DEP/DUA/1/39/20 (Transcript version)

William Walker

(1785-1786)

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Wm Walker.

Of case of this patient can now say very little more than when form spoke of him.

Then gave it as my opin, that although no cert. yet strong pres. of Phthisis.

This had then reason to inferr from long cont. cough & pain of breast without expector.

But still more from contin of these sympt having induced emac. & unhealthy app. great loss of strength with feebleness & quickness of pulse.

And above all from the hectic sympt as indic by cold fits proceeded & copious morning sweats.

This Phthis was disposed to considr as being of the tuberc. kind.

To this conclus in some degree led by want of marks induc other species.

For here had not that state of expect which attends both the catarrhal & ulcerous.

With these, though sometimes diff to disting whether matter expect is prin purul, or mucag. yet very generally copious expect.

At least after hectic fever comes on.

Here however on contrary cough of dry kind.

While at same time, hectic fever very consid.

And this circum, the exquisite hectic, I consid as anoth strong mark of the species of consumpt.

For in tuberc no doubt that this much more the case than in other spec of Phthis.

And accord. very gener. at least, course of disease, much more rapid.

With our patient however, in [space] of three months, emac & great prostr. of strength had ensued.

From species of Phthis therfore confess most danger, though every species highly so, & from affects which had already prod, had reason to look for fatal termin.

And this accord prognos. which was disp. to give.

During course of attend here, no reason for altering sentim either with [regard], to nature of disease, or to termin.

For although at one time, some sympt a little mitig, yet this by no means case with all.

And partic no mitig of the indic of hectic fever, the cold fits, & prof. colliq sweats, with const. quickness of pulse.

These during time of attend cont even to be unif encr.

While relief from cough at utmost but tempor.

In so much that when last visited us here, even worse than ever.

Have not indeed seen or heard any thing of him for some time past.

But even this also consid as a circum corrob. conject.

For probab. that this the conseq of disease having made such progr. that no longer able to attend.

After these remarks will readily suppose that here little to be said as to good affects remed empl.

Am not indeed of the opin of those who hold that in no case of Phithis are remed of any serv.

Think have even seen manif. benefite & recov. in conseq of use, where strong evid of Tub. Ph.

But much more freq. even in less danger kinds disease proves fatal.

And must on all hands be allowed that in tuberc. Phithis recov. very rare.

And utmost benefite derived eithr from regimen or med is mere allev.

But by this means remaind of life, may often be rendred somewhat more tolerab. & easy.

For obt these ends certain partic with regard to which all pract. are agreed.

As for ex. restr. colliq diarrh by opiates, obv. costiv by gentle laxat. &e.

But others still matter of controv.

And this even very much the case with regard to Regimen.

Some recommend full diet of anim food.

By others again patient entirely confind, to most cooling & least [nutr] vegetab.

In favour of one, conten that tuberc. Phithis, may realy be consid as a modif of scroph.

That well known, scroph often consq of very poor & meagure diet.

And that ulcers often get dispos. to heal, by liberal & nutrit alim.

This it must be allowed so far in fav of system that plan.

And farthr argued that facts have occurrd in pract conf. adv.

Partic that indiv long treated on starv plan, manif adv. from liber. Diet.

On othr hand contend that much more num facts on opp. side.

That patients viz [induged] in liber. diet, great benef. from being conf. entirely to vegetab.

That every stim artic, prod greater quickness pulse & rend augm. hectic heats & [flush]

That admit tuberc to be of scroph nature yet that prod hectic fever only by degen into state of [illegible].

And that this always conseq of preceding inflam.

That there occurrs a success. inflam of diff. tubercles

And that therefore every thing giving inflam dispos or quick circulat to be caut. [shunnd].

Here am inclind to think that errors on both sides.

And that chiefly arises from not making prop. distinct between affects of alim as acting on stom. & as entering circul. system.

In formr way artic of alim differ from each other as more or less stimul.

In latter again as being more or less nutrit.

Is indeed true that many of [those] which operat as most powerful stim from action on nerves of stom, are also most highly nutr.

And that others, which from action on stom rather even refrig effect. are much more slightly nutrit.

