DEP/DUA/1/41/32 (Transcript version)

James Thomson

(1786-1787)

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James Thomson April 14^th

Of disease of this patient no room for doubt.

When came under our care formr obs. that was distinct markd inst of Catarrh.

And in that state has since cont.

Catarrh however during whole progr. often not with same sympt.

And partic begining as febrile often degener. into a chron disease.

This degener. partic apt to take place at late periods of life.

And besides this chron catarh one of most freq dis of old peop.

At least in our clim.

Hence has in genr. got name of Catarrh. senilis.

Are not however from this circum to pron every catarrh of old people to be of that kind.

For with oldest as well as young people may app in [for] form.

To be disting therefore not be period of life but by sympt.

And accord. better disting by names of acute & chron.

Indeed unless with those long habit to catarrh seldom that does not begin in first & afterw. pass to second state.

This partic apt to be case with those adv. in life.

And such a trans. has I appreh. occurd in pres inst even since pat. came under our care

Or rather perhaps, during whole period, disease in what may be calld interm state

For at that time could by no means be consid as in chron cond.

Was then only of ten days stand.

And although pat consid past 60^th year, yet had by no means been former. subj to catarh.

Was then obv. conseq. of expos to cold.

A cause from which well known that this affect almost univ if not solely origin.

In so much that in common lang. passes by name of cold.

And indeed any one who pays slightest attent to facts, cannot possib entert any doubt resp. it.

From period of durat. then no doubt that still in recent state.

And that therefore could not [with] any prop be stild chronic

But on other hand not markd with distinct sympt of febrile catar.

Pulse indeed consid quicker than natural.

For with a man even at earlier period of life 98 above nat. stand.

And had also impaired app. & consid thirst.

But was at least without febrile heat or anxiety.

And pain of breast & side, could not be consid as conseq of inflam state.

For at least chiefly felt [sever] from viol of cough.

But to this still farthr to be added that expector. cop.

A circum rarely occurring during febrile condit of catarh.

For then in gener. there takes place what calld dry cough

And is always consid as mark of progr. if not to recov. at least to separ diff state when expect. consid.

Upon whole then in this cond. of progr. was affect when this pat came under care.

And during contin here progr still farthr markd.

For now, even sympt with which formerly affectd of febrile kind [entirly] gone.

While consid secret contin, matter to be expect. more viscid.

Hence greater diffic in disch occas more viol fits of coughing & greater dyspn from want of free disch.

Now therefore no less reason than before, to express appreh. as to obstin of case.

With this patient tend to augm separ at lungs seem now to have taken place.

And when this has once occurrd well known that by no means an easy matter to remove it.

Or at least that renewal from slightest accid expos to cold, giving constrict of surface.

Hence cure more to be expected from change of weather than any thing else.

And accord obs. with many habit to this disease, that disapp. during steady warm weather in summ. season but [reccurs] again from cold in winter.

In case of pres pat then recov hardly to be expected, during prev. of chilling easterly winds.

For from these more effect in aggrav the disease, than benef. in remov it from any remed that we can employ.

Imagind however that might at least do something towards allev affect.

And if progr to recov. not prev. by unfav. weather, might prom & forward natur termin.

Was with this intent. that here directed for him what we call comp. powder of Crem of Tart.

A formul. consist of equal parts of Crem of Tart & Flower of [illegible].

Of this powder need hardly remark that one of most comm conseq is that of mov. belly.

For both artic well known to be gently laxat.

And indeed are among best & most com. of gentle cathar.

But besides this in Cream of Tart also a powerful diuret.

And well known that from prom disch in both ways benef. often obt in this affect.

For necess conseq is some deriv from lungs.

In this way in partic often remark aided by diuret.

And indeed may readily conceive that should have nearly same infl as encr. of perspir from mild weather

For well known known that disch by kidneys & surface [illegible] compen. each other.

In obv effect of this powder were not disapp.

For from begining operated both as gentle cathart & diuret.

And seemd also to have some good effect on cough

For this accord to pat. acct somewhat allev.

From persist in use these good conseq. rather encr.

For cough became still easier

And I own was not disatisf to observe, that had still farther effect in mov. belly.

For notwith age of pat. no reason to appreh conseq of sev loose stools.

Afterw found however, that even contin of this, did not prev recurr of affect.

For while still great quant of matter disch by expect, dyspn. became more severe

Seemd in this situat necess to do something with view of unload br.

And with this intent, pres. an emet, to be repeated at short interv.

Emet as expect, perhaps to be [consid] indeed, as oper. on mechan prin.

But of all expect little doubt that most immed & most powerful.

Accord no artic more suddenly benef in inst of chron catarrh.

But besides more disch from lungs prob also useful on othr princip.

And partic. as giving determ to surface.

Here also imag. that might at least moder. looseness.

For this often affect both of encr. disch by surface & of evac by stom.

In obv. operat of vomits were not disapp.

But cannot say that in othr respects attended with desired conseq.

For while Dyspn. still contin loosness also freq.

And now began to think that pushd as far as strength of an old man would [permit]

Have directed therefore at least for time that powder should be omitted.

And if again employ it will be only occas. if bound state of belly should occurr.

In mean time have again ordered repet of emet.

And if these have not effect of relieving dyspn. shall not expect this by vomiting.

May prob. in that case have recourse to blist, conv into issue.

But in this, & other pract, will be regul by state in which find patient.

And as already said, hardly expect much benef. till steady [illegible] weather.

And from this prob. more than from any thing we can do for him