DEP/DUA/1/36/13 (Transcript version)

Robert Moulray

1784

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Robt Moulray. Decr. 4^th 1784.

Disease to which this pat. sub by no means distinct or cert. markd.

At same time but too much reason to appreh. that subj to a disease no less freq. than danger. viz Phthisis Pulmon.

And this the rather to be dreadd as well known to be a disease in its nature very insid.

Hence has often made consid prog even arriving at what may be calld last stage before cert. of exist.

In case before us patient subj to many of those sympt. which most common attended of this affect.

As such may mention the cough dyspnea & pain of breast

May mention also as sympts no less common, the quickness of pulse, shiv fits & colliq. sweats.

For while formr sympt in comm to Phthis & Catarrh, latter again charact. of hectic fever pecul. to Phthis.

But although from this collect. of sympt may assert. that Phthis often exists, where less distinct markd yet here other circum to create doubt.

This partic case with respect to situat of pain.

Is seated you will obs. not prop in the breast but at pit of stomach

And there gives sensat of press on parts seeming to push them upwards

Hence then some ground for inferring than an abscess may be formed rather below than above the diaphr.

Anoth circum giving some doubt is freq. vomiting to which pat. subj.

This indeed it is true not unfreq. does arise from cough.

But here would appear that something farther.

For not only does vomiting ensue on severe fits of coughing, but even constant inclin to it.

In so much that are told nothing retaind in stom for any length of time.

This therfore would argue irrit deep seated if not entirely below lungs.

To these circum may be added as anoth partic giving doubt, state of expect. & state of tongue.

Cough of this patient dry & bound as is stiled.

And no app. of any disch having mixt of purul.

Tongue you will obs. of white colour.

But wherever purul expect in any degree takes place well known to put on very diff app.

Accordingly in Phthis very gen. happens that tongue uncomm red.

Often from being depr. of natur. covering has resemb. to piece of new flesh.

Not unfreq even in an ulcer. state.

Hence then from this circum. consider us as having cert. evid. that no purul. expect.

Or in other words that although vomica exists in lungs is still entire.

And this I own is idea I am inclind to form of the disease.

For none of circum mentiond which may not be expl. on suppos. that there here occurs a large vomica still unburst deep seated in lungs.

And this suppos. the more probab. as there such abscess more common than in other neighb. parts.

This however suggest only as what to me seems most prob. conj.

But notwith this uncert. with regard to disease have I own but little concern prognos.

And here I think but too much reason to dread that disease will in no long time have fatal concl.

For if such vomica exists whether above or below diaph. equally dang.

And sympt which have already taken place of most alarm nature.

Under colliq. sweats & diarrh patient cannot subs. long.

And loss of strength which has already taken place so consid that do not I own again expt to see him at the Disp.

One circum indeed which consid as giving him some chance of recov.

That is the bursting of vomica in such manner as to give opport for free disch of matter.

No doubt that at least better opport. of recov. when this case than when contin shut. & only outlet by absorb.

For on bursting opportion at least afforded for adhes inflam.

But on other hand, bursting in place of leading to recov. may hasten fatal conclus.

For well known that this often conseq of opening large abscesses.

Partic exampl. in case of [Psoas] suppurat.

Where before opening, hectic fever but very inconsid, has been found rapidly to encr.

Prob. conseq of change in state of matter from access of air.

And of sarnies or ichor fluid being now obs. in place of bland pus.

Same also well known not unfreq to happen, on rupt of vomica of lungs.

Hence then on any view of matter hopes of recov. here at utmost but very faint.

And I confess that what consid as prin chance of patient is that entirely mistaken with regard to nature of disease.

And if this the case cannot even pretend to guess whethr more or less danger than now repres.

But on idea which entert concern nature of disease & on opin deliv of prognos. need add but little with regard to practice.

Am I own disp. to think that if cure at all to be affected must be by operat of syst. itself.

And by natur progr, of proper adhes inflam. after rupt of vomica & disch of matter.

In forwarding these ends however in situat of pres pat. am inclind to think that very little can be done.

Might indeed employ emet with view to rupt of vomica as first step towards cure.

But this pract should esteem very hazard.

And in pres. weakned state of pat. espec if rupt took place, concl. might be immed fatal.

Hence then utmost here left in my opin to palliate

And is with that view that have had recourse to pract here empl.

At first you will obs. directed for pat. a mixt. consist of powder of cicuta & of liquor.

This med empl. in hopes of obt. from it some affect in obv. cough.

And although latter artic, the liquor, from abounding with mucil & sach parts, in gener. consid as a demul. yet here prin empl. as an [excess] & to give form

Was on narcot power of Cicuta that put prin dep.

May indeed occurr that in this way, could have obt. more cert. & powerful affects from opium either in solid state [or] in that of Liq. Laud.

But to opium here tend. which has to induce sweating seemd to me to be an obj.

For patient already exhaus with colliq sweats to great degree.

And influ of opium which has very powerful effect in relax the surface as encr. these well known.

That from Cicuta very consid affect may be obt. as allaying cough is I think incontest. proved.

For introd with this intent indebted to Dr Butter, who recomm it as infallib specif in cases of Pertuss.

But although by repeated exper. found that in this was mistaken, yet from same exper. discov. that useful in all coughs.

And accord in many inst. where thought that obj occurd to opium have had recourse to Cicuta as means of [alleviating] cough.

And if my observ. not mistaken has in many such cases been attended with advant.

Cannot however say that this was the case in pres. inst.

Seemd indeed to have [soome] good affect in settling stom.

Or at least while was itself [retain] without inconv. seemd to him, that less affect with vomiting than bef.

Cough however nothing dimin in severity.

And if vomiting somewhat allev. seemd now to be more affected with anoth & no less distress. compl. loosness.

As allev. this could expect nothing from Cicuta.

And as only means of obt. such relief seemd necess to have recourse to opium

To avoid however inconv from more excess sweats during night directed it in morning.

And that might have better [chan] of action on infer. part of alim canal empl in solid state.

Of these med. patient was you will obs contin use at last report.

And if have affect of allev can I own expect nothing more from them.

But even with this intent am affraid will not long be [illegible] as I own inclind to consid death of pat as at no great [dis]

If however should happen otherwise, future attempts to palliate must entirely be directed to circum at the time.