DEP/DUA/1/27/04 (Transcript version)

James Low

(1781-1782)

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James Low.

As to disease of this patient no doubt

While at same time an affect which in this country no less freq than obstin

Sympt are dysp, cough & copious expect of viscid mucus.

Here no room for doubt may without hesitat concl. that two former sympt. affect of breathing & cough, are conseq of matter disch by expect. being lodged in air vesic & bronchiae.

In some inst, mattr thus this disch evid purul. in others plainly [mucus]

When of formr kind the disease is Phthisis Pulmon. when of latter Catarrh.

Not in every inst however that can posit say is entirely either one or other.

And even where evid princip mucus yet sometimes very diffic to determ whether does not cont some mixt of pus.

Farther to be observd that in some inst catarrh evid does degen into Phthis

Would not therefore pretend to say that this disease may not yet occur with pres patient.

But that at pres. merely catarrhal may inferr from sevr. circum.

1 Expect mattr so little [appro] to app of pus that posit asserted to be mucus in hist of case.

2 Patient entirely free from any thing like hectic fever in so much that pulse heat & appet. whethr for solids or fluids perfectly natural.

3 Patient has passed period of life during which at least Phthisis is most common.

From these consid. then no diffic in pronoun. that disease merely cattarr.

Here however proper to observe that does not exactly correspond to defin of Catarrh as entering Nosol. systems.

And partic to that of Dr Cullen

Here indeed one of great charact, Muci ex glandulis bronchiorum excretio aucta.

But at pres at least no sympt of Pyrex.

Although febrile sympt howevr entirely absent, yet no object to disease being catarrhal.

For well known to every one who has been least engaged in pract, that these pres only at begin. of affect.

And that in place of termin in health, often degen into chronic state.

In this condit as with pres pat often contin for many years.

Or at least if slight interval during summr is again removed with cold [win]

In this state most freq affect those advan in life.

Hence in many practic syst has obtaind name of Catarrh. Senilis.

But in many inst occurrs where from age of patient can with no prop. have title of Senilis.

And even with pres patient althou passed 50^th year that name could not be consid as applic.

Hence then at whatever age occurrs am inclind to think that with much greater prop. may get name of chron. catarrh.

And have no doubt in pronoun. pres case to be an inst of that affect.

Here indeed to be observed that in differ nosol. syst. sever. species of this affect pointed out.

Mr Sauv in partic has enum no less than seven

Most of them howr in my opin with impropr.

For in reality either merely sympt of othr gener as Catarrh. Rubeolosis.

Or should propr. constit gener. by themselves as in Catarrh. [Ferin] & Epidem.

Both these diseases sui generis depend on pecul. & specif. contag

And accord in pract. lect. shall consider one under title of Pertussis other of Influenza.

From what have just said, natur follows that obj. just made to Sauv species of this disease extends also to Dr Cullen.

For although he has admitted two species only. Catarrh a frigere & Catarh. a Contagio, yet hold latter of these notwith simil of sympt to be in reality distinct & separ. genus.

Upon whole then consid pres case as inst of Catarrhus benignus of Sauv Catarrh a frigore of Dr Cullen

Respect pathol of this disease almos all pract agreed in opin.

In state in which occurrs in our patien is very generally admitted immed to dep. on encreased secret. by mucus glands of lungs.

And this universally admitted very gener at least the affect of cold.

That cold should have this affect by prod determ from surface to extern [part] by no means unnat suppos.

And accord disease most readily induced where change of determ great

As for ex. when circul. on surface encreased by prev expos. to heat.

In this manner at least greater part of Pathol. disp to expl. well known fact, of freq occurr of disease in conseq of transit from heat to cold.

A very diff theory of this affect [now] lately pub. at this place by Dr Jones.

And that too as means of introd a pract as diff from what formerly [pursued].

He contends that common catarrh is a disease which is affect of heat.

And that most ready & effect mode of cure, is expos to cold.

If novelty be suffic recommend to trial of new pract this does not want that charm.

For as far as I know has never once been prop by any formr writer.

But in my opin before any pract deserves attent should be support at least by probab. evid. & free from obvious object.

Any refutat however of pres doctr. altog unnecess.

For requires only to be stated to refute itself.

Are indeed told in Dr Jones book that Dr Brown the author of this discov. made first exper on himself

And that since that time success employd on sever of his friends

Here however to be obs. that no acct is given of sympt to which either Dr Brown or his friends subj.

Had a full & fair relat of sympt been given many readers might [perh]. have been disp to think that cold operated as remedy of very diff. diseas

As at pres related therefore there is more assert. & therefore deserve no credit without vestiges of proof.

And indeed may with just be [observd] that progr of med no little less retarded by bare assert being passd for truth, than be even wildest & most extrav theories.

Greatest caution therefore due on part of every one in receiv medic facts as well as med opin.

And even where facts well authentic yet a few solit inst. never to be put in oppos to daily observ.

Even admitting therefore inst ment by Dr Jones in way he himself would wish, can be of no conseq.

For what weight will case of Dr B. even when supported by a few [friend] have in scale when put in oppos. to common daily exper & common sense of all mankind.

Catarrh is so well known to be effect of cold, that disease itself much more freq passes by that name than by any other.

He who denies that cold freq prod it may as well deny that one & two make three.

He who affirms that is to be cured by expos to cold may as well affirm, that cough & the expect of mucus never take place as sympt of the disease at any period during whole course.

In short is to me matter of very great aston that any man of com understand ever allowed himself to be so far mislead as to adopt the opin.

Extr. however as this [tenet] is, yet must be admitted that is by no means most [extrem] in public to which I allude.

