DEP/DUA/1/38/39 (Transcript version)

David Bickerton

(1785-1786)

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David Bickerton

Disease of this patient cannot be said to be altog. without doubt.

But at same time many circum giving strong presumpt of Phth. Pulmon.

His most distress sympt, cough dysp. & pain of breast, though not cert. marks are yet const attend of Phthis.

These indeed even with such app of expect as here descr. occurr also in chron. catarrh.

But age of patient much more in fav of Phthis.

Is you will obs in 19^th year a period when Phthis freq, chron catarrh but rare.

From this circum however much less decis evid than some others

Partic state of pulse & strength.

Latter has faild so much that though a young man, now with diff able to go abroad.

Has not indeed, as far as we can learn, any distinct markd access of hectic fever.

But pulse when we have had oc to observe it, unif small & quick.

At 120 in minute.

To this might add also, other circum.

Such for ex. as app. of counten of Tongue & of Eyes.

Is not indeed, of that colour of hair & complex, marking the sang. temperam., & with which prob. disease most comm.

But this well known to be no security against affect

And notwith black hair & swarth comp. yet somewhat of that app. often the attend of Phthis.

A circums. redness viz in cheek.

Tongue more app. of health, than of disease.

But markd you will obs. to be partic red, towards point.

This condit of tongue, more a mark of Phthis, than of very much furred or dry.

For never fails to be attend of any purul in the expect.

Often even gives reason to presume it, where from app of expect matter should not inferr so.

And when, as in case before us, no susp of pus, either from disag taste or smell.

When expect highly purul. mouth not merely affected in this way.

Not only abraded Tongue which may alw suppose to be case, where pecul red, but even ulcerated.

Such a condit indeed, has not here taken place.

But at same time, app of tongue such, that may evid pron it, to fav, opin of Phthis.

Same also may be said respect eyes.

The adnata, markd to be of pale blue colour, & with few red vess.

An app. which although neither const. in Phthis, nor never occurr in other diseases, yet markd to be freq. concom of that affect.

But all these circum, though giving presumpt of this disease, weigh much less, than anoth yet to be ment.

Manner viz in which affect comm.

Began you will observe, by very prof. haemoptys.

This, I need hardly obs., very freq. lays foundat for Phthis.

Not indeed by any means in every case that one a conseq of other.

Many inst where after very prof haemopt, a complete & perf. recov.

And can readily conceive, why haemorrh. from lungs, as well as from nose, or any other part, may termin without suppurat.

Indeed, as far as my obs. goes, this more freq. case, where haemr. very copious at once, than where slight but very long contin.

And accord. if had seen pat, during time of haemorrh, should have consid him as having better chance of not termin in Phthis, [here] if much slighter.

But at same time, cannot be [alledd] that copious disch of blood, from lungs, never termin in Phthis.

And to be remarkd, that since this accid, our patient never free from sympt indic that affect.

Upon whole then, though cannot be said, that in this case, a distin. markd hectic fever yet will at least be allowed that presumpt of Phth very strong.

And espec. when consider insid natur of affect.

For can be no doubt, that in man inst, where Phthis in end fatal, dis. has subs. for long time with much less app. of it.

From cause assignd are led even to conject as to species of Phthis.

For every inst, where death from purul of lungs not of [illegible] [illegible]

In pract lect shall endeav to point out these spec. falling under genus of Phthis. which I think require consid variety in [treat]

These disting by appellat of the catarrhal where purul entirely from surf of lungs.

The ulcerous where proceeds from some large vomica or ulcer.

And the tuberc. where, sometim even without suppurat, an ichor sanies yeilded by hard indur. subs. prob. scroph. glands in lungs.

Without here entering into Hist. or even diagn of each, may only obs. that consider our patient as subj to second species.

To this opin as have already remarked am in some degree led by condit at commen

For very gener. where vessels rupt. in prof. haemorr from lungs do not heal by first intent, termin in large vomica or consid supp.

Bloody expect indeed sometimes arises from tuberc.

But then in gener. only very slight app of blood.

And that freq. occur. on severe coughing as if merely of pass. kind.

What I stile ulcer. Phthis. chiefly disting by fixd pain at some partic part of breast & by uneas of patient when lying on side not paind.

Whereas in other spec. no partic pain of breast, & patient lies with equal ease on either side.

Here indeed cannot be said that either of these diagn in such state as to give strong evid of the diseas

Of pain of breast he compl only in a general way.

And can lie without augm of dyspn. on either side.

An evid proof that not at least so consid a vomica, as to prev resp. even by diseased side of chest.

For when that the case patient can breathe only on diseased paind side that other may be free for expan, which not the case when comp. from weight of body.

But although these diagn not here to such extent, yet some affect from diff in posture.

For obs. that cough most troub when lying on right side.

An evid proof that then some uncomm cause of irritat.

And that disease of lungs a local one.

Hence then, taken in conjunct, with other circum, partic mode of attack, gives at least consid prob of this species.

From this view of disease both with resp to genus & species, natur led to Progn.

And here, need hardly obs, that when pron. disease to be Phthis, must at same time consid it as danger.

For no modif of Phthis, in which danger is not very great.

But all not equally danger.

And though recov. from [any] [illegible] yet much more rare, from tuberc than any other.

Recov. most freq to be met with from the catarrhal.

And that species to which pres patient subj hold in point of danger to be interm

From this therefore all I can venture to say, is, that consid recov. as neither beyond power of art nor even of nature.

For where abscess formed in lungs & free disch of matter, may heal there as well as in other parts.

