DEP/DUA/1/32/13 (Transcript version)

Alexander Stuart

1783

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Alexr Stuart. June 12^th 1783.

In history of this patient affect but few sympt mentiond.

And these evid indicat a catarrh affect.

An affect to which he has been subj for many years.

And which prob. not a little aggrav. by prof. which he follows that viz of flax dresser.

His affect we are told both now & formerly under form of cough & dysp.

These however by no means exactly prop to each other.

Rather indeed obs. to altern.

For formerly much more subj to Dysp. with less cough.

Whereas at pres. again when came under our care, cough severe dysp. less consid.

But under whatever form affect always worst during winter.

A circum almost constantly happen with regard to such catarh affect.

And accordingly in all probab. proceeding from want of due circul. on surface in conseq of constrict.

Accord. by warm & even temper or steady clim almost univ. remo.

But besides season have already hinted that in case of pres. patien something also dep on occupat.

From trade of flax dresser air which he breathes must cont. large quant of dust.

Not wonderful that such extran matters should often give obst. to passage into air vesic.

And accordingly with this prof. dyspn a very freq. compl.

Nor is it at all surpriz. that dysp. thus induced should occur more readily in winter than sum

For in former case encreased secret of viscid mucus to which more readily attachd.

This then idea as to nature of affect to which pres patient subj.

And in my opin very little room for doubt with resp. to it.

Here indeed as in every case where cough to any consid degree some ground at least for being app. of Phthisis.

For while no disease equally danger. more common in this country is also an affect app. in diff. forms.

And has often even made very consid progr. before susp.

If however any expect of being able to comb. it must attempt cure at comm.

In pres. case however no ground for suspect Phthis.

Age of patient, state of [pulse] & durat of disease all strong obj. to it.

May indeed to held as a circum somewhat susp. that immed before came under care rapid emac. took place

This it must be allowed always alarm.

Partic when conj. also with rapid loss of strength.

Had lately occas. to treat a case of Phth termin fatally [where] almost no other sympt.

Or at least where disease with these sympt alone had made very consid progr. before either cough dysp. hectic parox or even quickness of pulse.

Such cases howver very rare.

And in that inst. both age, habit & family of pat gave ground to susp. Phthis

Here therefore notwith cough, occur of Phthis if had taken place would have been still more extraord.

And that no tend of this kind now beyond all doubt estab. by termin.

For in no long time after came under our care termin fav.

And for pres. at least patient free from his affect.

From this circum observat respect prognos. may be consid as [imprud].

May only remark that from all circum, age of pat. state of compl. season of year & like had hopes of fav. termin.

At same time did not expect that would have taken place so sudden.

And may also add that am doubtful how far will be found perman.

Probab. indeed that unless from accid or imprud expos to cold will cont. free from it for summ season.

But have reason to dread reccurr. during succeeding winter.

Prevent of future returns howver a matter but little connectd with cure of affect when pres.

And much more to be brought about by regim than med.

And hence very much depend on conduct of patient himself.

Was therefore entirely with latter intent, remov. of affect viz that pract. here directed.

How far conduc to this end is next our business to inquire.

Here you will observe began pract. by direct. for our pat. the use of an Emet.

From this need hardly obs. that princip. intent was the unload breast

For no doubt that emet the most immed, perhaps may also add most powerful expect. with which yet acquainted.

In cattarrhal affect. also often of use by giving determ to surface

For even, by [moment]. affect in this way, from action of vomiting, perman circul. [there] often rest.

How far on these princip operat of emet here to be entirely expect. will not pretend to say.

But at least probab, that were princip source of change for better, which took place.

And at least certain that while emet attended with all obv. oper. that could have wishd, affect at succeeding report found to be very much relievd.

This however I am inclind to think in part also to be attrib to pills

For at first report, was you will obs. directed to use of Pil. Scillit.

To these pills, while squills give name, are also to be consid as most active artic.

Gum. Ammon, Squills Cadam seeds & Extract of Liquor. indeed enter. [compos] in still larger proport.

But none of these artic of any great activ.

Partic in small quantity to which can here be taken.

And while cardam. seeds used merely as corrigens, Gum Ammon as well as Extr. of Liquor. may be consid as intended merely to give form.

Active powers therfore to be viewd as entirely depend on Squills.

And in this mode of exhib can I think be no doubt that Squills very powerful.

May seem somewhat singul. that Squill pills, which have long had place in Pharm of almost every Colleg. were rejected from last edit of that of Ednr.

This however did not proceed from any idea of want of effic.

But because squills a med which when in state of pills apt to suffer from being kept.

Was therefore thought that by want of formul, Phys. more [illegible] of having them fresh made.

And that also more latit in [varyn] prep. of squills accord to circum of case.

But these reasons by no means suffic for reject.

For Squills pills a med so much in demand that for conven. must be kept ready made.

And so much [prescr]. by patients for themselves, unacq. with compos. that some fixd stand must be followd.

Accord. although no place in last Pharm were always kept in shops as prep by edit of 56.

And may farther add that fixd standard need in no degree prev. any pract from varying prep. as he pleases in extemp. prescript.

Hence then College in pres. edit of Pharm. have I think with prop restored form for Squill pills.

Accord to this formul. near a grain of powder of Squills in every five of mass.

And this quant you will obs. directed for our patient twice a day.

Squills taken to this extent have very generally effect of encr. secret by kidney.

With our pat. such a change not indeed at first obv.

But from short contin of use not only augm of urine, but also open belly.

And can be little doubt that from both derivd benef.

For my own part, [however] am fully persuaded, that active parts of squills, taken into lungs circul. act on [excreter] by lungs as well as kidney.

And that therefore justly entit to charact of expect.

On this footing then would expl. in part at least, that benef. [which] seemd to derive from them.

For in no long time dismissd free from his affect.

And have little doubt that was in great meas to be attrib to remedy employd.