DEP/DUA/1/36/19 (Transcript version)

William Smith

1784

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Wm Smith Decr. 8^th 1784.

This patient subj to a disease no less common than alarming

That species viz of haemoptysis which most liab to termin in Phthisis.

Does not indeed correspond with defin of the disease as given by the best nosol.

Not at least, partic markd, as of the florid complex.

Nor from any accts which we have had, does he disch blood, in a frothy or florid state.

But at same time has on diff occas been abund distinct. markd in matter expect.

Sometimes of bluish colour at other times mixd with mucus & of blackish app.

Circum from which may inferr that effus from vessels yeilding it takes place in slow & grad [mannr]

And that before disch by [expect] subj to consid stagn.

Here then may occurr as quest whether Haemorrh of active or passive kind.

Especially as attended also with severe cough.

But where even passive haemorrh from this cause, blood usually florid.

And am I own here disp. to think, that both cough & haemorr from same cause.

That proceed from some local disease, prob. a tubercle in lungs.

This I suppose has not yet degener into state of suppurat.

But is in such condit as to give irritat. hence the severe cough

While at same time, the surrounding vessels, yeild grad effus of blood.

And from this again, are I appreh to acct for dyspnoea.

While pain of side conseq of slight tempor. inflam. excited in tubercle or neighb. parts.

In short consider this case as a distinct markd inst of the Haemoptysis a tubercule of Sauv. or Haemopt. Phthis of Dr Cullen.

With this view of nature of disease cannot give very fav. progn

In most inst has at length fatal termin.

And this I am inclind to suspect will be conclus in pres patient

Hold such haemoptysis to be much more danger. than where large & free disch of blood.

For then condit of vessels such that may unite & heal by first intent, in same manner as when haemorh happens from other parts

But here haemorrh chiefly conseq as it were of disease cond in lungs.

And of that condit too giving rise to worst Phthis the Tubercul.

An affect by many consid as being almost cert. fatal.

That therefore will termin in this, at least highly prob.

But at same time, if even tuberc Phthis should occurr, are not thence to relinq all hopes of recov.

For have no doubt in asserting, that have met with some distinctly marked inst of this affect from which recov take place

This however gives I own but faint chance of recov.

And consider us as having better ground for expect. on a diff. footing.

That tubercle viz does not pass into state of suppurat.

For this though a common by no means a necess. conseq.

In all probab. has already subs. even for space of some years, without such an event taking place.

And although in end may occurr. yet may contin for equal or even greater length of time before happ.

Nay may either contin for life or even be removed by absorpt.

But at same time these prospect must be repres as but very faint.

And much more probab, that in no very long period pat. will fall a victim to affect.

In removal of cause of disease here, the tubercle viz which suppose to exist in lungs, can do little.

And practices princip to be directed to prev of those changes from which greatest danger to be dreaded.

Partic to prev. inflam & suppurat

Is with these views that pract hitherto directed have been empl.

Began by ordering applic of blister to paind part of side.

And directed, that after blister, drain should be supported under form of issue, by episp. ointment.

Of explan of action of action of this mode of cure in such cases diff. opin have been entert

Can however, I think, be little doubt, that partly if not entirely to be attrib to change in mode of circul.

Has unquest the affect of prod encreased circulat in part from which disch takes place.

And from this reason to think that may have influ in dimin flow in neighb & diseased part.

Prob. also in some degree oper. as gentle & perman evac.

And not improb. that in has some degree operates influence as partic outlett.

And that thus has affect, [quasi] nova glandula, as some have [exprssd] it.

But whatever diff of opin as to mode of action hardly any with respect to affect.

By every one whose judgem guided by observ in actual pract, univ [allowd], that in such cases, a remedy of very consid service.

Partic, where haemopty occurring but to slight degree, attend of severe cough

Though does not prev. termin in Phthisis, yet often gives tempor. susp. of haemorrh. & mitig of cough.

These then chief ends, which expected would be answ. by it in pres. case.

And at pres, is my prin view, with this patient, to see how far by means of it, these ends can be obt.

Besides blister indeed, directed also, at same time, anoth med.

A mixt. viz of powder of G. Arab. & Nitre.

From former, might derive some benefite, in allaying cough from power as demul.

While latter, will to certain degree operate, as refrig.

And that thus some influence in restr. both tenden to inflamm, & to haemorrhage.

For can be no doubt that sense of cold which excites in mouth & stom also attended with dimin of impet. of circulat.

From these artic given in conj. expected more advant. than as taken separately.

At least G. Arab. operates as a corrig of nitre.

And thus less apt to occas [sicknss] or general affect of syst. from immd action on stom.

From use of these med. cannot say that patient has yet reapt any consid advant.

Powders indeed taken taken without any inconv.

And blister & issue, prod of copious disch.

During use, pain of side became somewhat easier.

But cough still contin very severe.

And was not free, from return of bloody expector.

Imag. however, that by farther longer contin, better affect may be obt.

Hence without any farther addit. directed that should persist in use at least for anoth week.

If during that time, should not receive matter benefite, will still I own, be averse to relinquish pres plan.

But will naturally think of aiding it, by something else.

And partic, with view of mitig severity of cough.

With this intent, nothing seems to promise more immed benef. than use of opium.

For remark power which has as allaying inord action, univ known & admitted.

Here however some obj to use from dyspnoea to which patient subject.

For little doubt that will retard expector of that matter, containd & effused in vesicles, on which Dysp. depends.

But this more than compen. by relief of cough.

And at least deserves cont. trial.

If therefore cough contin severe shall prob. give up formul of Nitre powder.

And in place of it, may direct a mucul. mixt with Nitre dissolved in it, adding such proport of Theb Tinct, as may reckon suff for obt sedative affects of Opium.

Or if no haemorrh, may employ mucil mixt. with Theb. Tinct without nitre.

If from these med, shall obt freedom from cough, pain of breast & haemoptysis, is perhaps the utm that can here expect.

And may dismiss patient, with alarm affect. warded off at least for pres.

This however could by no means considr as cure.

And on every slight accid, reason to dread return of compl.

If however, which no less probab. even in thus fav, should not take place other pract. which may at least be tried.

And accord to circum of case at time, may try course of Cicuta, Merc or Gum Myrrh.

But if employ any of these, must reserve explan to some future opportunity.