DEP/DUA/1/25/07 (Transcript version)

John Lethem

(1780-1781)

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John Lethem.

In case of this patient no great variety or complic of sympt.

And what most alarm at same time most distinct marked.

viz very consid bloody disch by the mouth.

For of this, cough & dysp. to be consid as merely symptom.

And same also evid case with respect to sense of tumour which refers to region of stomach.

Here then no doubt in consid affect as referable to head of haemorrh.

May however by some question whethr blood disch. from lungs or stom

That is whether affect to be consid as inst. of Haemoptysis or Haematom.

May be consid as in fav of lattr suppos that disch of blood to consid extent.

That in quantity even of pounds comes up by vomiting.

And lastly that disch preceded by sense of tumour which [referrd] to region of stomach

But must at same time observe that none of these sympt. conclus

For on some occas disch of blood from lungs very copious.

And when that case seldom fails to excite vomiting

While again as to feeling great room for decept.

And what referrd to region of stom may very readily be above the [diaph]

While these circum of little weigh as determ it haematom, others as [strong] favour suppos of Haemoptys.

This partic favourd by cough & dyspnea with which attended.

By blood being often evid coughed up from lungs in small quantity

And by state of expectorat when no cough bloody disch

For then accord to acct given us has every mark of serous & sometim even of purul. appear.

Farther also to be added that no blood disch by stool.

A circum almost never failing to happen where haemor in stomach or any part of alim canal.

Upon whole then although not altog without diffic yet would pron it a case of haemoptys.

Still however a quest of no less import.

Whether viz haemorrh of active or passive kind.

For while in both disch of blood yet require very diff treatment.

Here little doubt that at comm. haemorrhage of the active kind.

Took place with habit of body & at period of life when active ham most common.

And did not arise from any viol or accident.

Little doubt howevr that from [rup.] this induced way paved to future [diseas]

And am inclind to think that now both renewed & [supported] by agitat from coughing.

Hence then inclind to think that what has taken place since came under our care prin of passive kind.

At same time from quickness & hardnss of pulse little doubt that fav by disp. to active haemorrhage.

This then idea of disease on which to found opin of pract prognos as well as plan of cure.

With respect to former sentim not fav.

Affect always consid as danger.

And from sever circum more remark so than any other haemorrhage.

In case before us already of consid contin & has gone to great height.

And even fatal conclus to be appr in two ways.

Either viz from immed effect of excess. haemorrhage.

Or from superven. Phithis in conseq of suppurat.

And of the two, this the termin of which must own am most appreh.

At same time would fain hope that neither one nor other will take place while remains under our care

And although cannot expect to remove dispos to renewal from slight causes yet for pres at least may ward off danger of affect.

Meas to be pros for this purpose directed with one of two views.

1 The restraining or stopping disch of blood when urgent.

& 2^dl. The prevention of return.

These according to circum of case to be aimed at on differ. prin.

And on what prin have here endeav. to accomplish them will appear from few remarks on pract. employd.

First prescript powder of Succus Jap & Crem of Tartar.

First of these artic, a veget extract from a species of mimosa one of most powerful of veget. astring.

With which however at same time combines mild mucilag quality.

A circum here partic fav as [might] then be serviceable in allaying cough.

But prin used with view to astring.

And from idea that haemorrh now a good deal of passive kind & [supported] by state of vessels.

No doubt that astring power of this med as acting upon stomach commun to every part of system.

And accordingly in last edit of Ednr pharmacop. is one of artic of Pulv [Styp]

Here expected that as gently encreas resist to passage of blood through [rupt] vessels, might have tend both to prev return & to check pres disch & prev. return

From idea however that still tendency to active haemorrh could not trust to this mode alone.

While at same time after exhaust [which] had already occurd unwilling to empl. any powerful evac.

Imagind therfore that intent might be better answ. by Crem of Tart than any other.

And in this conj. of refrig with gently purgat powers.

Could not howevr in latter way expect much from ʒiii in day.

But this quant with most [people] will move belly.

And hoped at least that might counter tenden to Suc Japon to bind

From conjunct therefore in sever respects lookd for good effect.

And from contin for space of week sympt if not allev. at least cont moder. - Little bloody expect

Still howevr much affected with severe cough, hoarseness & dysp.

In this situat recourse to blister with issue.

From which while expected that these sympt might be relievd hoped also that as dimin determ to [breast] might prevent haemoptysis.

Benef. reapt has led even to repetit.

And although sympt very far from gone yet is I think in such situat as to encourage to contin.

With this view mean not only to persist in repeatd blister & issue but to encreas both Suc Japon & Cream Tart

And shall probab. also conj. with these some demul. with view of lubric fauces.

If these measures unsuccess. may next have recourse to more powerfu evac or more powerful astring according as sympt seem to indic that tend to active or passive haemorr. is the greatest.

Or perhaps even may be necess to turn atten to counterac sequel.

But meas for this purp hope will not be necess.

And therfore nothing at pres to be said with regard to them