DEP/DUA/1/29/08 (Transcript version)

Robert Haitley

(1782)

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Robt Haitley.

Most urgent sympt in case of this patient is cough with which affected.

This cough with such expect & dysp. that can have little hesit in consid affect to which he is subj as being either Phthisis or Catarrh.

In these affect however so many sympt in common that in many cases till disease has made consid progr. distinct very diff, if not imposs.

Case before us not altogether without doubt.

But of the two affect, am inclind to think that by much greatest prob of Phthis.

Of this some presumpt from cough being most troublesome, in the afternoon.

In catarrh commonly most distress after sleeping in the morning.

And then both cough & dysp. the conseq of that viscid which mucus acquires during night.

In catarrh Phthis on other hand again usually most severe when feverish exacerb. takes place.

And this more freq at least in afternoon than any other time

Here indeed must be admitted that cough besides being troublesome at night also severe in [morning].

Hence then this circum if taken by itself, but of little weight.

Latter partic mentiond Severity of cough in morning however by no means an obj to suppos of Phthisis.

And if some slight presumpt of that affect from excacerb of cough in afternoon, still more from state of matter expectorated.

Besides colour & viscid of pus, is also repres as having very disagr. smell.

And as thus rendering the breath very offensive.

But besides this gives also disag taste in mouth.

To all these circum giving pres. of purul. still anoth to be added.

Mixt viz of blood in matter expect.

This, if ever happens at least very rare in Phthis cases merely catarrhal.

And if any doubt as to [purul] state of expect from circum before ment. this suffic entirely to [remove] it

But besides evid of purul expect, here also distinct marks of hect fever.

Of this at least strong presump from chilly fits

With these we are told patient freq affected.

And that too, even when at work, & may be supp to be kept warm.

Are not indeed told that these shiverings succeeded by augm heat.

But from state of pulse, may I think presume their being febrile.

In pulse indeed a pecul. observ.

Not only liab to freq intermiss but in other respects also irregul

Partic obs. to vary very remark. in point of strength.

But with these irregul unif [qual].

A circum. which when taken with others, always consid as ground of distinct, between Phthis & Catarrh.

To these circum may add also, anoth giving probab of Phthis.

That is from which affect had at commen.

Began we are told with spitting of blood, pure & unmixd, to consid quantity.

Is not indeed in every inst, that haemoptys. termin in Phthis Pulmon

But must at least be admitted, that haemoptoe one of the affect of which haemopt. Phthis freq. sequela.

And when succeeded by cough, with such expect, & such hectic sympt. as describd in pres. case, little doubt that such transit has taken place.

From all these circum then taken togeth, can have but little hesit in pron. that pres pat subj to Phthisis.

And from this view of disease are necess precluded from fav. prognos.

Would not indeed repres patien as past all hopes of recov.

And of diff kinds of phthis am even inclind to consid his case as fav.

At least Phthis from Haemopt, which commonly depends on consid ulcer formd in lungs less cert, & rapidly fatal, than what arises from tubercle.

If however ulcer consumpt, & such hold disease of pres. patient to be, less danger than tuberc. is more so than Catarrhal.

And I own expect of recov. here are not great.

Should not even be surprizd, if in short time disease makes such progr. that patient incap. of farther attend.

Reckon it however more prob. that shall here have opport for trial of diff pract.

But how far, these will have much influ in remov. or retard progr of disease, dare not venture to say.

Here from idea given of [affects] prin morbid condit to be comb, is state of ulcerat in lungs [furnish] purul. matter.

And this to be removed by induc adhesive inflammat.

If this can be effected, radic cure of the disease, will be brought about.

But ere that can be accompl. may naturally suspect that urgn sympt will occur which necess to obviate.

Pract however to be directed, with this view, must be accomod to occurr.

And in mean time endeav. to be prin empl. in at least attempt radic cure.

What now said will explain to you intent in view in pract [already] advised.

Have you will observe put this patient on course of Cicuta.

Need not obs. that this remed, of late introd [freely] inten, as cure for Cancer.

And although has by no means answ. expect. of every body in that affect. yet employ there has at least demonst, free use that may be made of it.

And for my own part must be of opin, that in many other ulcer. partic those of scroph tend. has often good effect.

Accord. has of late come into freq. use in Phthis cases

Here employd in what I [reckon] one of best forms that of powder of leaves.

But with view of afford [prop] [illegible] & at same time giving some mitig of cough this powder added to mucil. mixt.

Cicuta at pres. in mixtr to quant of Ji in ℥i.

So that patient at pres takes gr X – thrice a day.

On this course if nothing [part] occurrs is intent to cont. till see whether Cicut. can give disp. in ulcerat to heal.

And accord to circum may grad encreas quant.

With this course however other pract. prin with view of obv. sympt. may be conj.

And accord. have already had recourse to a blister directed to be converted into an issue

This intended for diminish determ to lungs.

From which may both expect mitig of cough & that tenden. to healing of ulcerat will be augm

But still more hope that will have some inf. in prev. [haemm] from lungs which still cont.

If pres. course prove unsuccess. & no reason to alter opin of disease too other pract which prop to try in success.

The use of G. Myrrh & of Mezer.

But if either of these empl. shall afterwards speak more fully of intent in view.

If [cont.] of disease attend [pract] must be accomdd to idea then adopted.