DEP/DUA/1/38/67 (Transcript version)

Joseph Begbie

1786

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Joseph Begbie Janr 21. 1786

Respect disease of this pat, when had form occas to ment case expr. great doubt & anx.

And though now for consid time under our care yet that doubt very little rem.

Still I own much at loss what idea to form even of most manif & distress. part of compl.

Of these first ment in his case is pain of right breast.

This while fixd to partic place is of dull & obt. kind.

Is aggrav. both by full inspir & by coughing.

And last we are told a circum by which sometimes much harrassd.

When to this added the unhealthy & emac. app. of pat. may be consid as giving some suspic of Phthis

For that disease as have often had occas to obs. at comm insidi.

And freq. has subs. even for long time where fewer sympt giving susp. than even in pres. case.

But here I own am inclind to hope that not of this kind.

Has not that quickness of pulse whc at least comm attend of Phthis

Has never as far as can learn been affected with access of hectic kind.

And with pain here occurring [thou] fixd & obtuse yet some circum which would lead to consider it, as of same nature with other pains to which subj.

For also affected you will obs. with severe shooting pains in back & loins.

And these as well as pain of breast, are we are told most severe in bed.

While at same time augm also on press.

From these circum then should rather be disp to consider them as of rheum kind.

And to look even on pain of breast, as more conseq of affect of muscles & integ than of thorac viscera.

While however disp to view these of rheum kind somewhat doubtful whether this case also with headach.

For though headach often from Rheum yet may arise also from other causes.

And well known to be in many inst a nerv. affect. arising from symp with other parts, espec. stom.

In case before us however affection of stom occur to very great degree

These indic not only by want of appetite & encr. thirst, but also by distens of stom, flatus, borborygm &e

And no less probab. that headach connected with these, than with pain of Rheum kind.

Espec. as not like other pains obs to be augm in bed.

Have then I own been inclind to consid headach as chiefly of nerv. kind.

While look upon affect of alim canal as conseq. of atonic & irritab state of its muc. fibres.

Great gener. weakness to which subj as well as want of sleep, may be looked upon as necess conseq of other affect.

Espec. when consid that these have superveend to long cont. affect of acute kind.

And when reflect that appetite so bad, that syst. neither [recruitd] from these nor during pres. prop supported.

Whether these conj as to diff parts compl. well founded or not, yet here at least little doubt that disease of compl. nature.

And hence hopes of speedy recov. cannot be very sanguine.

Espec. Nay cannot consider case as by any means free from danger.

For if pulmon affects from dis. condit of lungs, in all prob. will prove fatal.

Nay even though this not the case may termin in death from mere exhaust & debilit.

But this at least less prob.

And if conj. well founded as to affect of breast not being Phthis here no reason for much alarm.

And am I own disp to view affect. rathr as what will prove obs & distress than danger.

In pract here from doubtful as well as compl. nature of affect could hardly prop. to myself any gener. plan of cure.

Have I own hitherto cheifly directed remed to partic sympt.

And see little reason to expect that shall hereafter be able to cond. pract on any diff. plan.

Began by direct. for this patient the use of an Emet.

This I consid as in some degree indic by condit of appetite.

From avers. to food, as well as great thirst, had reason to suspect that stom loaded.

And if this the case in conseq of free evac. might expect both that appetite would be impr. & other sympt mitig.

As an Emet here had recourse to powder of Ipecac.

This I own am inclind to consider both as most safe & most cert. Emet with which we are yet acq.

And when given in subst to extent of Ji or so for dose, very gener [prod] of desired effect.

Though larger dose, taken without any danger of viol vomit. yet this will in gener. be found suff.

And where smaller would answr yet from this no reason to dread too much.

For as soon as begins to act, have reason to inferr, that superab. quan will be thrown off.

Hence while abund cert. is at same time more moder in operat. than Emet. Tart. or indeed most other Emet

From use here were not disapp at least in obv. oper.

But cannot say that attended with any remark affect on compl.

For appetite still cont. as bad as before.

And pain contin with usual severity.

From this led to think of some remed. more partic adapted to them.

And imagind, that if remed empl. such as could obv. costiv to which patient subj. might have good effect in prom. appetite.

For no doubt that constip often a cause of anorex.

Remedy to which had here recourse a powder [composed] of equal parts of G. Guaiac & Crem of Tart.

To this compos. have of late in Rheum cases very freq. had recourse in pract.

And is you will obs. introd among formulae most freq. in use in Disp under title of Pulv. Guaiac comp.

The Guaiac given in variety of forms has long been in use with Rheum. pat.

Often fash. in form of Volatile or spirit Tinct.

Often empl. acted upon by watery menst. as in decoct of woods.

