DEP/DUA/1/35/08 (Transcript version)

Henry Bruce

1784

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Henry Bruce. June 4 1784

When this patient came under our care his prin sympt. cough & headach

And these attended with remark loss of strength a circum [attendedenc] on many affect.

Sometimes as a cause inducing other compl.

Sometimes as sympt result from princip morb. affect which has taken place.

More freq. as a conseq. of disease

And indeed is as it were a natur & unavoid conseq, of every disease which has subs. for any length of time.

Hence in gener encreas in prop to contin of any consid affect.

Here however durat of compl not great.

But at same time when consid that had been attended with very consid [eructat]. still inclind to cons view it as being sympt.

And this disch indeed of which in all prob. conseq to be consid as most import & alarm part of affect.

Had indeed been affected with no bloody expect. for two or three days before came under our care

At same time when consider attend to the consid evac of blood which had taken place for three success days prior to these, must look upon it as better entit to [appella] of Haemoptysis than any other.

And no sympt in the case which is not freq. either conseq or concomm. of that affection.

Here as patient imagind that pain first induced by lifting heavy load may be [supposed] of [passive] kind.

And that this may have had share in giving rupt of vessels by lungs is at least I think very possib.

At same time from state of pulse, as well as headach, have indic of gener fulness & tend to encr. action.

And may therefore presume, that at least accomp with dispos. to active haemorrh.

In headach here something you will obs. pecul.

Though cont. to cert. degree through the day, yet always most consid severe in the morning.

In so much that upon first rising, is affected with consid vertigo.

These I am inclind to think are conseq of horizont posture.

And no doubt that then greater determ to head than in any other posit.

Hence to be consid as giving som addit proof of fulness & encr. action

May also perhaps be [stated] as mattr of doubt, how far may not attrib to same cause, those morning sweats with which part affected.

Encr. cutic disch. may [unques] arise either from augm of impet or dimin of [illegible] at surface

And here may be effect of formr circum.

More reason to appreh. howevr that connect with latter.

And indeed a very common sym of an affect of most danger. nature which often a conseq of Haemoptys. viz Phthis Pulmon.

In giving prognos therfore in this disease tenden to Phthisis the circum most to be had in view.

Of this in case before us cannot be altogeth. without appreh.

For besides morning sweats other sympt also somewhat alarm.

Partic severe cough & quickness of pulse.

But at same time nothing here like decided Phithis.

And upon whole rather inclind to hope fav. than otherwise.

This you will obs. with pres. patient already at 24^th year, is a first attack.

Is in general however, from success affect only, that termin in Phthis occurs.

From haemorrh itself, seldom fatal conseq.

And indeed with pres. patient before time that came under care, seemd as it were to be termin.

Since he has attended here no threating of any return.

While at same time, health in every othr respect better.

Hence then in hopes that for pres. at least, fav. termin will be obt.

And although liab. to danger return of affect, yet may soon be dismissd for pres at least free from compl.

Even if this however should be the case, cannot I own attrib much to remed empl.

And recov much more to be ascr. to operat of nature, than to effect of any med.

While however say thus much would by no means be understood to inferr that pract here directed altog. useless.

And if princip part of affect really termin before use begun had at least prod yet probab. influ in prev. [return]

Here first obj. was to dimin at least in some degree impet of circulat.

To restrain & [mitig] cough by which such const. irritat given, as to endang. fresh rupt of vessels

And so far to strength vessels that rupt will not so readily occurr from triffling causes.

With first of these intent many diff remed might have been [empl]

And indeed intent answered by whole tribe of evac. operat without encr. impetus

Of the evac none more directly operates, as dimin impet, than blood letting.

And may here naturally occur as quest, why had not had recourse to that pract.

No obj occurrd to it, from state of pulse.

While seemd to be indic both by headach, & still more by pain of breast.

And do not doubt that in both respects patient might have derivd from it consid relief.

But was prin led, to deferr [usin] it from two consid.

In first place imagind, that circum might occurr when more urgently requird.

And if used now would be less prop to employ it then.

But still more [deterrd] from use, by great debilit of which patient compl.

For to this part of affect could be no doubt that would add very consid.

Wishd rather therefore, to try how far dimin of impet could be accompl by other means.

And for this purpose, had recourse to Crem of Tart.

This directed to be taken to such extent, that hoped it would operate both as gentle laxat, & refrig.

While at same time expected, that by giving determ to intest canal, would dimin tend to prof. disch by surface.

To which in all probab, loss of strength not a little to be attrib.

On differ. grounds therfore expected that might here be of service.

But besides this remed, had at same time also, recourse to another

A mucil mixt viz with addit of Infus Rosar.

From this again need hardly observe that obj was to answer two latter intent ment.

From lubricat of fauces by mucilag. expected mitig of cough.

While by astring power of infus Rosar, more indeed from Vitr. acid which cont, than from veget from which derives name, expected that vessels rendered tender by rupt, which had already taken place, would be strength.

And [for] Vitriol acid also as well as from Crem of Tart expected consid effect in dimin morning sweatings.

For in this way no doubt that this powerful astring has very consid influ.

On this course patient has unif. persisted since treatm here first begun

Can not indeed say that every intent which have had in view has been fully answ.

And in partic patient still affected with some degree, both of headach & of sweatings.

But other sympt, very consid dimin

While cough much mitig strength also consid augm.

And what of still more conseq. has contin entirely free from any return of bloody expect.

Reason therfore to hope that soon all affect will be removed.

And that for this purpose nothing farther necess than contin in course already begun.

If however in this disapp. by fresh & alarm return of Haemorr. may be obliged to have recourse to blood letting, blisters, or stronger astr.

If on contrary termin in Phthisis must direct plan of cure to that modif of the disease which shall occurr.

But as already said am in hopes that shall have here upon whole a more fav termin.

And that may soon be able to dismiss patient for pres. at least free from his compl.