DEP/DUA/1/32/15 (Transcript version)

Charles Watt

(1783)

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Chas Watt. June 12^th.

Sympt of this patients case not very dissim from last.

At least also consists princip in cough & dyspn.

But as in former case pron. these to be merely catarhal so in pres. on the other hand, but too much reason to susp. Phthis.

Here no diffic to that suppos. from age of patient, or durat of comp.

For still within limits of what reckond the Consumpt period.

That is, at age when consumpt most comm.

Affect but of few months stand.

And during that time patient very consid emaciated.

In so much that from exam of face, partic project of cheek bones might even consid him as app. to facies Hyppocrat.

This however must obs. seems evid to depend much on make of face.

And therfore less alarming.

But at same time is in him connected with make of body rather fav. to Phthis.

viz Long neck & narrow chest.

But to these circums. others still strongly indic susp of Phthis are here added.

This partic the case with respec to expectorated matter.

For remarkd that not only of [purul] app. but also of very bad taste

From these indeed, cannot by any means with certainty inferr pus.

And on this acct. wishd to have had opport of exam expect matter by Caust alk lixiv.

Which in my opin affords very cert test of pres or abs. of purul.

For in concentr. state operates as a solv. of mucus.

But if with mucus any purul connected on addit of water is deposited.

This trial however have not hitherto had opp of making.

As from dimin of expector patien could not collect it.

Still therefore must conject only from other circum.

But while app. taste & smell gave presumpt of pus, state of tongue also in fav of that supposit.

For this we are told pecul red & clean towards point.

Such a state of tongue however a very common attend, nay may almost say a necess. conseq. of purul expector.

Hence then justly to be mentioned among other susp circum.

Upon whole then when consid insid nature of Phthis. here but too much ground for susp. it.

Pulse indeed it must be allowed not remarkab. quick.

In hist. of case little above natural stand.

But this unquest no security.

And at times consid quicker.

Even such varieties however no less [threatn.] than greatr permn quickness.

Upon whole then all circum of this case led me to concl. that was Phthisis.

But suppos it such anoth quest to be determ of import in Pract.

To what species of Phthis viz are to be consid patient as subj.

For in this disease on all [hand] admitted that very consid diversit.

In my opin with view to pract. may be most usefully disting into three [Species].

The ulcerous where matter [formed] from large vomica.

The tuberculous, where [tubercule] indur glands passes into suppurat. yeilding only small quant of bloody sanies

Or The Catarrhal where purul. separat takes place merely from intern surf of lungs.

Into distinct of these species cannot here prop. to enter.

Would only obs. that consid diseas of our patient as being of lattr kind.

To this led, from origin of his disease, accid expos to cold.

From copious expectorat, evid containg at least mixt of mucus, & without app of blood which must attend erupt of Vomica.

Besides wants fixd pain of breast very gener. the attend of the ulcerous

And without constant tickling dry cough again occurring in tuberc.

From this idea of disease progn as fav. as can be, at least, in any inst. of Phthis.

For unquest more recov from catarrhal than any other.

Besides this season of year also much in fav of patient.

Partic as admitting of exercise, & affording diet most conducive to recov.

To these as a circum not less [flater] than either may add also change for better which has taken place.

For since came under care expct much dimin cough much easier

Hence then notwith danger natur of Phthisis here ground for hope

And shall not consider recov. of patient as any evid that supp respecting disease ill founded.

Must indeed be admitted that in greater part of inst. where Phth. said to be cured, the disease has never existed.

At same time is I think no less erron. to assert that from Phthis no recov.

In more than one inst, am very much persuaded, that have seen best effects result. from that remedy empl. with this patient.

I mean the Gum Myrrh.

At first indeed you will observe prescribd an Emet for patient.

This however done princip. with view to allev of cough by unload [bres] & to prep. for Myrrh by unloading [his] stomach

For most full acct of use of Myrrh in Phthis, may referr you to treatises by Dr Simmons & Griffi

Since these publicat, have often empl.

Princip as in pres. case, conj. with Crem of Tart. as a refrig.

Since began this remedy, affect for pres at least much allev.

And patient now looks upon himself, as almost perfectly recov.

In this however, would be very wrong, to put too great depend on his feelings.

Espec. as in Phthis, to be consid alm as part of the disease, that patiens never aware of their danger.

And in general even in uncomly high spirits.

Would not therfore be at all surpr to find that in end yet falls victim to it.

At same time must own that entert hopes of more fav. concl.

And expect that in no long time may be able to dismiss patien from attendance.

In that event whether can with justice attrib much to med, or not, shall yet consid case as example of recov. where at least strong presum of Phthisis.

If such recov. howevr, does not take place, may be obliged to have recourse to other pract.

If such necess, shall prob. have next recourse, to Blisters & Issues conj. with Cicuta.

In this respect howevr, must be very much determ, by situat of patient, at the time.