DEP/DUA/1/27/13 (Transcript version)

James Mitchell

(1781-1782)

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James Mitchell.

Sympt of patient such as often met with in pract.

And indeed what already have oftener than once had occas to mention in pres. course.

Prin compl. cough, dysp. & expect of viscus whitish matter.

With these sympt only doubt whether affect Phthis or Catarrh.

Even at commen from sympt of case consid pat as subj to former affect

But if then any doubt now none

For from what afterwards saw of prog of affect Phthis suffic charact.

Partic by distinct marked hectic fever, colliq sweats, & colliq. diarrh.

And indeed under these, patient since came under our care has fallen victim to disease.

Unnecess therefore to offer many observ. on circum. charact it when first calld for assist.

While sympt as cough & dysp, in common to both affect, many more partic indic Phthis.

Of this some presumpt from age

Patient at 30^th year only.

This indeed in gener. consid as past Phthis period.

And unquest that Phthis, partic that species which most comm., occurs more freq. between 15 and 25 year of age.

But if somewhat passd Phthis period is still more dist from cattarh.

Or at least from that period when catarh app in chron. state, in which condit alone resemb. Phth.

Admit indeed that may occur at any age

But much less freq than Phthis at 30^th.

Besides age presumpt in fav of Phthis from app of expect matter.

Expect indeed copious & of white colour

But without that degree of viscid which very gener occurs in chron. catarh.

Anoth circum giving presumpt swelling of legs.

This indeed in common to both affect.

But seldom that occurrs so early in Cattarh affect, as in pres. inst.

If from these circum some presump. still stronger from state of pulse.

With pres patient, unif much quicknd above natur stand.

Even when most free from fev, sym, never under 100.

And prob. if opport of exam when fev. exacerb. came on much quicker.

This however while almost const attend in Phthis, rare in Catarh.

And perhaps no circum which seems more to distin Phthis, where makes app. under form of other affect.

For to be obs. that Phthis an insid affect. and often has made consid prog before distinct marked.

When quickness of pulse however with other marks always strong susp.

To all these circum, in pres case [still] anoth to be added.

And that too not less charact of affect

I mean colliq sweats during night.

In many inst indeed Phthis even fatal termin without occurr of these.

And on other hand often do occurr in cases where no Phthis.

But when accomp. other sympt of Phthis not only cert. charact, but also very danger. app.

From all these partic then, at first concl. case to be Phthis.

And as already obs. from farther prog had no doubt that opin just.

For in course of disease had opport of observ distinctly markd Hect. fever.

And besides colliq. sweats there occurd also, towards concl of affect colliq diarrh.

Hence then no no hesit. in pron. that this patient subj to Phthis.

Has been much disp among nosol & other writers, whether Phthis should prop be consid as genus of dis or not.

But in whatever light view it, no doubt that both one of most common & most danger affect in this country.

And besides pron case to be Phthis, for prop cond of pract, must go one step farther.

For Phthis one of those diseases in which room for many distinct.

Without entering into consid of these shall at pres only obs. that with view to pract, may be divid into 3 Species

These shall aftrwards have occas partic descr. in pract. lect.

And shall then asign reasons for disting them by title of Catarh Tuberc & Ulcer.

Here then to inquire to which of these patient to be consid as subj.

Look upon case now read as exhib example of first spec catarrh Phthis.

To this concl. led both from sympt with which is attended, & from abs. of those marks which comm occur in [oth] others

Here no fixd local pain in side commonly sympt of ulcer.

Not that dysp, from lying partic on either side, with which attended.

Not great disch of matter obv. purul or pecul. cleaness of tongue, with which almost unif attended.

From these marks then would [inf] that not the ulcer.

On other hand passed period of life at which tuberc most common.

Did not as is commonly case, thus arise without any obv. cause.

And Is not attended with dry cough without any expect as commonly these are generally happens there.

And no other marks from which smallest reason to inferr Scrop. hab.