But with other parts of it have at pres no concern.

May only observe that after [careful] perusing this new public am still disp to hold same sentim with regard to catarrh as did formerly.

With this idea of disease then come next to give opin as to Prognos.

And here may obs. that in pres circum of patients compl, nothing immed alarming.

For although consid affect of Respir yet circulat contin in ordin cond.

While appet for food, disch by belly, & other natur funct. contin unaffected.

Besides no sympt whatever of superv. affect [such] as dropsic com or like

Till these however occurr & have even subsisted for consid length of time seld that affect has fatal termin.

And indeed even where meas for cure ineffect by no means uncomm for patients to contin subj to this compl for space of many years after which freq fall vict to other affect.

Hence then will at least app to me a very uncommon occurr. if shall turn out fatally under care.

At same time must own entert equally little expect. of being able to obt. here an expedit cure.

Are indeed possessd of means, by which in urgent circum. mitig of affect may be obt.

But after contin for consid time is very diffic matter to remove it.

This espec the case during the winter season.

And indeed, as formerly happened with our patient is very common [illegible] to find it disapp during temper [summr] weather & again begin on comm of winter.

But in case before us while season unfav. is still more so, that has now contin with him during whole course of last summr.

From this may concl. that [disp] to encreasd secret by lungs now so great that even free circul on [surf]. does not prev it.

Besides this both pat. rank of life & age are unfav. circum.

Though cannot be calld old yet is now arrived at that period of life when this disease most common & most obstin.

Were he in rank of life to admit of it, might reason entert. greatr hope of cure from passing wintr in warm climate.

But not only obliged to be subj to severity of weather here but also to freq expos in earning lively hood

And prob also during remiss from lab. but a cold & [uncommt] dweling

Under these circum then shall not be surprizd if affect rather augm than otherwise.

At same time shall at least have opport of trying those meas from which in such compl. relief often afforded.

By these hope that some mitig at least may be obtaind.

And even not altog without [expec] that from pract not gener in use may derive still greater benef.

In this affect. it natur occurrs as obj of import, with view to cure, that air vesic of lungs should be unloaded from viscid mucus accum

But still of more import to restore secretion by lungs to natur state.

This well known in othr cases to be affected by various circum.

Partic by state of secret organ & by determ of fluids to the part.

Hence then from circum influ both, mitig if not remov of the affect may be expected.

In latter way benef obt. from warm clim, warm cloathing & othr means giving determ to surf. in [general]

While again is as from giving determ to partic parts & deriv from lungs that would acct for good effects of blist issues setons &e.

From all which no quest. that very consid mitig of sympt has often been obt.

In formr way viz as affect state of secret organ fewer med empl.

And may even observe that artic used with this intent freq appar prod of bad effect

This freq the case with respect to Peruv Bark.

Well known to be a med often [success] empl. to dimin encr. secret in othr cases.

And such dimin a necess conseq of astring & tonic powers.

In case however of chron catarrh although may have some influ as dimin secret has still more as dimin excret.

Hence gives rise to accum in breast augm dysp.

And by this means in end aggrav. most urgent sympt of affect.

This still more the conseq of use of opium.

Influ as restr disch well known.

As necess conseq of very powerful effect which has as dimin action

Hence daily in use as restraining inordin disch, by alim canal, under form of diarrh.

But in catarrh although effect means of reliev of tickling cough yet by no means applic in such cases as pres.

For much more effect as prev excret than as dimin secret.

Hence although tempor mitig of cough yet augm dysp. & in end render cough more severe.

For not only greater quant of mucus to be expect. but from longr stagn has acquird greater viscid.

And indeed some of those people long habit to this affect, do not like to want it.

For then always in worst health

A circum not to be wondered at when consider how much influ want of any accust. disch has on syst.

At least where prop compensat for that disch in othr respects is not made.

Hence then appears that in [empl] of remed. with view of restr. disch as affect condit of secret organ caution at least necess.

Yet far from thinking that never to be attempted.

And accord in pres. inst remed prin empl is used with this intent.

After these observat on general plan of cure, will be necess to add but little of partic pract here empl.

Have directed for this patient the use of repeated Emet.

The action of vomiting I hold to be most immed & most powerf. expect.

And emet here intended with [view] of disch mucus already accum in lungs.

But besides this are farthr of service also as giving determ to surface.

With use of emet you will observe combind a remedy not commonly used in such affect the Pulv. Fol. Uv. Ursi.

This artic here empl. from hopes that it may have affect as dimin encreasd disch.

Must however admit, that of influ in this way, in chron. catarr have for my own part no exper.

This remed, need hardly observe, first introd into pract, by Dr De [Haen] of Vienna.

By him recomm as highly serviceable in calc. cases.

Exper. however has now abund demonst, that, as affect calc itself, has realy no influ.

But at same time many pract & these too men of accur. observ. of opin. that highly useful in [ulcera] & other affect of urin passages

And partic in Cyst. or Catarrh [vesiac], an affect which prin consists in encreasd mucus disch from bladder.

Of its good affect in a compl of this kind have very lately had a very strong inst. in a gentleman of this city who by means of it is now perfectly recov. from very alarm & danger distress affect of urin passages.

From simil inst, in former pract had often occurrd to me, as means of restr. mucus disch also by lungs.

And have accord often suggested in lect use of it in such cases.

When threw out such [hist] last winter, a gentleman then pres. afterwrd fav me with three cases which had fallen under his observ in which use had in this affect been attended with success.

In one of these patient affected both with chron catarrh & a disease of urinary organs.