DEP/DUA/1/34/14 (Transcript version)

James Lundie

1784

---

James Lundie Febr 6^th 1784

Case of this patient somewhat doubtful.

Affect chiefly markd by severe cough & pain of breast.

These however well known to be sympt of diff. affect.

And partic to be chief charact of both Catarrh & Phthis pulmon.

In pain of breast however which here takes place a pecul. occurr.

For according to his descript [consis] rather in sense of strict than any thing else.

In this however nothing pecul charact either of these or any othr affect.

Nor can we considr it as in any respect singul that during cough pain not felt

For may reasonab. suppose that by agitat to which pat subjected this sensat. for the time not attended to.

But when consider that sensat most strong preceding the pain cough may from thence concl. that from this irrit the cough proceeds immed arises

And from this circum joind to want of expect. am I own inclind to fear that affect more import & dangr than catarrh.

Is indeed true that have not here all those sympt which usually occurr in Phthis.

Pulse in partic not affected.

For while of [midling] strength in point of No does not exceed 80.

Whereas in Phthisis patient even at early stages of the disease seldom under 100.

Besides this othr remark sympt of Phthisis also wanting.

Patient not affected with shivering with hot fits or with flushings

No night sweats or othr [hectic] sympt.

Although however all these wanting must still remark that Phthis a very insid disease

And that often [subsits] for a long time & has made very consid progr before [know] to exist.

And when this duly consid from urgency of cough & pain of breast.

But too much ground for susp. that affect.

Of this affect also some suspic from origin of disease

For began we are told under a form somewhat diff.

Was first affected with severe [headac] succeeded by prof. sweating

Prob. depending on some slight febrile access.

Soon after this however retuned to work.

And from that period dates comm of cough.

Probab. the conseq of expos to cold air when surface in very sensib state.

A cause freq. obs. to induce not only catarrhal affect. but more serious pect. compl. such for ex as Pleurisy Peripneum & the like.

Here then reason to presume that pain to which has been so long subj may be somewhat of sim. nature

Or at least that dep. on fixd & local cause.

From contin as well as fixd seat of pain anoth concl also may be drawn

May infer that if Phthis exists is neither of tuberc nor catarrhal kind.

For in both these affect not in general at least limited to any partic spot of lungs.

But extended over many parts.

Here on contrary may presume that suppurat rathr under form of large vomica.

And that disease of that kind which would term the ulcer. Phthisis.

From state of expect howevr may conclude that this vomica not yet ruptured.

And from this probab. to account for absence of many of the Phthis sympt.

But if conject well founded a [rupt] may soon be looked for

And in that case, farther evid of nature of disease will be afforded by purul expect.

If this series of sympt shall occurr prognos. will be as little doubtful as disease.

And at least great reason to dread that pat will fall victim to the affect.

Is indeed true, that in some inst of Phthis recov. does take place.

And this more the case in inst of ulcer than of tuberc consumpt.

At same time however even from slightest, recov. but rare.

And therefore I own, under great appr. that notwith all we shall be able to do, pat will fall victim to affect.

Prin chance of recov. is, that our idea respect nature of disease a mist. one.

And that both cough & pain to be acct for in some othr manner than from abscess.

On this suppos. howevr & on idea of Phthisis, treatm has hitherto prin proceeded.

And although must acknowl. that am acquainted with no pract, from which much success to be expected, yet diff meas which may be tried with at least some chance of success.

Here, on suppos of abscess, prosp. prospect of cure in some degree dep. on [purul] matter already collected being disch.

And after disch has taken place on ulcer being heald by means of adhes inflammat.

With meas suited to these intent however must be conj, on many occas at least, pract directed [against] accident occurr.

Partic with view of obviating unquest sympt & of counteract effects of purul absorpt.

These diff intent, will expl. pract. to which as will obs. from register have had recourse with this pat.

Began you will obs. by directing for him the use of an Emet.

From concuss thus induced, on suppos of vomica, had reason to think that rupt & free disch might be induced.

And had also some grounds for hoping that by deriv to surface might, somewhat relieve breast.

Accordingly though no purul [dis.] was conseq of use, yet cough somewhat allev.

Still however contin to be very distress. to him.

And as one of most urgent symp seemd to require some immed means of allev.

Was with this intent, that had recourse to Mucil mixt comb. with Cicuta

Formr well known in many cases to have very consid influ as lubr. fauces & thus taking off irrit.

While latter again, prob. operates as counteract affects of irrit

That is by narcot power renders influ of irritat less consid.

Prob. on this prin that are to expl. operat in cases of Chin cough.

And since introd against that compl. has been used in many othr cases of severe cough with consid [advn.]

While this however empl as means of allev. cough had recourse to anoth remed for obviat costiv.

Was with this intent, you will readily suppose that had recourse to powder of Cream of Tart & Sulph.

From this were not disapp in obt operat wishd for that viz of keeping belly gently open.

But cannot say so much of the affect of mixt. with Cicuta

When first began use indeed [though] that pain of breast somewhat allev.

A conseq, if at all to be attrib to it, probab. result. from sedat. affects

But had not the same influ on cough

For this contin with equal sever. as before.

And with out allev of cough, thought that had affect of excit vomiting.

At same time belly now so open that nothing aiding disch seemd for pres at least to be necess.

On these acct. gave up use of both med

And had recourse to pract directed with other intent.

Now found that much affected with diff of breathing.

Which while may be supposed to have arisen from encreased size of vomica, may also have in part at least proceeded from some degree of inflam surrounding it.

As counteracting this had recour to blister

And with view of support [determ] from breast directed that disch should be cont. under form of issue.

But besides this had now farthr evid of what seemd to me to be affects of purul. absorpt.

For though freq of cough dim yet strength very much impaird.

Consid this as affects of purul. absorpt. had recourse to use of G. Myrrh.

An artic which of late has with some pract had consid [illegible] in Phthisis

And of which, I own, am from my own exper. inclind to entert very fav. opin.

For most partic account of use may referr you to a treatise lately publ. by Dr Simm on Consumpt.

Among those suppos it useful, operat indeed has been diff. expl.

For my own part am inclind to look upon it as chiefly useful where vomica rupt and expector. of purul matter, has taken place.

And am disp to explain affects from influence as promot adhes inflammat.

In same manner as has long been esteemd useful when app. externally to ulcers of diff. kinds, under form of Tinct or like.

A very diff opin howevr is [conted] for by Dr Simmons.

He again considers influence as depend on antisept. power.

Or rather on affect, which has, as counteracting purul. matter absorbd.

And was I own, on this ground, that had here recourse to empl.

If pat. realy realy subj to the disease we suspect & if persists in use for suff. length of time shall from thence at least be able to determin how far Dr Simm opin well founded.

In some cases, from employm, inconven arises as tending to prod looseness.

Hitherto however with pres patien has had no influ in this way.

But cannot say that either from blister, or powders, much benef. has yet been derived.

This however to be expected only, from trial for some length of time.

And if no circum occurr [leadg] to alter opin of disease, or indic other pract. shall wish to persist in use both of issue & G. Myrrh.

Or perhaps even discont. former, to go on with latter alone.

And if after fair trial shall found unsuccess. future meas. must be accomod to situat in which shall then find patient.