DEP/DUA/1/27/06 (Transcript version)

Henry Johnstone

(1781-1782)

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Henry Johnstone

This patient already oftener than once under care at the Disp.

And liable to an affect which but too justly reckond among [oprob] medic.

When formerly under care no doubt that affect was a distinct markd inst of scroph.

And indeed then appeard under most common form that viz of an affect of submax glands.

For this comp. various remed [which] then employd.

And as one of best with which am acquainted directed sea bathing during that period when in this country can be empl. with greatest safety.

Under this although former ulcert heald up & other compl seemd in some degree to be mitig. yet pres. affect. began.

And have no hesit in still view his disease as being Scroph.

Now indeed princip app. under form of cough & dysp, sympt which may arise from many diff causes.

Among others however often the prod of Scroph tumours of lungs.

And not improbab. that this may have here consid influ.

But at same time to be remarkd that cough & dysp. connected with evid distort of bones of chest.

That such distors a freq. sympt of Scroph. well known.

And no less cert. that when taking place often prod of very consid affect of Respirat.

To this cause then would prim referr pres sympt of patient

But if contin to encrease in manner which has done for some time past may soon also look for others

Partic for paralyt affect of parts below.

Curvat indeed may be very great without prod this effect.

For when sever. verteb disp so as to form large arch spine marrow not compr.

But when compr. of this takes place paralysis an unavoid conseq.

And this never fails to be case from one or a few verteb. proj. much by themselves.

This however, from appar protrus. of spinal processes, great reason to believ, will happen in pres. inst.

To [calam] therefore suff. great, prob that others will soon be superadded.

From view now given of disease may readily concl. that have no hopes of speedy recov.

Indeed do not expect that in any length of time shall be able to accompl

My opin is that pres affect will prove fatal to our patient.

And that event too, am appreh is not very far distant.

Disease has already gone to such heigh, that patient not only unab to attend us but almost const. conf. to bed.

And should we hear of his death even at next report is by no means an event which would surp. me.

At same time must not repres. his affect as altog. despr.

May in reality be the case, that cough & affect of breathing are entirely from distors of bones.

And no doubt that after first effects are over, many inst of patients enjoying tolerab. health where distor much greater than has yet taken place with pres patient.

If no local affect of lungs [theref] still hopes of recov.

But what means have any prob. chance of accompl this, in pres circ of patient, must own app to me a very diffic matter.

Have already obs. that during use of one of most powerful med, affect in pres. danger. form conn.

And even not imposs, that pres. form of disease, in some meas the affect of Sea Bathing.

Well known, that even from tempor applic of cold to surf, in Sea Bathing, determ given to lungs.

And as thus obs. to have effect of augm & aggrav phthis, when has already taken place, so also not [imposs] that some share as induc it.

But if effect in this way, not improbab. that had still more, from curing ulcerat.

For although these unquest in time exhaust & destr patient, yet sudden obt of disch for some time [hab] habit very apt to induce affect on other parts.

Disease therefore may now have affected bones & viscer of Thorax from ulcerat about face being [heald] up.

When therefore such probab conseq. of most powerful mode of cure hard to say what are to expect from others.

Still howevr case not so desperate as to preclude all trial.

And have here had recourse to a pract. from which if any thing to do good have some expect of it.

That is the use of two issues one on each side of curvat.

On idea that affect in some meas conseq of obst to former disch. this might seem to be in some meas nat indicat.

And might be expected that the excit artif might in some meas supply natural or rathr morbid disch.

But here I own induced to trial from very diff reasoning

Have had recourse to it in imit of the pract of a very emmin surgeon in London Mr Pot.

Not long ago Mr Pot pub. a treatise on Palsy of lower extrem induced by curvat. of spine.

And in that public repres. drain under form of issue or seton, in neigh of the distors as having often been [success] means of cure.

On such authority may readily be supposed that pract would soon become very common.

Has accord been ordered by many practit.

And all of them have by no means agreed with Mr Pot as to success.

Have myself directed it in more than one inst.

And cannot say that have met with any case which conf. Mr Potts account of it.

At same time from cases which I have treated would by no means concl. against it.

May have good effect in some [altho] not able to cure all.

And may often also fail from want of due persever.

For to be observed that in order to derive benef. contin required for very consid length of time.

And cases treated under direct of Mr Pott himself leave no room to doubt that under prop [adminisit] may in some cases inst. at least be prod of best effects.

When last at London saw many patients under this mode of treatm by direction of Mr Pott in St Barts hospit.

And sever of them who had been under cure for consid length of time accord. to own acct. much better than at time of admiss.

On these grounds then, although pres case a very bad one, resolvd on trial in pres. inst.

If however has effect of prev aggrav. of affect, is utmost that for my own part expect from it.

And am hardly of opin that patien will live so long as to give chance of recov. by means of it.

Yet know no meas. which can here empl. with greater prosp of success.

This howevr will obs. not only meas to which have had recourse.

When first came under care, prescr. for him, the Pulv. Cretae. to quantity of half a dram twice a day.

From this expected, that there might be some effect, as destroying acid in stomach, which in such cases often preval.

But princip intent in reality was that might not seem inactive, & that might engage attend of patient or parents which could hardly expect if ordered nothing but contin of issue.

At succeeding report however found that consid degree of constip had occurred.

To this condit the pulv. Cretae unfav.

In place therefore ordered the Cream of Tart a med of very oppos tendency.

But this taken to extent of ℥ii daily has not had influ to obv. costiv

Have now therfore ordered slight add of Jallap with view of counteract augm activ

Intend however no more than that shall keep belly regul.

And with this, shall at least have that chance of cure which issues afford

If howevr obliged to desert pres. plan hard to say to what shall next have recourse

In that shall prob. be entirely regul by circumst