DEP/DUA/1/24/09 (Transcript version)

Andrew Hutton

(1780-1781)

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Andrew Hutton

In this patients case a set of sympt very freq. at this season of year.

Compl. in many respects simil to those occurring in case of M Hutton [Ainslie]

Consist princip of cough, dysp. & pain of breast with cop. expect.

These we have already observed a set of sympt. in common both to Catarrh & Phthis Pulmon.

And here only doubt with regard to disease, is, to which genus should be referrd.

With regard to first evid that cannot be consid as acute or febrile catarrh since has already cont. for space of sever. months.

Can as little [stile] it Catarrh senilis when consid that patient yet only in 12 year.

Yet even with pres patient may be what would call chron. catarrh.

Or what in vulg lang. of this country commonly calld sitten [down] cold.

Inst. simil to pres. where no susp of Phthis, point out prop. of disting by partic name.

But here I must own not without suspic. doubt

For in this case many circum leading to susp. of Phthis affect.

In matter expect. indeed neither taste nor smell indic purul. [appear]

And can be no doubt that by much greater part purul. mere mucus

At same time have had no opport of determining whether any mixture of pus.

This however may exist to some degree though princip part mucus

But in Phthisis besides purul expectorat should also meet with hectic fever.

And cannot be said that this formally exists in pres. inst.

Have no accts at least in history of case of period shiv succeeded by heat.

Nor is patient in any degree affected with colliq. sweats or diarrh.

But these well known to be sympt only in advan. stages.

And phthisis one of most insid diseases which pract. have to treat.

Has often made very consid adv before any susp. of it.

And in this inst patient by no means entirely free from febrile symp

Heat indeed as in gener. observd nearly about natural standard.

And no affect of disch by stool or urine.

But appetite impaird, thirst augm & pulse consid acceler.

To these febrile sympt. still anoth circum to be added giving ground for alarm.

That is pain of breast.

In inst of chron. catarrh, even where cough very severe this symp in gener. commonly entirely wanting.

And when does occurr is in gener. only conseq. of severe fits of cough.

But here besides being aggrav. from coughing const. exists.

Is not indeed so much conf. to any one spot as to give evid of inflammat or suppurat there.

But from whole middle region of breast extended partic to left side.

Such gener. diffused pain partic occurs in one species of [illegible]

And indeed in some meas [serves] to disting it from others.

For here may observe that prop treatm of disease requires distinct into species.

And as shall afterwards more fully endeav to shew in practic lect. three species

These disting by appellat of ulcer. catarrhal & tuberc.

In first pain fixd to partic part

In latter no pain

While catarrhal with diffus pain or rather gener. soreness of breast.

But besides this disting also by state of expector.

In ulcer. at times at least [large] & evid purul. disch.

In tuberc. for most part dry cough or at least very little expect.

Hence then if any Phthisis in pres inst no doubt as to being catarh

And from circum already ment must own am appreh. that this is the case.

Nor can I observe any circum in compl. that can be consid as obj to it.

Affect indeed seems to have begun under diff form.

That viz of Rheumatism.

And this, as is indeed in general the case conseq of an obv. cause.

Expos viz to action of cold when much heated.

For when consider that this by much most common cause, no reason to imagine that fatigue to which subj. operated in any other way than as heating body.

But after contin of Rheumatic for few weeks was succeeded by catarrh pneum affect.

Although sympt repres. as from begining very much same yet have little doubt that at first under form of mere catarrh.

Now however from all circum taken togethr inclind to think that if has not already degen into catarrh Phthis strong reason to presume that on verge of it.

In this situat Progn. cannot be very fav.

For if conject well founded from mere name of disease most pract. disp to pron. it fatal.

Must own however cannot look upon every inst even where phthis the best charact as incurab.

And of all species recov most freq. from that to which suppos pres patient subjected

Is also farther in fav. that [dises] has not yet made any very great progr.

No sympt. have occurd of very threatin or alarm nature.

Besides this consider period of life also as in his fav.

For in early age constit [unques] best able to weather diseases.

And has not yet arrivd at period when inflam affect. apt to [rise] to greatest height.

Hence then do not consider him as without chance of recov.

At same time no inst of Phthis in which can be surp. at fatal terminat.

And this most probab. conclus. of pres. case.

Yet at least prospect that shall not soon happen.

And during that period from circum mentioned have greater reas to entert. hopes from remed empl.

In catarrh. Phthisis of which have alledged that consid this case as inst. suppose purul. separ. not from any abscess or tubr. but from inflamd intern surface.

