DEP/DUA/1/24/17 (Transcript version)

Robert Hume

(1780-1781)

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Robt Hume.

Disease from sever circum doubtful.

But in any view not without danger.

Consists princip of pect. compl.

Sever cough viz with viscid expect.

These well known sympt of diff dis.

And judgem to be formd by concom sym

Here room for three diff suppos.

Catarhal affect. Phthis Pulm or Pertuss.

Of these diseases lattr indeed when in state calld formd, charact. by a very stricking sympt.

Viz Kink or Hooping.

But in some inst does not occur for long time

And that too in very bad cases.

In others of slighr nature disease runs whole course without any app.

Absence therefore for two months no certaint against affect.

And here some circum fav. supp.

At pres. to be met with among many children in Edinburgh.

And do not learn that this patn. before subj to it.

Fits of coughing also obs. termin by vomiting.

A circum if not charact of Pertussis at least very common

This however far from amount to any strong evid.

And here I think still stronger reason for believing that a more dang disease.

Cheifly divided in opin whethr Phthis or Catarrhal.

But of two most inclind to former.

Season of year indeed such that mere catarrh affect supp for great length of time.

And even with infants may degen into chron state.

But here many othr concom symp seldom attend on pure catarh Phthisis

At head of these may ment. period [feb] [access].

Accord to hist of case regul. attacks every afternoon.

And this [access] contin for consid time.

During night anoth unfav appear. fav that suppos.

viz Partial sweatings.

These not always attend of Phthis

And sometimes take place where [absen].

But when comb. with cough & fever always give ground for appreh. of Phthis.

Anoth circum also since came undr our care which would lead to same conc.

Looseness viz with which affected.

Very much appear of [colliq] diarrh.

A sympt well known freq occur in Phth

To all these may add anoth circum

viz constant quickness of pulse.

Upon whole then although no certainty yet strong presumpt of Phthisis.

Suppos this the case however hold it to be quest of import in pract. to determ species.

Have already observd that with view to pract. distinct of greatest conseq into three species.

Catarrh. Ulcer & Tuberc

And here also room for doubt.

Cheifly however whether first or last.

For of prop. ulcer consumpt. [illegible] [illegible]

Expect. indeed copious

But cert. that princip mucus.

And if cont. any pus. at utmost [be] inconsid mixt.

Cannot therfore be supp. to proceed from vomica already burst.

As little reason to suppose that that large vomica in lungs unburst.

For patient not affected with any violent or fixd pain.

No constant dyspnoea.

And no partic diff of respirat when laid on either side

Princip diff then whether catarrh or tubercul.

And here circum fav. each supp.

Copious expector in fav of formr.

Appear of patient of latter.

For very much the fine skin & [beat] compl. of scroph. patients.

Must however be obs. that as far as can learn has not scroph as hered.

And while [parents] free has not appeard in other child of same family.

Has occurd also at early period of life.

For when scroph affects lungs most commonly later than on other parts.

And accord tuberc consumpt. most freq from 15 to 28^th year.

But yet on other hand occur of tuberc consumpt. even at early period by no means rare.

And even in own pract. have seen younger child fall victim to it.

Not appear on other parts no reason why should not affect lungs.

For where hered or family disease those most apt to die Phthis with whom scroph. swellings not [obv].

In all circum mentiond then no ground for certain conclus.

In such doubtful case perhaps best disting mark, from exam of [expect] matter.

For if contain mixt of pus. reason to presume that separat from surface of lungs.

This oftener than once attempt in pres inst by what hold to be best criter viz caustic alkali.

And although experim not conclus. yet such depos on addit of water as [would] argue some mixt of pus.

At same time unless alkali here capab. of dissolv. pus also, is but very inconsid.

And own does not seem suff. to acct for sympt.

Yet upon whole think it [full] as probab. that catarrh Phthis as any other.

And with this idea more fav progn. than if concl. that certainly tuberc.

At same time in state of uncert [cannt] help being very appreh of patients fate

And even if entirely catarh. yet unquest very danger.

Esp. [after] with const quickness of pulse colliq sweats & diarrh. have proceeded to such length.

For although these at times dimin yet never entirely free.

And often mitig of one has happ. only on occurr of other.

Upon whole then if patient recov. is I own more than expect.

At same time very far from [view] as desperate case.

And many meas. which may at least be tried with some prob. of [succ]

Here have hitherto cond treatm on suppos of Phthis.

And have prin at least had in view its being a catarh. Phthisis.

In this affect great obj is to alter state of separat by superf. vessels.

An end prin to be effected by dimin of impet of blood there.

And by restor tone to these vessels whether by acting on them in partic or by strength whole syst.

But besides these gener. intent becom requis also to obv. sympt.

And from attent hitherto necess bestowd on last have yet done little towards formr.

This however will more partic appear in taking short [illegible] of [illegible]

Began treatm of this case will obs. by repeated emet.

At that time more in doubt than at pres whethr catarhal or [phthisic].

But this pract. prom some adv on either footing.

And whether tuberc or catarrhal Phth not [ill] accom.

For besides gener effect of [unload] lungs serv. in both as determ to surf.

In catarh thus fav as alter state of circul separ at lungs.

In Tuberc tenden to bring about resolut.

In obv effects of emet not disapn

And probab. that some share both in tempor allev of cough & dimin of febrile [access].

But how far any influ as tending to radic cure a much more doubtful matter.

Still howevr effects such as to encourage to repetit.

But as means of allev. cough & that might not at same time seem inactive empl. also mucil. mixt.

To this will obs. besides mucil. & water added consid prop. of Vineg.

In this had in view the employm a cheaper substit for a med of late very famous in Phthis

I mean recent veget acid partic under form of Lemon juice.

Juice of Lemons to great extent of late used in Phthis with high [rep ]

And I think is cheifly in Catarr that can expect benef from it.

Operat would prin referr to dimin of impet of circul. thus prod [alter] of state of separ

Same intent in some meas from [acet.] acid

Which for Disp patients can be afforded at much cheaper rate

And this only reason for pref in pres. case

After this course howevr begun another sympt & that too of alarm nature appeard. viz Looseness.

This might proceed either from emet operat downward or from mixt.

Reckond it howevr more probab. that affect of the disease

Yet determ me at least for some time to omit both.

And in place subst. a med with view of checking looseness viz Inf. Japn

On use of this has now entirely ceased.

Yet other sympt much as before.

Have again therfore had recourse to Mixt Mucilag as formerly.

If does not renew loosenss shall wish to cont. it for some time

If does shall be obliged entirely to desert it.

And with view to deriv from [breast] recourse to blister with issue

But besides these other meas prob also requis.

And have thoughts of trial of Peruv Bark or Cicuta.

If these unsuccessful regul by future circum.

And by opin which shall then entert with regard to nature of disease