DEP/DUA/1/26/15 (Transcript version)

James Forrest

(1780)

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James Forrest.

Compl. not numerous.

And are at same time what freq to be met with in pract.

Yet so much in common to sever diff affect. that do not distinct mark disease to which subj.

Only compl. to which const. subj pain of breast & dyspnoea

These occurr in many diseases.

Partic in Catarrh. Phthis Pulm & Astm.

And in case before us circum giving conten to each of these suppos.

Is something at least in fav of supp of Asthma that affect aggrav in fits

And these too not occurring as is common in catarrh oftener in course of day, or regul in morning from [stagn] of mucus during night, but at interv of two or three days

This much more freq. at least the case with Asthma than with Catarrh.

And perhaps may also be consid as anoth circum in fav of that suppos, that fits termin by expect.

For this at least a circum in common both to Catarrh & Astma.

In latter affect with termin of fits often very consid mucous disch.

But if these circum leading to suspic of Astmat affect, many others against it.

Fits here occurring of much shorter durat, than those of Asthma gen obs. to be

Not attended with those sympt which the univ concom.

Partic sense of strict in breast.

But above all do not consist in dyspn.

Consist entirely in freq of cough

And no farthr attended with dysp. than this may natur be supposed to produce it.

Hence notwith circum ment above can have little doubt in assert that patient not subj to this affect.

If some circum giving susp of Asthma so many from which might be inclind to susp. Phthis.

Well known that Phthis is an affect in which, pain of breast, cough, & dysp. are const. sympt.

But while these sympt in comm to this with other affect. some othr partic leading to suspic that as here occurring depend on Phthisis.

This some ground for suspect from cause by which induc.

Affect, origin, we are told, from fever to which subj about six weeks before

Well known however that Phthis not unfreq conseq of fever.

Suspic also of Phthis from cont quickness of pulse.

While rare in pure catarrh almo unif occur in Phthis.

Suspic also from sweatings during the night.

These well known to be not only one of most common but also most alarm sympt in Phthis

And at same time no freq occurr either in Catarrh or Asthma.

At least as regul contin every night, & without aris from any partic cause.

If these partic however give susp of Phthis others giving diffic.

If common for fever to be followed by Phthis, is no less freq. attended with followed by catarrh affect

And is in fav of this latter supp, that both cough & dysp. mitig [illegible ] commen.

For at least very rarely that this happens in Phthis cases.

While again no more, than natur to be expected, in cases of catarrh.

And in case before us, what would incline rather to suspic of Cattar than Phthis, is mode of attack.

Began with const cough, & cop. expect.

And at same time the matter disch, by expect according to descript clear mucous matter without any purul. appear.

And still no reason to susp. [even] any mixt of purul. matter, in what disch by expect.

Even in quickn of pulse, & sweating, have not what to be reckond comm appear in Phthisis.

For these in general at least the attend only of distinct markd hectic fever.

These however no access whatever under form of shiv.

No acceler of pulse at partic [hours]

Sweat not partic observd to be an occurr in morning when with Phthis patient, very gener ensues as conseq of [illegible ] access.

But happens during whole course of night.

And from this circum may inferr that rather conseq of warmth in bed than any thing else.

Upon whole then should rather ascribe both quickn of pulse, & sweatings to state in which syst left by fever than to any other cause.

And from this state of syst, not improb, that catarrh affect here puts on appear, somewhat diff from what commonly occurrs.

Upon whole then though case with many pecul. yet look upon it as being a catarrh affect.

And as deriv appear which here puts on from cause giving orign to it, viz feverr.

Or at least from state & condit of body induced by fever.

On this view of case prognos. more fav than would be either if entert [suppos] of Asthma or Phthisis

And while less reason to dread, that affect would be ted than in former case, no less danger than latter.

Here however as not altog without uncert as to case, so also must be uncert as to termin.

And if either of former suppos well founded, may yet prove both a ted & danger affect.

Even on suppos of catarrh, [althou] no immed danger yet in end may prove fatal

For from this cause patients adv in life not unfreq cut off.

