DEP/DUA/1/25/14 (Transcript version)

Phillis Denham

(1780-1781)

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Phillis Denham.

With regard to disease to which this patient subj little room for doubt.

From hist of affect before came under care no hesit as well as from pres sympt no doubt in consid it as inst of distinct markd Phthis Pulm

This abund evinced both by state of pector compl & other sympt.

No room to doubt that with cough & dysp. matter expect. of purul. kind.

This may presume both from smell & taste which told very disagr

But still more from bloody expectorat which here occurrs.

This still at times very freq takes place.

And from hist of affection learn that at first occurrd to very great degree.

Besides these partic, if any farther proof wanted, afforded in clean of tongue

For with very consid quickness of pulse, will observe that has not white furrd app which might thus be expected.

But cont. both moist & pecul clean

Such an app. however never fails to take place where consid purul expec

And from contin often even goes to greater length.

In place of natural colour gets pecul. redness rawness & soreness.

Often even to such degree as to be very painful & even nay ulcur in diff pl.

Here though has not proceeded so far yet, at least, in such a state that from thence no obj to suppos of purul. expect.

On contrary affords even addit argum, as far as such here necess.

But besides state of expect. every other sympt also corrob suppos of Phthisis.

This if not evid at least [rend] highly probab. from very app of patient.

For in extern marks of exhaus habit & gener express of count, has as much of consumpt app. as can well suppose

This indeed not as far at least as can learn effect of coliq sweats or looseness.

For while not subj to former, belly in gener. rather bound.

With freq hectic access however is subj to almost const fever.

And indeed pulse in general between 100 & 120.

At same time never free from very consid thirst.

Besides these sympt, anoth also which may here be consid as deserv some notice

I mean state of menst. disch.

This before she came under care, had been absent for space of two months

And for near same length of time, during which has been here under care, no appear of it.

Obst. to this evac, freq occurs in pract, both as conseq & cause of many diff diseases.

And in some inst, gives rise to such sympt as here occur partic bloody spitting

But in case before us no ground for such a suppos.

For while phthis compl. of more than 12 months cont. this superveend only very lately.

Here then, in as far as any connex no doubt that to be consid as conseq.

And although menst. will [sometim] contin in very exhaust. state of Phthis yet failure a very freq occur

And that had faild from this case in inst before us, may be inferrd if not with absol. cert. at least with high degree of probab.

Consid it therefore as one of the many sympt of Phthis in this case.

But while thus confid pron case to be Phthis, with view both to progn & pract, necess. that should go one step farther.

For every inst of Phthis not of same nature, or requir same treatm

This nosol. have endeav to [correc] by divis of affect into num species

But, as shall afterwards endeav to shew in pract course, for most useful divis may be referrd to there

These, which shall then have occas partic to describe, may be disting by title of catarrhal, ulcer, & tuberculous.

In first purul. matter afforded merely from intern surface of lungs.

In second from large ulcer or vomica

And in third from tubercle or indur gland commonly of scroph nature.

Case before us consider as an inst of second kind ment. or ulcer. Phthisis

To this in first place led from absen of charact of Catarrh or tuberculous.

And in second place from being attend with common charact of ulcer.

In partic manif by quantity to which purul. matter expect

By pure state, in which accord to accts given us, is disch.

But above all by bloody expector by which was at first usherd in & is still attended.

On this view of affect then as being viz an example of ulcer Phthis nex proceed to few remarks on Prog & Pract

And here need hardly observe that Phthis of every kind unquest a most danger affect.

Presumpt therefore is, that patien will in end fall victim to this dis

And when consid pres. situat reason to appreh. that this termin. not very far distant.

For although patient still strong enough for attend here, yet state of expectorat & of pulse as well as general app of habit, give every reason to concl. that affect of very danger. tend.

Here may only obs. that this species of consumpt. while more danger than catarrhal, is yet less so than the tuberculous.

And accordingly has not in gener so rapid a course.

Matter in general commonly formd in [illegible] large abscess. more mild & bland than the sanies yielded by tuberc of scroph kind

And accord hectic fever less rapid in progr.

From this however do not [illegible] us as having any great ground to hope for cure.

But from slow progr at least better opport. for trial of meas for that purpose.

And if by any meas which can here employ, recov affected must own will consid it as strong evid, of effic of these meas.

In ulcerous consumpt. great obj to be aimd at is the healing of the ulcer.

And for this purpose first necess. that prop adhes. inflam should be induced purul. matter [collectd] should be disch.

And secondly that prop. adhes inflammat should be induced.

Here no doubt that vomica already burst

And by coughing, which matter [chiefly] excites, suff free disch prod.

For first purp. then no meas [seem] here necess.

And indeed when consider tendency to haemorrh by lungs, becomes necss. to shun every cause of concussion.

Here therefore in as far as meas to be employd solely to be directed to second obj

The healing up ulcerat from which pus already disch.

This it must be allowed in great meas if not entirely a process of nature

And suppos. that cert. artic possessd healing, or unit power in great meas. if not entirely founded on credul.

At same time no one can deny that process of healing connected with certain state of inflam.

To this in contradict to suppurat on one hand, & gangren on other [most] phys, partic Mr J. Hunter of Lond have I think with prop approp. name of adhesive

The induc therfore of such a state of inflam is of great conseq in cure.

And for this purpose sometim necess to encr. sometimes to dimin action of vessels.

Is on former of these princip that are I think to acct for operat of med here employd. viz G. Myrrh.

And with this intent had here recourse to use.

On this ground can readily understand why pres. as well as other healing balsams, as have been calld, sometim of service sometimes prejud in this comp.

And accord while one set of pract entirely cond use, by others very highly extolld.

But whatever may be princip of opera, none on which greater [illegible] of late best than the G. Myrrh.

Has in partic been for long time a fav remedy with the Phys at some of the hospitals.

+ Of princip indeed on which operates diff opin entert.

But if effic ascert. this a matter of no great conseq.

And at pres very much used both by Dr Fordyce & Saunders two of most emmin teachers of pract in London.

>+

For most full acct of obs. respecting it, may referr you to Dr Simm. treat on consumpt.

And this author. also may be add to that of other gent. ment, in test of effic.

For my own part In confirmat of these, can I think also venture to add the result of my own exper.

For although far from repres it as what has always succeeded with me, in cases even most fav. yet have sometim I think seen it prod of best effects.

And as far as my observ goes prin useful, in this species of consumpt, the ulcerous.

On these grounds then here resolvd, as far as circum would permit, to give it full & fair trial.

Comb. with cream of Tart with view of obv costiv to which patient subj.

Under this course patient has now cont. for several weeks.

Cannot however say that as yet prod of any consid advant.

And patient during course of attend rather losing ground as otherwise.

This however no more than [should] have expected, in progr of affect.

And no reason to believe that has been prod of any bad effect.

Is still therfore intent to persist in use.

And Should it be necess to [relinq] empl. have at pres in view no other partic remed. to which thoughts of having recourse.

And pract. must entirely be directed by circum of case at the time.