But of all formulae which I have tried, am inclind to consid pres. as one of cheapest, most conv & best.

From conj with Crem of Tart while influ as diaph. not dimin, has in gener. less affect as healing.

While at same time, has in gener, influ effect of keeping belly gently open

Imag. therfore that might here be useful both against Rheum compl & affect of alim. canal.

While however empl. this, direct also at same an extern applic. with view to immed action of paind parts.

To ungt. Terebinth, as is calld in Disp pract, a compos. formd by rubbing, with hogs lard, a prop. of camph oil Ol. Terebinth, directed addit of prop. of Tinct. Theb.

The Ungt. Terebinth in simple state, often empl. as subs. for Camph oil.

And though not applic in every case, yet not a few, where answ same purp.

Partic where, skin unbroken, & deep seated pain to be comb.

Where does ans. is a much cheaper med, a circum always to be regarded in Disp pract.

But as the Ungt. Terebinth by itself a cheap subs. for Camph. oil, so with addit of Tinct. Theb, here ordered, furnish subs. for Anod Bals.

An artic which need hardly obs. often success. used for comb. severe pain.

And was with this intent that had here recourse to subs. ordered.

In expect from this however, as well as from powders, were somewhat disapp.

For notwith use of both, pains nothing allev.

And while powder had effect of gently moving belly, imag also that occas that occas some uneas. at stom.

While at same time informd that from distress during night, patient could enjoy very little rest.

From these consid then determ to employ powder less freq. & at same time to give an anod [med] at bed time.

But in place of using opium by itself, here conj it, you will obs, with two other med.

Equal parts viz of Opium Camph. & Assafoetid.

From first had in view the obv. pains in gener. & procur. sleep.

Camph again empl, with view to headach in partic.

And may here obs, that by many pract, partic by Dr Hope, has been found in cases of nerv. headach, prod of best effect.

And this, if am not mistaken, have seen confirmed by my own exper. in such cases.

With view again to disten of stom & flatul. directed the Assafoetid.

This I need hardly obs. one of the most powerful of carmin.

And here consid distens of alim canal with wind as being cause not only of many of stom ailm, but also in some degree, of dyspn.

For by such distens, free desent of diaph is prev.

On diff grounds exp. that from these pills, pat. might derive som benef.

And in this expect. whether conj whether conj as to nature of affect well founded or not, am incl. to think, not altog. disapp.

At least, at succeeding report, both breathing relievd & slept better.

In this situat was natur to hope for still farther benef, from contin of med.

Accord directed to persist in empl. as before.

But a circum occurrd, by which this interrupt.

For at succeeding report were informd, that from use of powders, was affected not only with sickness, but vomit.

This I own was inclind to consid, as rather uncomm.

For although from these powders, have often seen brisk cathars, yet do not recollect any former inst, where occas. vomiting.

At least, if we expect those cases, where vomit conseq also of every other med.

For in some inst. condit of that viscus such, that by every thing touching it, vomit excited.

Here therefore, should I own be disp to ascrib it, rather to condit of stom. than effect of med.

Time indeed, at which taken, rather unfav.

For no doubt, that many med have this effect, when taken on empty stom in morn. though no influ if taken later in day.

Perhaps also, dose of preceding even. had some influ in this way.

For will obs. that besides Camph & Assafoetid, took in pill at bed time to extent of gr is of Opium.

And this well known to be an artic, which though first effect, to quiet & allay action, yet after oper. over, with many leaves stom in [pain] irrit state.

In so much that though opium prod of best effects during night, yet often succeed. morning sickness & vomit even spont.

But whether these circum, any influ in induc. vomiting or not, its occurr from Guaciac powder an obj to contin of use.

Since that therefore, have contin him, with use of Pills of Op. Cam & Ass. alone.

But during use, quant as is indeed requis with opium, has been grad [encr]

So that now takes two pills 3 de die

That is between 7 & 8 gr of opium.

Cannot decidedly say, that from this course, pat has derivd any gr. ben.

For very possib, that all change for better which has taken place, may have occurd without med.

And indeed, as have already remarkd, uncert. as to nature of affect, now little less than at first.

But at same time during use at least, very consid mitig of affect has in diff resp. taken place.

Unless therefore led to it by some partic occur shall prob. [thin] of persist for some time long. in use.

At same time, am unwill to render habit to pat, opium to extent here given.

Unless therefore pain urg & watchf. great, shall prob. both dim. dose, & freq. of repet.

While at same time, have recourse to some stom. bitter, with view to strength tone of alim canal, & to impr. appetite.

But in these partic, must be very much directed, by situat of pat at the time.

And where so great uncert as to nature of case, diff. to form even prob. conj. with regard to pract which may be necess.