Here suppose pus yielded in same manner as from infl. state of cutan vessels induced by blister followed by applic of issue ointm or like.

Such a state then extend to greatr or less degree is morbid cond to be removed.

Hence in this species of phthis intent of cure differ. from what are in others.

State now mentiond partic supp. by impet of circulat. at lungs.

Becomes therefore princip obj in cure to dimin this impet.

And several meas. by which as giving determ from lungs this may be in some degree affected.

But in most inst. becomes also necess. to dimin gener. impet.

By these means cause may be so far counteracted that natural cond. of superfic vessels from which disch. afforded may be restored by operat of syst. itself.

But where these ineffect. attempts to cure may be made by endeav. to strengthen tone.

From these general indicat will better understand pract. already [emp.] & which hereafter in view in this case.

Of measures therefore already taken come next to offer few remarks.

Here will observe that meas. mode of cure princip employd with this patient a course of Emetics.

To these the rather led as hoped to derive benef. from them whether disease as suspectd was realy Phth or only catarrhal.

On either suppos. hoped to derive benef. from them expected that migh be serviceable as unload. lungs.

Expectd that in this way should at least remove immed cause of dysp.

For can be no doubt that expect. more immed promoted by action of vomiting than by any other means

But besides thus affording tempor. relief, expected still more as altering state of separat. at surface of lungs.

For unquest. an effect of emetics that give very powerful determ to surface.

This an effect both from nausea which excite & from action of vomit after induced.

And perhaps few means more powerful as dimin impet. at lungs than determ to surface.

And when by operat of emet, [circ] through superfic vessels renewed, will freq. contin, till occurr of some cause again altering destrib.

Accordingly from repetit of emet. & prop intervals have in such cases I think seen very consid advant.

Hoped therefore that might have simil effect in pres. inst.

And from conseq. of operation have I think reason to believe that [expec] not altog. disapp.

Obv. operat at least such as could have wishd

For without distress. patient, both had effect of prod free & brisk vomit.

And conseq was that both cough & breathing much relievd.

Whether therefore had effect of prod determin from lungs or not had at least reason to concl. that had removed, cause of these [symp]

But when consid that with this allev. expect. also dimin gives presumpt of latter effect.

Here however would be improp to ascribe allev. entirely to emetics.

For besides these anoth med also employd.

A mucilag mixt viz with addit. of a prop. of a sedative.

This however rather meant with intent of not appear. to patient & mother to be inactive than with view of any matter. benef

At least expected nothing from it as tending to radic cure of disease

But while engaged attent of patient imag. also that might be of some benef as dimin freq of cough.

Partic in as far as depended on irritat at fauces.

Here vinegar added to mixt. was meant only with view of giving [agrea] acid taste.

While hysop water with no other intent than to give form.

From mucilag. expected that power of irrit causes might be dimin, in conseq of lubric fauces.

And imag. that opium under form of Tinct Theb. might in some degree take off tenden to inord. action.

Respect. operat of opium indeed diff opin entert.

Yet no one who has in least degree attended to effects in pract. can deny that most powerf. means of allaying inord action.

And therefore in sense in which term sedat. taken by every author, of any note is most powerful one.

Upon these artic then have reason to look for some effect.

And prob. that mixt. some share in prod allev of cough.

With this opin, in situat in which found pat. at succeeding report, thought repet of emet. at that time unnecss.

Resolvd therfore to interm use for short interval.

And to contin patient with [mix] alone, at same time direct to diet & med which might best [coresp.] in cure.

Under this course, for some time affect seemd to be much allev.

But on such favour appear, where suspic of Phthis can by no means put depend.

And accord at last report some of sympt. again very consid aggrav.

Were attended even with sympt circum rathr more alarm than formerly.

Freq. returns viz of shiv. fits which but too often prelude of hectic fever, & other hectic sympt.

In this situat have again had recourse to the Emet.

And if from repetit any prospect of success shall still reckon it advis to persist in course alr. begun

If however urgen of cough with copious expect, shall rekon it necs to have recourse to blister.

And with view of protract. good effects to be obt. shall order drain to be supported under form of issue.

In such case also as pres. may I think expect good effect from use of refrig.

And with this intent, may here make trial of remed of remed of late highly extolld & I think very useful in such inst. of Phthis. viz Lemon juice.

Or may employ with same inten, nitre either in powdr or solut.

There are also circum in case from which may be led to hope for advant from Peruv. Bark.

But if necess. to have recourse to these meas shall afterwards more fully expl. intent in view.