DEP/DUA/1/33/30 (Transcript version)

Robert Mitchell

(1783-1784)

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Robt Mitchell Janr

In case of this patient nothing very remarkab. or pecul.

Lab. under a disease however which in this country & at this seas of year no less freq than troublesome

And as such here selected as subj of pract & lect.

Affection consists in troublesome cough, partic severe & freq in night

And at same time attended with copious viscid expect.

When consider age to which this pat has arrived 64^th year might without hesitat term it Catarrhus senilis.

As however, though most freq in advanced age yet by no means pecul to it, with greater prop. termd Chron Catarh

A disease entirely depend on uncommon secret of mucus by lungs.

Where from [filling] & irrit [air] vesic gives both dyspn. & cough.

And accord, on free disch, by excret in large quantity, tempor relief at least is obt.

This augm secret, very gener. at least, conseq of change in determin

And partic of want of free circul on surface.

Accord disease much more freq during winter than at any other seasn

And indeed many with whom a period affect, return regul with cold weather.

While by change of season almost completely & spontan removed.

This disease in general at least not esteemed danger.

And indeed numbers subj to it for course of many years.

But though on this acct. often disregarded, yet in end not unfreq. fatal.

And partic so with those far advn in life.

For after accumul consid, & strength become insuff for expect, suffocat must be necess. conseq.

In such a case therefore as pres. prognos. should always be given with great caut.

For although app. relief obt. yet apt to be renewed on slightest accid.

And espec. with those during such an inclem season as pres, necess. exp to severit of weather

Hence then with pres patient, already subj to freq recurrence, cannot [now] at least promise any perman recov.

In case however nothing at least immed alarm

And by diff pract. may hope, although cannot in pres circum remove, yet in some degree to allev. his affect.

In this disease most immed relif obt by unload. breast from muc. already accum.

But still more perman advant from dimin future secret.

Not so much however by restr. secret at part, as by giving determ to other parts.

Partic to surface, to urin passag or to intest canal.

With these diff intent, recourse had, in this affect, to various remed.

And from what now said, will readily understand meaning, in diff pract here employed.

Began you will observe by directing for this patient the use of an Emet.

In this need hardly observe that intent in view was much more to unload the stom breast than the breast stomach.

Most immed & obv. effect indeed is evac of stom.

And where no matter accum in air vesic of breast has prob. little effect on these.

But can be no doubt that in cases where such accumul. takes place greatly prom. expect.

In so much, that some even disposed indeed to consid emet as only [exp]

To this opin indeed, must own, that for my own part, I cannot subs.

Yet at same time, have no doubt in consid vomiting as most ready means of prom Expect.

Perhaps may add most powerful

This then princip affect here expected from it.

But besides this, also expected somewhat, from influ of Emet vomiting as giving determ to surface.

For in this way effect, though indeed but temporary, unquest powerful.

And from prop circul on surface, in this disease, greatest benef. obt.

This abund [evin], from relief in warm, & aggrav in cold weather

From benef derivd from warm cloathing, keeping the house &e in cold weather

And from great relief which those long period subj to it, obt from passing winter in warmer clim.

No disease in which change of clim so as to avoid severity of winter, more benef than pres.

And this, entirely I appreh to be explained, from diff. state of circul on surface

From Emet indeed effect in this way at utmost but temporary.

Has still however influence both as encr. disch & renewing circul on surface.

And when once restor. often supp. by means before insuff. such for ex as warm cloathing or like

How far on these prin was here benefic to pat. cannot pos. pretend to say.

But at least were not disapp. in obvious operat.

And to this, am I own, inclind prin to attrib that consid allev of sympt which succeeded.

This were warranted to infer, not merely from relief in med succeed operat, but from having been form obs. attended with same effect.

Thus then, from former exper, as well as from princip here stated, may concl that benef derivd from it.

But besides vomit must be [admited] that here also had at same time recourse to anoth med.

And one too from which benef I think might have been expected.

Viz the Pil. Scillit.

In last edit of Ednr Pharm, pub. under direct of Dr C. squill pills had no place.

Were not however thrown out on suppos of their being pernic or inact.

But merely because imagind that more effic as an extempor. prescript than as kept ready prep in shops.

And that more conven for pract to have it in his power, readily to vary prep of Squills than to be tied down to any fixed formula.

But though these [argums] of some weight, yet were not suff grounds for reject.

From having fixed formula, pract. by no means prev. from varying prep in extempor prescript as he pleases

And though pills made of recent squills, soon apt to suffer, yet those prep from dry powder of root, kept good for consid time.

And as thus prep. unquest most certain, & most effic med.

But besides this, still an addit reasn for keeping them in shops.

Many patients, long habit to use, in pract of prescr. them for themselves.

Hence, so often calld for, that when no formula given by the Coll that apoth obliged to keep them in shops, as prep. by former edit of Pharm.

For these reasons then Ednr Col. have thought it prop to restore Squill pills in pres edit of Pharm

And in doing so have consid altered formula.

Besides Squills indeed, some other artic in both, such for ex as G. Amm as adjuv, & Cardam as corrig. still retaind.

But in place of recent root, powder of dried root now empl.

And this unquest a much more active subst.

For in adher. water, which constit diff between the two, prob. no activ whatever resides.

And by differ in prop of this water, strength of root, in what calld recent state, very much varied.

Hence pres. a much prefer formula to former one.

Into each pill, of grV powder of dry squills, now enter to nearly [quant] of grain.

And though this much less prop than formerly, yet no less active & more certain.

Was from squills here, that benef. as empl in this case, entirely expected.

Gener prop of squills, need not here stop to enum.

Needless to obs, that in certain doses, from action on stomach oper. as emet.

And no less certain, that when not sudden disch from alim canal, active prin carried into circul mass.

From reaching kidney in course of circulat, have very gener. at least effect of oper as diuret.

And indeed, though no diuret always to be dep. on, yet in gener ranked among most cert of that tribe of med.

But if thus certain operates on urinary organs, may observe that has at least equal access to other parts

And from observ. of facts has long been prev opin, that has effect on [secret] by breast

This opin indeed some disp to deny

But judging, not from any theory but from own observ, can entert no doubt, of expector. as well as diuret power.

As far however as has tend to encrease secret by breast, may seem adverse to this disease.

But while influ in this way has still more effect, as promot tend to speedy disch.

Hence mucus excreted before [acquire] that viscid, giving great dyspn & severe cough.

And thus it is, that has app of rendering mucus thinner, though in reality, no affect in that way.

Is then from influ on state of expect, as well as from diuret power, that prod of benef in cases of Catarrh

And indeed whatever princip. no doubt that here very consid advant derived from it.

And as formerly found benef. to patient again expected same effect from it.

Cannot however say that in this respect expect. yet accompl.

For from [inquirg] at his habit find that still much distress with cough.

This however may in part perhap ascribe to himself.

For as will obs. from regist. has not given regul attend and of course has not been supplied with med for some time past.

But at same time if want of med somewhat against patient, state of weather still more so.

And with pres severe frost while continues to go abroad in course of his employm. can hardly expect benef from any pract.

If however returns to attend in former condit shall think of pros. same plan

Or in case of partic urgency of sympt, may have recourse to a blister

In case of costiveness, may [direct] Cream of Tart. either by itself or comb. with Sulph.

In these partic however must be directed, by condit in which shall then find patient.