And although our patient cannot be said to be in that situat, yet has passed his 50^th year.

But if thus unfav, condit of body with which has occured, still more so.

And if fever has left syst in such situat as to give partic modif of disease, has also augm dangr

This especially indic by quickness of pulse & sweatings.

Upon whole then even in view of being a catarrh affect, can by no means consid it as being either sligh or free from danger.

And may the rather be supposed to prove obstin. from occupat in which patient engaged.

That viz of black smith.

For by this means, necess subj to sudden & consid vicissit of heat & cold.

By such however well known that this affect in partic manner both induced & supported.

But if these circum. against [patn] season of year much in fav.

And [may] also look upon it as fav., that since affect began consid mitig.

May then upon whole hope that shall soon obt. if not cure at least farther mitig of affect.

For obt this, suppos affect to depend on state of mucous [illegible ] taking place by the lungs, endeav must be empl. to alter it.

And at same time, so far to alter state of excret, as to prev. retent. & accumul in breast.

From this reason to hope that both pain of breast & dyspn [prev.]

And that cause of cough being removed would of course cease.

These gener intent will expl. most at least of pract. to which recourse has here been had.

Began pract indeed by prescrib for patient an oily mixt.

And to this must own was led [rather] by attent to what had before hap in case than from any other circum.

By use of Florence oil we are told that cough when formerly most distress was consid allev.

And indeed found by daily exper. that in many cases of catarrh affect prod of very consid relief.

Is however in gener supposed & probab. with just [that’s] acts only as lubric fauces.

And indeed freq happens that slight inflam there gives irritab. in conseq of which cough from slightest cause.

By lubric & sheathing parts [him] this in good meas at least prev.

In case before us however no [reasn] to belive, that such a state to any consid degree took place, from time at least that patient came under our care

Might seem therefore now less indic

At same time relief which had formerly obt. induce to give farther trial.

And although for my own part consid relief as prin from action on fauces yet would not venture to assert that entirely from this cause

And if in any degree acts as demul from entering syst influ may be still farther extended.

These then inducem to having here recourse to empl. of it.

At same time however directd also squill pills.

For my own part no doubt that active power of squils as introd into syst. capab of exert influ after collect at excret.

And partic that not only exerts action on Kidney, but also on [secret] organ by lungs.

From this while tendency to encr secret, has also effect of prod more ready excret.

Thus the inconv arising from accumul of mucus in lungs or viscid acquird there in good meas if not entirely pres.

If therefore in pres inst should have any influ in this way might expect that pat would be relievd

How far relief which afterw receivd in reality to be attrib to these med, will not pretend to say.

But after began use of them, for space of forthnight, less affected with cough, dyspn, or pain of breast.

In so much, that at report on first inst, found him compl only of weakness.

Since that however, compl have again returnd with greater sever.

And partic more affected with Dysp

In this situat. in place of contin of oily mixt. which while effect of [illegible ] cough, might at same time dimin freedom of expect. directed applic of blister.

By this hoped that determin to breast might be dimin.

And that thus dimin of separ of mucus, on which both cough & dyspn depend.

This reasoning indeed with regard to action of blist, in pneum affect some disp to deny.

But without entering here into controv, with confid may assert, that in various affect of breast, prod of greatest benef.

And in none more manif than catarrhal affect.

If therefore should not at pres be prod of benef, expectd, may be induced even to order repet.

Or to support disch for some length of time, under form of issue.

And with this by contin of pills hope that affect may be overcom

At least shall prob do nothing farther than augm squills, till course now prop has had fair trial.

If however shall be found [illegible] & if compl. contin nearly in pres. state, have thoughts of trying patient with gentle astring.

And for this purpose is my intent to have recourse to Uv Ursi.

A remedy which in such cases have been inclind to prop rather on prin on which expected benefit than exper.

But which at same time am [inform] has lately been used in some such cases as suppose pres to be with advant.

While however at pres suggest this trial must also obs. that very prob. before opport of making it, circum of case may be much [alterd]

And in that case future treatm must entirely be regul by condit in which shall then find patient.