DEP/DUA/1/25/09 (Transcript version)

Alexander Downs

(1780-1781)

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Alexr Downs.

Affect evid of a complic nature.

Or rather when came under care subj to two diff. diseases.

And these probab. totally uncon with each other.

Of these first mentiond in case & at same time most obv. a cut. affect.

Not however extended over whole body but partic conf. to legs.

Of diffic of prop distinct among cutan affect have already oftener than once had occas to speak.

And need not here again enter into causes of it

May only observe that from dry scaly appear when came under care, might be consid as appr. to descript of lepr. affect.

Yet from acct given of progr. more exact corresp. with that of herpet. kind.

For here also incrust succeed only an erupt attended with consid watery disch.

From this idea then, of this part of affect. reason to concl. that less obstin than if consid as of Lep. nature

For prop. Lepra when of any consid standing a most invet disease.

Still however could not view affect as of slight nature.

For even herpet erupt very often diff to remove

And with pres. patient before came under [care] already of consid cont.

Had subsisted for space of sever months.

Was indeed somewhat in fav of patient that affect only local.

And that at same time attrib to local cause

Yet must own did not expect that would have so speedily termin.

Conclusion which has already taken place supersedes necess of farther obser on prognos.

For would now hope that patien entirely rid of this part of compl.

From commen of treatm here howevr subjected as already obs. to other sym

viz Severe cough & dyspn. with diffic expect of viscid mucus.

This could have no diffic in consid as catarrh sympt.

And in patient advanced to 50^th year might perhaps with out [impr] get name of catarrh senilis.

Yet may I appreh in every case be with greater prop stild chr. catarr

Of this affect in case of some other patients already occas to speak in pres. course.

In inst before us nothing remark.

Neithr any uncom sympt. nor any ordin ones to consid degree.

At same time with patient adv. in life, exposed to vicissit of weath & during season when changes most apt to occurr. could not look for speedy removal.

The less to be expected as was intent, first to direct endeav in pract. cutan affect.

And indeed for this princip [selected] as obj of pract.

Hoped howevr that even under [treat] for that affect pres. might not be augm.

And expected that by meas directed to it might be mitig.

This indeed cannot say has yet taken place.

But still hope that in no long time may be effected.

Partic if mild & steady spring weather

And in forwarding attainm of this end something, may I appreh be done by med.

Is indeed with view to this that meas at pres empl. with patient [entir] directed

But as already observd treatm begun on diff plan.

And meas at first directed prin if not entirly with view to cut. erupt

Began treatm will observe with what I call the Mist. Vitriol.

viz. ʒi of Vit. Acid to ℥i of syrup & water taken togeth.

Of use of this artic as empl in cutan affect have already spoken.

And pres course has I think [afford] some exampls of effic.

And that too both in inst of Psora & of Herpes.

These used against affect general extended over body & either arising from no obv cause or attrib to infect.

Here then wishd to try empl. in [loca] disease & referrd to partic accid.

And in use were not disapp.

Had indeed no influ in way of obvious operat.

And at same time from taking mixt to extent of ℥i twice a day no inconven.

Under this however affect of leg [soon] began manif dimin.

And in space of few weeks had entirely left him.

Has now since med intermittd [rem] under care for some weeks longer

And during that time no return of affect.

When consider that before subj to it for many months without any [inter.] can have little doubt I think in attrib cure to this pract.

And am now in hopes that for this part of affect no farther meas will be necess.

When began vitriol mixt howevr besides cutan compl. had also in view the catarrhal affect.

My idea of this disease in chron state is that all sympt. in great meas affect of augm mucus secret.

Hence then although immed ease from expuls of what accumul in lungs yet radical cure from secret being [illegible]

And as in case of othr disch may be expectd from astring.

Well known however that few artic more powerful effect in this way than vitriol acid.

While therefore med empl with anoth view still hoped to have opport of observ. influ on this affect.

Cannot however say that seemd prod of any good affect.

For at succeeding report both cough & dyspn. rather augm as otherwise.

These circum I consid as cert indicat that viscid mucus accumul.

And was even inclind to think that aggrav. might be conseq of astring as giving occas less free excret.

Reckond it therefore advis to employ some med with view of prom disch.

And for this purpose had recourse to squills.

An artic the expect power of which some theorists indeed disp to deny.

But notwith ingen speculat any one who has had opport of seeing or exper effects can have no doubt of them.

By this however am very far from meaning to assert that will be cert effic in every case.

And in inst before us example of this

But no more surpriz that should not always have effect in this way than that does not always operate as diuret.

In that respect although often fails no one I appreh will be hardy enough to deny gener. influ.

Although therfore for first week but little allev of cough, yet orderd contin for eight days longer.

But as at end of that period symp still distressing had recourse to blisters.

This also a pract with regard to rationale of which some have [entert] their doubts.

For my own part think that influ satisf expl. from change in mode of circulat.

And from diminut of flow to lungs in conseq of augm determ to part to which blister applied & disch from thence.

But however much this reasoning may be liab to obj. nothing to pres quest.

For must on all hands be allowed that of much less conseq to determ how effect prod than what it is

And no one will allow himself candidly to attend to facts can possib deny that blisters applied to chest relieve many affect of lungs

Accordingly in case before us found that both cough & dyspn. allev.

To secure these advant howev with that disch. [supported] for some time.

And for this purpose have ord issue by means of epispast ointm

Under this measure, with contin of pills hope that patient may soon be in situat to be dismissd.

If however pres. drain not prop supported may have recourse to [illegible] of blister.

Or if sympt of large accumul in breast may attempt to unload it by emet.

But in pref. to either of these if shall contin nearly in pres state have in view anoth meas.

A trial viz. of remedy which had lately occas to mention in lect on chron catarh use viz of Uv. Ursi.

But hope even that this may not be necessary.

And that without farther aid patien may soon be dismissd free from affection.