Of first ex in many diff. kinds of solid anim food.

Of last again in [illegible] veget fruits & greens.

But from this by no means [follow] that qualit of stim & highly nutrit or of refrig & slightly [nutr]. necess connected.

And in my opin in Phthis great obj is to empl. nutrit & to avoid stim diet.

Former nutrit diet indic by general wasting and emaciat.

Circum clearly demonst. that supply necess for support & recruit of system.

But still more by state of app.

For in this affect, in place of [pron] often keen desire for food.

Patients, not here as in fever, affect with sickness & vomit on taking food.

On contrary action of digest as far as stom conc, goes on well.

And while this the case with keen app. may at least venture to say, that seldom improp to indulg.

Indeed is perhaps very seldom if ever [improp] in cases of disease to indulge crav of any kind.

Some [indeed], trusting to their own theories have stild these, cases of unnatural instinct.

But for my own part at least, have never yet met with any hypoth in med, which would for a moment put in competit with calls of nature.

On subj of indulg. appet, have repeatedly heard, an obs. from late Dr Monro, in which have unif. followed his advice.

When any of his patients expr. strong desire for any thing in way of food or alim, first asked their reas for it

If in them this longing desire, the effect of any theory, such as that if would warm them, cool them or like for both patients & nurses as well as Phys. have theories, he indulg. request or not accord to his own judgem.

But if had longing for which could assign no reason never faild to comply with desire.

And never once met with any inst where had seen bad affects from it.

The longing for solid food then in cases of Phthis, with me a strong argt. in cases of Phthis for empl. than any thing urged against it.

But here, as far as my own exper. goes, longing not for stimul but from nutrit diet.

Patient often strong desire for chicken, beef stake, [illegible] or like but never for highly seasond or alk. food.

And while waste of syst. may be consid as pointing out prop of nutrit diet, state of circul strongly [constraind] stim.

Not to  be expectd, by any one who allows himself in smallest degree to reflect on subj, that, wasting of solids in syst to be supp. by arden spirits, aether, volat alk, or othr artic decidedly strong stim.

And no one I believe has ever thought of employm of such artic, those excepted, whose pract consist entirely in words, not in treat of disease.

Nay certain that even very small quant of wine, & with those too, formerly in habit of taking it, has affect of augm. very consid, heat, flushing quickness of pulse, & other hectic sympt.

On contrary from milk, an artic which while highly nutrit is at same time of mild & bland nature no such affect.

And accord. hold milk, where agrees with pat, to be one of best kinds of alim which can employ as being nutrit without being stim.

These then sentim, on controv. respecting diet in Phthis, which has lately taken place.

And accord diet directed for this patient, of mild & nutrit kind, partic milk.

But though from this some advant may be obt. yet satisf, that in major of cases cure neither to be accompl. by regim, nor med.

And indeed latter as well as formr chiefly servicab. in allev. sympt.

Here indeed wishd to make trial also of the Gum Myrrh.

A remed in Phithis cases, of which as of late recomm by Dr Saund. Simm have already had occas to state sentim.

After prom emet therefore with view of emptying stom, had recours to Myrrh under form of comp. powder.

But cannot say that in this inst any exam of benef.

After began use indeed, cough for a little time somewhat mitig. & pain of breast rathr relievd

But still freq. cold fits & sweating even more prof. than ever.

From this led to use of the Vitriol acid as gentle restring.

Well known that few artic more powerful as astring restr encr. disch of passive kind

And perhaps few affect, in which more evid useful, than where encr. disch by surface.

But here no obv influ.

For although, during first week of employm, cough still cont. easier, yet sweatings nothing dimin.

And at succeeding report, with cont of these, cough again consid aggr.

While at same time, pulse much quickned.

In this situat howver, did not see what benef. could expect, from altering plan.

Accord. directed contin.

But since that now more than a month has elapsed since heard any thing of him at this place.

And as already said reckon it most probab. has proceeded from prog of disease giving aggrav of sympt.

But whether this the case or not now no reason to believe that will be any longer subj of treatm here.

And hence farther observ. on case unnecess.