And by assist of art, both with respect to regim & med, may do something to forward it.

But at same time from reduced situat should not be surp. if very soon sinks under affect.

Of this however no immed app.

And am at least hopeful that may afford us opport for trial of med on which have here put him

In this disease as have already had occas to remark first step towards cure is disch of purul. matter alredy formed.

This may sometimes be aided by artif. means as action of vomit.

But in gener. purul. matter itself, from acting as irritat in lungs, ex cough suff. for this purp.

And much more an obj as far as can be accompl, to promote adhes inflam. by which ulcer to be heald.

This indeed also very much an operat of nature.

And perhaps more depend, on cond of habit, than on any other circum partic.

But from this very circum, may inferr, that will be affected by remed altering state of action in vessels.

Whether on this or on some other prin, that to expl. operat of med here directed for this patient I know not.

But at same time in former inst of simil nature am much deceivd if have not seen it attended with good effect.

The remedy here empl. you will observe is Gum Myrrh.

This, till of late years at least, has not been exten used in Phthis cases

And indeed all healing vegetab bals. as have been calld, have been prom condemned in Phthis, on auth of that acccur. obs. Dr Foster.

That many some of these, notwith boast name of Bals. in many cases prejud will not deny.

Nor would I contend that this [nevr] effect of the Myrrh.

Must only obs. that in my own pract have not found this to be the case.

And for some years past have empl. it pretty extens in such affec

This remed of late partic recom to attent of pract in a public by Dr Moses Griffth.

And afterwards still more fully by Dr Simmons in his treat on Cons.

But prior to either of these public. had been much in use with Phys. of Guys & St Thos hosp. in London.

And in former in partic as will observe from Dr Simmons public very extens used by Dr Saunder.

An Gent. who attended that hospit during course of last summer inform me that Dr Saund. no less fond of it than ever.

A proof that farther exper. has not altered his opin on this subj.

In formula recomm by Dr [Griffith] with Myrrh united to proport of nitre a certain quant of Sal Chalyb is added.

But Dr Simmons seem to think that is from addit of refrig alone as corrig that to look for any advant.

Hence he seems to preferr combin with nitre alone.

In Guys hospit is chiefly pres. under form of what they call Mist Antihectic.

In which have indeed a comp. by no means ineleg. but with more affect of art than to [me] seems necss

And more comp. than is I think in any case advis.

Cont. prop. of Ag. [Alxr]. Simp. & Of Ag. Alexr. Spirit, with Syrup.

But while from these, are to look for no more, than any other [excip], as for ex. simple water, & be obs. that G. Myrrh, comb. with two artic which may act as adjuv.

Sal. Chalyb viz recomm by Dr Griff & a propor of Sal. Absinth.

How far these really advant will not pos. venture to say.

Not improb. that Sal. Absinth may not only facilit its combin with water but also supply place of Nitre.

While Sal. Chalyb. From its tonic powers may give the system, that condit. connected with tend to adhes. infl.

But as far as my own exper. goes have not been able to see benef of any addit.

At least any farther than as giving minute divis of resin parts of Myrrh.

Hence, in choice of artic, with which comb. it, am chiefly directed by circum of care.

Partic by state of belly.

Where pat. rather costive, or even where belly not loose, give it in combin with equal propor of Crem of Tartar.

From this, have I think, every adv, to be derivd from addit of a refrig.

Obt. affect of keeping belly, in easy state.

And have advant of minute div of resin parts of the Jallap.

But although in Phthis, belly often bound, yet freq. happ, partic towards conclus, that diarrh. occurs.

And indeed, colliq diarrh. one of most alarm sympt.

In that case the Myrrh even by itself, but still more with Crem of Tart, has tend to encr. sympt.

Then have given it in comb. som with absorb, as Pulv. Cretac or Oc. Carm

Sometimes with astring as, Succ Japon or Gum Kino.

And sometimes even with opiates.

In all these ways, have I think seen it prod of very consid adv.

Whether as Dr Simmons supp from pecul. antisep. power, as I am inclind to imag from alter state of action in vessels of diseased part or on prin diff from both not very matter.

That is advant. is fact of chief imp. & of this am very much conv. from exp

And partic in that species of Phth to which supp. this pat subj, Ulcer.

There I think, more useful than either in the tuberc. or even in the catarrhal a slighter disease

But in all, may I think be often empl. with advant.

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Am far however from ascert. that in any of them gives much chance of cure.

For must acknowl. that consider Phthis to be a dis. in which a great major. of cases will prove fatal in spite of every remed we can empl.

But must hold it to be matter of very great conseq. if by this remed. can overcome some inst.

And on ground of my own exp. in former inst as well as of that of other pract mentiond, have directed it to pres. patient.

And if here fails, must own that have no great expect from any other article.

If however do not soon find some benef from it in pres form is my intent to add to it a proport of Sal. Chalyb.

Or perhaps to employ at same time a chalyb. in some other form.

If notwith this affect goes on in progr. see little here to be done but to obv such sympt as may occurr.

As for example Dysp. & cough with which at pres most harassed by blister & issue.

And any others that afterwards may take place by remed best accom to these

At same time enjoin for patient as far as circum will admit the regim comm. directed to Phthis pain

Partic warm cloathing with view of support equab. circulat on surf.

And a diet, which while nutrit at the same time not stim.

Such for ex as milk, an interm subst. between veget & anim kingd.

And which while perhaps nearly as nutrit as even animal fats, is at same time as little stim as mild vegetab.