Hence then from mere absence of sympt. charact ulcer & tuberc Phthis should be led to consid it as Catarrhal.

But besides this, draw same concl. from sympt. here occurring, & from manner in which made attack.

Disease derivd origin from an obv. cause.

Imprud expos of body to cold after being very much heated by bod. [illegible]

Prior to this, patient as far as could learn, strong & vigor.

But although accid during warmest weather, yet succeeded by sympt of common cold.

These in place of soon abat, which in sum months, might nat. have been exp, not only cont. but aggrav.

In short, soon came to that state which in this countr. has name of sitten down cold.

A term gener empl. in those inst, in which catarrh in place either of speedy recov or degen into chron state termin in Phthisis.

From cause & progr then in this case strong reason for consid it to be a catarrh Phthis.

But still farther indic by sympt.

Partic by want of fixed pain indic any local affect at any partic part of breast.

By [illegible] being nothing affected by posture.

But above all by state of expect.

Matter of whitish colour we are told expect in large quantit.

From circum both of smell & taste may concl. that neith entirely nor even princip purul.

Yet reason to belive that cont mixt of pus.

And if opport afforded of making prop trials by aid of caust. alk lixiv or like should prob. have found decis evid of pus.

From this state of expect. then may concl. that purul giving hect fever & other sympt of Phthis [furn] by separat at surface of lungs.

This however idea which entert. [resp.]  sources of purul in what would call catarrh consumpt.

And to this affect take to have been species or modif of Phthisis to which our pat. subj.

A species which although much less common than the tuberc. yet by no means a rare occurr.

When occurs as well as every other Phthis a danger compl.

Of all the species of Phthis indeed from this more recov. than from any other.

At same time, as in inst before us often fatal.

And after concl. which has already had any farther observ. on prognos. now altog unnecess.

For same reason also need say very little of pract.

For before pat. came under care in such a state that little opport for trial of many med.

And even with these to which recourse might have been had without risk, from inab. to give regul attend, & other circum. little trial made.

In this species of Phthis great obj to be aimed at is the restor. separ. by surface of lungs, to natur state.

And this sometimes to be affected even without any change in vessels by which separ. affected.

But merely by change in circul through these.

Partic by dimin of impetus at lungs, & determin to other parts.

With these intent, in such cases often great benef. from blisters & issues.

And accord. from use of blister patient had before derived very consid benef. at least for time.

To such meas therefore, might nat have thought of having recourse.

But from circum of const. drain, oper as exhaust strength, chose rather to give trial to emet with same intent.

These from gener. [concuss.] often useful as giving determ to extreme vessels in other parts of syst.

And flow thus restored, often without any other meas becomes perman.

Besides this, here as in chron catarrh often of service also from unload breast.

Is on these prin I imag, that to expl. benef. derived from them in this species of Phthis.

Must however obs. that used also in others.

And in tuberc in partic prob. operat in very diff way.

In as far as have effect to be consid as conseq of prod resolut of tuberc. in same manner as said to do in some other cases of Scroph tum

But on whatever princip may oper, in inst before us seemd at first at least to have good effect.

For while operat such as could have wishd was followed by consid mitig of cough.

This however consider as having been merely conseq of [unload] air vesic.

And accord of but short durat.

For at next report dyspn. nearly as urgent as before

And patient still affected to equal degree with colliq sweats.

With contin of emet. therfore had recourse also to anoth meas.

Use viz of powder of Cicuta.

An artic which consid indeed as cheifly accomod for tuberc Phthis.

But which have only seen serviceab not only in chin cough, but in every inst of obstin cough.

And which probab has effect from dimin of this dispos. to this inord. action

But in inst before us, appears that very little influence.

For after this no saw nothing of patient for some time.

Then learnt that affect so much aggrav & strength so much exhausted that unab to leave house & hardly even bed.

In this situat had recourse to [Mixt] Mucil, merely as placebo & as means of slight tempor. allev.

But from this also cannot say that derivd any advant.

For soon after patient fell victim to disease.