DEP/DUA/1/33/28 (Transcript version)

William Aitken

1784

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Wm Aitken 18^th Janr 1784

With regard to compl of this patien when came under care was I own somewhat doubtful.

And not without appreh of danger. consequences

Princip sympt you will observe consisted in pain of breast a little above scorbic cordis.

This so consid that could lie only on one side & not even thus when in recumb. post.

For in order to obt ease obliged to have his head raised

This pain attend also with very severe cough

From these sympt had reason to appreh some serious compl of thorac viscera.

From contin indeed & from absenc of fever not not consid it as active pneum inflamm

And here charact marks both of Pleurit & of Peripneum were wanting.

But at same time had reason to suspect [such] a degree of inflam as might termin in supp.

And thus give rise to Phthisis an affect in most inst termin fatally

If however such an event to be dreaded even suppos conject well founded, as to nature of affect had yet reason to entert hopes of more fav conclus

For by prop remed might expect resolut of inflam.

And this even in most viol cases is at least most freq. termin

But in inst before us no certain evid that inflam to any degree

Or at least may have been merely such as the attend of Catarrh

And that affect at least to consid degree catarrhal may inferr from expect with which attended.

And here so much in doubt that treatm in part directed with both intent

But whatever conject best founded appreh. with regard to case now at an end.

And from fav. termin which has taken place observat on prognos now superceded.

This termin, am in part at least, disp. to attrib to pract. here empl.

Partic to the blister.

This remedy often empl. in Catarrh cases & with great advant.

But here more partic directed on suppos that pain was the effect of some local inflam.

On this idea indeed may natur be thought that should have had recourse to blood [lettin].

But here even suppos that local inflam had occurd was yet without encr. action in whole vasc. syst.

For pulse with a man not arrivd at 30^th year, only 80 & rather weak.

Saw no reason therfore for having recourse to general depletion.

And from blister I own expected more here than from topic bleeding.

Influ of blisters as useful again internal inflamm has been expl. in diff ways.

In general however consid as prin arising from antispas. power & from change in mode of circul.

On these grounds howevr should hardly expect more from applic to chest than to other parts.

For notwithst. situat nearness commun with vessels affected not more direct.

Must own however that inclind to think that some advant here arises from proxim of situat.

Perhaps to be expl from sympath perhaps from some other cause.

But whether any super advant from applic over paind part or not is yet unquest that as thus appl. prod of useful conseq.

And both with & without blood lettin most salut affects in remov.

If inflam here existed may presume that to have been case

For no sooner had operat taken place than pain of breast very much allev.

And in short time entirely left him so that could lie with equal ease on either side.

With removal of this sympt consid disease as termn.

And this termin, whatever nature was may I think be ascribd to the blister.

Besides blister indeed here empl. also some squill pills.

Chiefly intended with view to cough & expect.

But of these shall more partic have occas to speak under case next in order that viz of Rob. Mitchell.

This however delay till future lect.

And may concl. pres case with obs. that affords example how far even alarm sympt of breast will yield to applicat of blister over the paind part.