DEP/DUA/1/25/15 (Transcript version)

James Hamilton

(1780-1781)

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James Hamilton.

Princip affect pain of side

And as to nature some doubt.

Two suppos.

Might be dep on musc affect, or [dis] of integum.

Or might proceed from affect of Thoracic viscer or memb.

At first inclind to former opin.

And on that footing began treatm.

To this in some meas led from situat

Seated in under part of false ribs.

More freq. the situat of Rheum affect than of affect of Thorac viscer.

But still more from aggrav in conseq of press or motion.

For this a necess conseq of its being muscul.

As indeed is also augm from cough

For this in very quick & viol motion of all surround parts of chest.

Here however to be obs. that this a doubtful circum.

And fixd pain of breast attend with cough equally sympt of affect of Thor. vis.

At same time less susp. as free from every febrile sympt.

Pulse & heat perfectly nature.

Disch by belly & urine regul.

And even respirat unaffected.

Also fav that pain of side but of short durat

While cough of long standing.

Hence then, if any connex, cough rather conseq than cause of affect of side, on which pain depend.

On these grounds then first opin [formd] & treatm begun.

Now however more doubtful as to it being just.

And since that, treatm more [direct] to pect compl. than to musc pain.

At same time even on former supps this necess.

For no doubt that pain whatever cause, must be supportd as long as cough urgent.

As doubt respect nature of disease, so also of progn.

At first hoped that would be of very short contin.

After first meas unsucc howevr inclind & look upon it in more ser. ligh

Yet at no time consid it as threat much danger.

And although possib of degen into Phthis yet no appear of it.

Now I think so far dimin that may considr it as happily termin.

And next to inquire how far this effect of treatm here employd.

On suppos of musc pain, empl. in this inst an applic which had lately occas to mention as used in case of Marg. Rose

A combin viz of Vitriol Aether & Laud liquid.

There as in that case also conj with Camph Spt of Wine.

But useful as giving necess dilut & likewise as encreas power of applic.

From this applic as in formr case sense of heat excited.

But not here attended with allev of pain.

Concl. therfore that after contin for eight days without effect, nothing to be exp. from it.

And that either mist as to nature of compl. or that inadeq to cure.

Urgen of pain now still more than formerly connected with cough.

And whethr from affect of lungs or memb. lining them, or of still more superf. parts expected benef from [Blis]

While at same time as prod deriv from breast & taking off effects of uncom sensib well calcul. against cough

With these intent then ordered [applic]

And that might derive greater benef. applic orderd directed to seat of pain.

While had recourse to blister howev directd also anoth meas.

Use viz of Crem of Tart.

In this had in some meas in view refrig power.

But still more with intent of gently moving belly.

By this hoped that if disp to inflam existed, might be in some meas dimin

And that by prod determ from breast might obt. some allev of cough.

In these diff intent howevr in some meas disapp.

Blister indeed rose well & free disch

But neither followed by allev of pain of breast, nor of mitig of cough

More free expect indeed took place.

But this rather inclind to consid as dep. on progr of affect than on [remed] empl

While thus disapp in effects of blister equally so in Cream of Tart.

For had not even effect of open. belly.

This indeed not surp. when consid that given only to extent of ℥i.

For in order to prod any [degree] of cathar 3th or even 4 times that quan. necess.

Exp. however that might at least do something.

And with cert constit would have had consid effect.

But would app. that patient had not been of such habit.

Notwith want of success howevr did not think of immed desert. this plan.

But that might bettr obt. effects [ordrd] contin of cream of Tart to double quant

And with view to full conseq of blisters orderd contin of that drain should be supported by epispat oint.

By latter applic howevr whether from want of prop attent or othr circum little disch supported.

While even encreased dose of C. Tart no more effect than before.

To these therfore could in no degree ascribe relief which patient had obt by next report.

This howevr inclind to think was in part if not altog. to be ascribd to anoth meas. at same time directed.

Began now to susp. that cough great cause of sever of pain.

And that only by mitig of formr that could prod allev of latter.

Cough I susp. might be effects of irritation

And that therefore might be counter by demul. lubric fauces.

Was with this intent that had recourse to mucilag. mixt.

And in order still more powerfully to take off irrit conj with Laud.

This not taken to full extent of anod.

But to quantity of ten drops only in even dose.

Under this med wethr from mucilag or anod consid relief.

Severity Viol. of cough not only abated but severity of pain dim.

These effects was I own as well as patient himself in great meas incl. to attrib to med empl.

And therfore no hesit in order contin.

Still howevr expected some benef. [from] opening belly.

And as Cream of Tart itself insuff orderd addit of small prop of Jallap.

This the rather necess from Laud now empl.

But whether from this circum, or from pecul in constit, two drams of Cr. of Tart with Ji of Jallap no [effec]

Still howev cough & pain of side contin to dimin

With contin of anod muclig mixt. therfore ordered augm of Jallap ordered

But from addit of ten gr. in day rather more influ than wishd for.

Now howvr, cough much easier, pain of side almost gone.

Reckond therefore farther contin unnecss.

And although still cont. Mucil Mixt yet flatter myself, that for pres at least, not requis to employ any farther meas with this patient.