DEP/DUA/1/45/18 (Transcript version)

James Sinclair

(1788)

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N^o17. James Sinclair at 20^th

When formerly spoke of case of this patient expr. doubts with resp. to it.

And repres it as matter of uncert whethr merely catarrh or incip Phithis.

Of two however was I own inclind to latter suppos.

And of this presumpt afforded from sever circum.

Partic from age & app of Patient. From prof. sweatings during night without relief.

From aggrav of cough at that time. And from nature of cough, being rather tussicula than tussis.

Have met with many cases of Phth subs for consid time with less [alarm] app.

But at length prov. fatal patient under most decided form.

Now however I own rather inclind to change opin.

For all sympt of most allarm nature entirely gone.

And those to which still subj. belong to very diff. & less danger. disease.

Can hardly however supp. that if Phthis, pect sympt would so soon have left him.

Now concl. therefore that from begin has only been catarrh.

But may prob at leas be ranked among doubtful & susp. cases, by [which] reput given to the remed here empl.

Began you will obs. by direct for this patient the Pulv. G. Myrrh [comps].

This consist of equal parts of G. Myrrh & Crem of Tart.

The chief artic of this compos. the Gum Myrrh of late very much empl. in Phithis by diff. pract.

And for most partic acct of cure may referr you to late treatise on Consumpt by Dr Simmons of Lond.

This indeed as well as various [other] vegetab balsams, empl in Phthis at very early period.

But found that most of these of heating & stimul nature.

And by this means, often aggrav sympt of hectic fever.

This led Dr Fother & other pract entirely to condemn empl.

And accord fell into disuse.

But again revived by observ of Dr Griffiths Dr Saunds & others.

And found that any bad effects to be dreaded from stim power may entirely obv. by giving it in conj. with some refrig.

For that purp. Nitre or Cream of Tart. most freq. empl.

And chiefly determ in choice by state of belly at time.

Of late years have in my own pract, empl. this remed, in great numb of cases.

And from extens exper. can at least vent to assert. that when given in mannr here directed not prod of any bad effects.

And may also add, that at least much deceivd if have not seen it in sever inst attended with consid benef.

Am very far indeed from repres. it, as a certain, or even freq. cure of Phthis.

Nay do not recollect one inst of decided tuberc consumpt. falling under my own obs. in which success.

But in this respect, still at least equally powerful with every any other remd with which I am acquaint.

For recov from that disease when does happ. is at least very rare occur.

And then rather operat of nature than of any med.

But have met with sever cases where strong susp. of Phthis, app. yielding to G. Myrrh.

Have also seen it I think empl with benef in that catarrhal Phth

But still more than any in ulcer. Phth

There from large vomica in lungs copious disch of purul matter takes place.

And very apt to be contin in [consq] of fresh separ of purul. matter.

Have often been inclind to think that in these cases, by use of Gum Myrrh, adhes inflam prom.

And thus ulcerat prob. oblit. Hence then while have recourse to it in every species of Phthisis have partic recourse to it in Ulcer.

[If] however case before us, in any degree Phthis, was of tuberc. kind.

But whethr Phthis or not may at least venture to assert that Gum Myrrh prod of no bad effect.

From comm of use was prod of no uneas at stom or other inconv.

And in no long time cough much dimin.

Soon also became much less affected with sweating than bef.

Still however cont to be at times affected with pains of breast.

And although neither const nor fixd to any partic part yet very distress to him.

Became so to remark degree about end of Decemb.

And at that time not only seated in breast but attended also with much dysp.

I own became to this time to entert some susp. that an inflam affect may have existed within [breast]

And had once thoughts of directing blood letting.

But to this length of time for which patient had contin under disease seemd to me to be obj.

And therefore chose rather to see whether would yield to a blist

This accord directed to be applied

And in conseq of operat became much easier.

Soon after however became again more severe.

And by this led to direct empl of an opiate.

This I need hardly obs. one of most effect means of allaying pain with which are acquainted.

And even where no influ as tend to remove cause yet has affect of giving tempor. ease.

In this in pres. inst were not disappointed.

For although pains not altog. gone yet no longer fixed in breast.

Now app only under flying pain affect diff. parts of body.

And at same time almost entirely free from cough sweating or other sympt giving appreh of Phthis.

In this situat consid farther contin of Gum Myrrh as unnecss.

Accord has now for space of some weeks been intermitted.

How far in this case of any real service to patient, cannot pos pretend to say.

Certain that during its use got rid of those sympt giving appreh of Pthisis

And at least no reason to believe that did any harm

But now I own inclind to think notwith various circum giving [supp] of Phthis his affect only catarrh.

And prob. would have termin as soon without G. Myrrh as with it.

Since Gum myrrh intermitted still contin free from any affect of breast.

But by no means entirely free from pain.

And these with respect to situat at least have put on an app. somewhat diff from what did before.

For at last report found that chiefly affected joints of fingers.

And in joints most paind an obvious degree of swelling & inflam.

That now therefore of Rheum kind can hardly I think be quest.

And although seat which formerly occup, breast viz & other parts of trunk, not that which Rheum commonly occupies, yet gives strong presump that origin of same kind.

This however consid as no object to use of opium.

On contrary in Rheum, in most acute form, as well as in other influ, now every day used with greatest success.

Indeed an ingen London pract, engaged in very extens hospit pract, is inclind to think, that whole benef of Dov. powder to be ascrib to Op. alone.

Accord now almost const empl. it in simple & uncomp state.

+ Finds it thus equally effect both as inducing sweat & allev pain

>+

And I own as far as my own exper. goes tends very much to conf. his opin.

Here therfore not only directed contin of use intern. but have also advised it externally.

At least have directed [applic] of Anod Linim, Opium with Camph.

By these hopeful that mitigat or even remov of pains may be accomp

And if this the case, is my inten to try prev return, by means of Peruv Bark.

Perhaps conj. it with a propor of Cicuta.

A combin from which in some modific of Rheum, think I have seen very great adv.