DEP/DUA/1/26/04 (Transcript version)

Thomas Gray

(1780)

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Thos Gray.

In this case leading sympt obv.

Yet in some resp. not altog. without diffic.

At same time this rather with resp to what will be progr & termin of affect than pres. state.

Disease which here evid takes place neither uncomm nor slight affect.

Sympt most charact, & indeed most alarm, disch of blood by mouth & nose.

From extent to which this took place as well as from mode in which happ, when patient first came under care some doubt as to origin.

When disch at once both from nose & mouth is more freq. that from form than from latter.

For much more easy passage of matter from nose into mouth than cont.

In so much that while disch of blood from nose a very rare occur. both either in Haemoptys & Haemot. nothing more comm than disch of blood from mouth in Epistax.

Here then as disch from both if to judge from this circum alone should susp to be from latter source.

In those cases where entirely from mouth & no susp of nose yet still diff sources from whence may be dervd

Besides disch which may take place from gums or throat two great sources of haemorr by mouth viz Lungs & Stomch

Here one of most stricking diff that in former brought up by cough in latter by vomiting.

But is also in most cases at least a farther ground of distinct that in latter more suddenly occurs to great extent.

In as far as this circum goes would here incline us to suppose that [here] [from] stomach

For are told that not unfreq disch even to near extent of lb. at a time.

And when brought up so rapidly must always be diffic to disting whether in way of coughing or vomiting.

For even when not affect of vomiting seld that such [illegible] of fauces will not prod effects in that way.

Hence then from these circum at least equal reason for inferring that from stom as from lungs.

But these grounds for doubt as to source of bloody disch are I think [entir] removed when attend to hist given of progr of affect

From this progr. notwith circum [givin] counten to suppos that either from nose or stom. can have no doubt in consid disch to be from lungs.

At time when came under our care affect of 12 months standing.

At first commen preceded by pain of breast.

This pain evid connected with cause of haemorrh.

For from free disch of blood was carried off, at least for time.

Since commen pain of breast has been augm.

And with this augm encr of haem from lungs has taken place.

These circum alone suffic to indic source of haemorh.

But in pres case still farther estab by others.

Among these may ment cough.

With this affected not only during haemorrh. but also when about to happ.

But free from it at other times.

Circum evid shewing that then, there takes place pecul irritat of lungs.

This still farther demonst by pecul sensat indep of cough.

For will obs. that preceded also by sense of creep mot in breast.

To these circum, if addit proof necess, might add also state of disch at comm

For began with severe cough.

Then disch of blood only to very slight degree

And adhering to matter evid from lungs.

Lastly opin as to seat of disch corrob by cause to which attrib.

Affect here repres as conseq of chin cough.

And although in that compl. dep as to seat of prin morbid affect, yet no doubt that lungs subj to very viol. motion.

And thus a cause much more prob. induc haemorr from thence than from other parts.

Upon whole then pron this affect when patient came under care to be case of haemoptys

Here however a quest of some import. both with respect to progn. & pract, whether of act or pass. kind.

Is somewhat in fav of latter supp that immed arose from circum just ment.

Viol concuss viz conseq of Chin cough.

This however may have begun [disch] from mere mechan rupt, although now supp. by other causes.

And indeed may of itself have oper. as cause giving determ to breast.

Thus prod morbid state of action

And that on such state of action, now at least princip depends, is proved by many circum.

Partic by pain & sense of creeping motion [precd] disch.

But still more, by relief which the haemorrh affords.

On these grounds then consid it as being princip at least of active kind.

Yet would not assert that by concuss by chin cough as well as freq rupt since happen vessels may not have been constit brought to state [ready] [rupt]

From this view of nature of affect. next then to give opin as to prob. term

And here must own that not without diffic, although little doubt as to nat of disea

Haemoptys in gener. an affect if not from itself, at least from conseq hugely danger.

For in many inst gives rise to fatal Phthisis.

And this more to be dreaded at early, that at advan periods of life.

More to be appreh. when conseq of preced. disease in lungs, than when merely effect of haem affect proceeding from plethor or other causes; that is when [there] active haemorh.

For in such cases but chance at least of rupt vessels healing by first intent, & without suppurat.

In case before us however though consider it, as prin active yet in some meas of [mixed] nature.

Hence then perhaps upon whole most prob. event that will termin in Phthisis & from thence fatally.

This the rather to be dreaded from contin which has already had.

Has subsisted for space of 12 month.

And during that time has not only become habit to syst but encr in viol

In so much that disch at once to quant of near lb.

From this circum reason even to dread still more sudden fatal concl.

Would not be singul if patient cut off even by haemmoh itself.

Of this however must own, less appreh.

And although in other way ment [consid] case of danger. yet far from thinking it desper.

Still at least consider it as in state of simple haemoptys.

For no sympt of hectic fever or other marks indic tenden to Phthis have yet taken place.

Although danger therefore yet from prop meas not without hopes of recov.

In empl. of these however from irregul attend of patien little opport

Shall therefore think it less necess. to say much with respect to it.

Still however may state plan of cure & meas which should have [thoug] of empl. if attend cont & circum of case permitted.

Here disch at times to so great ext. that might even be thought necess to prop. meas with view to stop. during course.

In admin of these however great [nicety]

And as patient not immed under eye could not expect prop admin of meas. to be regul. by state of pulse & other such circum.

Here sudden stopage the rather doubtful as haem attended with relief.

And here became much more import obj to prev recurr. when stopt.

This however if conj as to nature of case well founded most immed affected by dimin of augm impet. at breast.

For this accord to suppos [entiret] is the cause by which renew prod

But besides this probab. also that state of vessels such that rupt [renewd] from very slight causes.

Hence also consid it as obj here to encrease resist. to pass at lungs.

For answering both intent various meas may be employd.

And although sometimes may be aimed at togeth yet in gener. more easily attain in success.

Was with view to first that in inst before us had recourse to combin of Nitre with G. Arab.

Latter artic intended princip for covering taste & giving form.

Imag Imagind however that in some degr might act as demul.

But was from former solely that expected any effect as tend to dimin cause of haemorrh.

Resp. action of Nitre indeed all pract. by no means agreed.

Can be no doubt that to cert. extent oper as stim to mov. fibres.

This appears both from applic to eye & other very sensib parts & likew from inject into rect. by way of glyst.

Then as well as common or Glau salt to cert extent at least prod Cath

Yet by greater part of pract held that from action on stom. prod refrig effect & dimin impet of circulat.

And this opin, from what have seen of effects in pract, have for my own part no doubt in adopt.

Is unden that by solut in [mouth] very great sense of cold excited.

And that this effect as discov on syst in gener. still more discov remark for action on stomach.

With dimin of heat there at sam time occurrs corresp. dimin of [impet] of blood.

And in own pract very much decevd if have not oft. found it prod of best effects.

Hence then partic calcul for cases of haemorh, where supported by encreased impet wheth gener or local, while at same time no gener plethor state

And still more where state of [illegible] constraind contrained farther attempts to dimin by evac.

Accord in such cases very few [pract] who have not recourse to it.

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On these grounds then here empl in pref to other meas

For trial during space of week taken to extent of ℥I a day prod of no incon.

And perhaps in some meas effect of med. that during period ment no return of haemorh.

In this situat then could have no hesit in order contin.

And even in persist in use till return of evac bleeding or other occurr should indic other meas.

In that situat had thoughts of blisters & gentle astring.

Partic Gum Kino or Succus Japon.

But in these must entirely be regul by circum of case.

And as not impossib that may see nothing more of patient farther remarks unnecss.