggrav since last saw him here.

And although no return of swellg of legs, yet very much distressd with cough & dyspnoea.

In this situat have ordered repetit of meas with which began & which indeed had in view if attend had been contin.

Applic viz of blister.

But must own am very doubtful how far this direct. will be compl. with.

If however patient does follow adv hope that will be attended with som benef.

And shall still be disp to advs repetit at prop intervals.

But during these in place of Spt of Nitre & squills to which now expr aversion, have thoughts of employ with nearly same intent the Cream of Tart.

And if shall prove properly diuret. may expect advant.

If not many others meas from which at least probab chance of allev to which may have recours

But with uncert of patients attend unnecess at pres to suggest any thing farther.