DEP/DUA/1/39/08 (Transcript version)

William Ritchie

1785

---

Wm Ritchie Febr 18^th 1785

In hist of this patients case many sympt enum.

And probab. not all to be consid as connected.

But I think little room for doubt, that most numer & most import sympt. are Phthis.

As such may ment. the cough dyspn. & pain of breast.

While cold fits & quickness of pulse, to be cons. as sympt of Hect fever.

Though indeed must here be allow that not with all sympt of that affect.

And partic neither hot fits nor sweatings.

At least not subj to these when came under our care

But even at that time very great degree of debilit.

And this as well as other sympt. now not a little aggrav.

Hence then even from sympt alon strong presumpt of disease.

But this presump much strengh by two other partic.

By sympt viz which usherd in though abs. whn case taken had occurd during course of pres. compl. & by diseases of near relat

From last of these reason to pres. that with our pat. their exist hered dispos. to Phthis.

For told that a brother who fell victim to Phthis.

While a [not] at pres with such sympt as gives strong presumpt of that affect.

But on this I own put much less stress than on other part. ment

About two months ago had an attack of haemoptys.

A circum from which I think may reason inferr morbid condit of lungs.

Is by no means indeed every case of Haemopt. that termin in const.

And espec. [where] copious bloody expect occurrs with those of pleth hab.

But at same time, even in these case where sympt of Phthis follow, much ground for alarm.

And partic alarm when bloody expect takes place, after sympt of Phthis have preceded.

This however the case with pres patient.

And taken in conj with other circum am I confess disp. to consider this as afford. if not cert. evid at least strong presumpt of Phthis.

While however view pat as subj to this disease other sympt in case prob. unconnected with it

This I am inclind to think is the case with his sickness at stom & vomiting after meals.

And still more with flatul & acidit at stomach.

For these, never I app, to be consid as Phthis sympt.

Pure Phthis univ without them

And when take place may always be consid as a compl. or [supr]. affect.

These latter sympt however not distress to any high degree.

And even if were so still much less import than Phthis affect.

For even in worst inst Dyspep. more inconv than danger.

If however little to appreh from this every thing to dread from other.

Need hardly obs. that every inst of Phthis to be consid as highly dang.

And this even, when pat. applied first for assist, seemd not to be, of least danger. kind.

Had not indeed, that exquis hectic, which is in gen attend of tuberc.

But from fixd pain at partic [part] of breast had reason to inferr that not of catarhal kind.

But that consid vomica formed in lungs which indeed very gener. case where either, preceded by Haemop or attended with it.

If however thus unfav, when came under our care, is still more so since.

For of late very consid return of Haemoptysis.

In this may consider him as subj even to a third affect

And that too even by itself of danger nature.

For if freq. recurr, patient may even sink under loss of blood falln victim to Haemopt itself.

But much more to be dreaded from it, as influ Phthis Pulmon.

For must not only tend to exhaust a pat. already highly debilit, but to usher in fresh suppurat.

Hence then expect of recov in this case now very faint.

And I own opin is, that in no long time, patient will fall victim to affect.

When came under our care imag. that might at least afford opport for trial of some med.

And as such resolvd as in case of David Bickerton to have recourse to Gum Myrrh.

Of this artic had already occas to make some remarks when speak of that pat.

Then ment. sever authorit by which of late supp, partic those of Dr Griffith Saundrs & Simmons

And ment also, that from some inst. which had occurrd in course of my own pract, was inclind to think fav of the remed.

But am sorry to say that cannot add that case to numb.

For notwith use pat as indeed gen happens in Phthis fell victim to affect.

And will I appreh have as [little] ground to draw any fav concl. from pres.

For when deserted use after trial for consid time pat. manif [worse]

Here from comm of empl. conj. use not only with Crem of Tart, but with Sal Chalyb.

To this rather led from author of others, than from any opin which have of use.

But in trying med, wishd to [exp] in state, in which found success by others.

As thus given, at least sat easily on stom.

And for some time, thought affec rather relievd.

But this relief neither perman nor consid.

And indeed when some sympt allev, others in gener augm.

Thus on mitig of cough & pain of breast, became affected with consid hoarseness.

Was with view to this sympt that on 7^th of Janr. in addit to Myrrh had recourse also to Mist Oleos.

For as far as my own exper. goes, have found nothing more affect in allev. hoarsness than oil in any form

And when from state of stom cannot be taken in pure state yet may in gener. be born with ease when diff in water by aid of small propor of alk whether fixd or volat.

When first begun this mixt, seemd to have but little affect, on hoars.

But after some contin, whether in any degree as affect of med or not, went at least off.

In so much that on 21^st of Janr oily mixt interm, & contin with employm of Myrrh alone.

But soon after an occur much more alarm than the hoarsn took place.

A fresh attack viz of Haemopty.

With this also a consid degree of pain in breast conj.

A circum from which might inf. that was of active kind depend on encr. action of vessels.

Even in this situat, do not imag that patient would have suff. any thing from contin of Myrrh.

At least should not inferr this, from any influ which have ever obs. it to have, on circul.

Espec as conj with Cream of Tart.

But has at least been commonly rankd among what stild by Dr Foth. & others the healing balsams.

And as in haemopt. not only necess to avoid what heats but to enjoin every thing of [contr]. nature, thought it more prud to omit use.

If in this situat had directd bleeding, would at least have followd common pract.

And have no doubt, that in such cases, has often affect. of putting stop to haemopt.

But in every debilit state, is in my opin, a pract always to be avoided.

A much easier matter to withdr. blood, than to replace it.

And soon abstr. by blood letting, what would make very great figure if collected as disch in haemopt.

Hence therefore, as disch had ceased to be excess, desirous to try whether could be stopt by other means

Accord directed applic of blister, & use of powder compos of Crem of Tart & Nitre.

To former of these pract some obj in such cases, some obj. the influ it has on state of circul.

Has been supp. that will be prod of bad affect as encr. impet

But influ in this way depend very much on prev. condit of pulse.

And at any rate this affect much more than counterb. by oper. in other partic.

From exper. which have had in many cases have no doubt that on whatever prin may oper. have seen it attended with best affect.

And of this I think even high probab. in pres. inst.

For with free disch from blister pain of side allev.

And soon after spitting of blood entirely disapp.

During this indeed, contin regul with Cream of Tart & Nitre.

From which no doubt that good affect deriv both as gentle laxat & refrig.

Accord in such cases this or something of simil nature seld. omitted.

And although entirely free from haemopt. yet as means of prev. [retrn] directed contin.

But notwith use contin to be subj to severe cough, & at same time had consid return of pain in breast.

On this account thought it advis to have again recourse to blister.

And to secure advant have directed issue after it.

Hope that by these means, with prop meas in other respects, pain may be allev & return of Haemop prev.

But even if this accompl. cannot I think entert any great expect.

For as already obs. now great reasn to fear, that nothing we can do, will prev pat. from falling victim to Phthis.

And very doubtful whethr shall now take any other meas than what [merly] calcul. to obv. sympt.

At same time if circum shall app fav. may yet perhaps try pract before suggest. viz weak [infus] in Digit, which by Dr [Willn] & some others of late extolld in such affects