DEP/DUA/1/45/30 (Transcript version)

David Ritchie

(1788-1789)

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N23. David Ritchie at 24

When formerly spoke of case of this patient expressd some doubt whether to be consid as Phithis or Catarrhal.

Was however upon whole rather inclind to formr opin.

And very appreh that in end would prove fatal.

During time for which cont. under care cannot say that this opin either conf. or refuted.

And when left us to go to countr. still remaind in same state of doubt as before.

From pract. empl. no matterial change at least induced in nature of affect.

Began by direct applic of blistr to his breast.

To this pract led from sever consid.

For in first place may obs. that often useful against cough whether phthis or catarhal.

But here more espec led to it by severe pain of breast with which pat. affected.

For this, whethr attend of Phth or Catarh, very gener. conseq of some degree of inflam.

As counteract both pain & cough blisters prob operat on diff footings.

But in my opin princip from changing mode of circulat.

Hence advant of contin disch under form of issue as perman supp such a change.

And on this ground led to direct it in pres case.

While however directed blister & issue, at same time ordered for patient comp. powder of G. Myrrh.

And artic prep of equal parts of G. Myrrh & Cream of Tart.

And of which as empl. in case of Phthis have already oftener than once has occas to speak.

By some as Drs Griffith, Simmon & Saunders, repres as prod of wonderf effects.

And although, can by no means, for my own part, subs. to all they have said with regard to it, yet cannot help thinking, that have seen it in some inst prod of good effects.

And as far as my own observ goes have never seen it prod of any bad conseq.

Hence in most inst where a fair opp. offers may be consid as well merit trial.

Soon after these med begun, pain of breast at least as will obs. from succeed report, consid dimin.

This was inclind to ascribe, to immed operat of the blister.

For while often prod of such effect, from other med could expect no benef unless from long contin.

Hence then, though cough & dysp still contin as before, yet still hope for benef from persist in use.

And although in place of dimin at succeeding report cough rather aggr. yet merely [direct] contin

Soon after however app in sever respects became rather more alarm.

For while cough freq & expect cop. notwith free disch from issue had return of pain of breast.

And what still more alarm [becam] freq affected with cold & sweat. fits.

These I need hardly remark the common sympt of hectic fever.

And when latter allowed to run to great extent, tend very much to debil & reduce patient.

Thus in remark degree forward conclus in death.

Is indeed true that all endeav to check colliq sweats often ineff.

And only to be obv. by removal of cause an end very rarely to be accompl.

Still however something may be done with view to [moder] it.

And that not merely by avoid causes tend to encr. it as warmth of bed load of bed clothes or like, but also by empl such artic as tend to restor it.

And perhaps no astring more powerful than vitriol acid.

To this accord had recourse in pres. inst.

And as most conven. mode of exhib, diffus it in Mucil. Mixt.

To this not merely led as a means of covering taste, but from hopes also of some benef against cough.

For as app. from empl in catarrh, serves at least to dimin irritat at fauces.

And effect in this way nothing dimin from addit of vitriol acid.

From which even in conseq of astring power, some allev of cough may be expected, as dimin secret of mucus.

Accord in this way seems to have had even more influ than in restr. sweat.

At least were inf at succeed report that thought cough rather easier.

Still however sweating contin as before.

Which with contin of other med a suff. inducement to persist also in use of this.

At this period however an opp. offered to patient of going to country.

And was I think with great prop. that he emb. it.

For although far from being cert or even gener cure yet prom at least some advant.

And from such a change, pat not unfreq. obt. relief.

Indeed opin of some, that in Phthis, more to be exp. from country air, gentle exercise, & milk diet, than from all med pract put togeth.

Two former indeed can be had in towns as well as in country.

And no doubt that from both very consid advant.

The one as affording mild & at same time nutrit alim.

The other both as leading to digest of that alim, & as to free circul through syst in gener.

And hence to regul support of every funct.

But though these to be had in towns yet in sever respects more readily & in greater perf in country

While at same time in most situat, there obt, what not to be had in towns, the breathing a pure dephlog. atmosph.

For no doubt that air of towns const. much contam, by smoke of fires.

Pure air however, in many [illegible]. salubr. to syst.

And indeed, for my own part, am inclind to attrib benef. of sea voyages, as much to this, as either to sea air, or to change of temper.

To advant of pure air, even benef of watering places have of late been by some referrd.

This partic the opin of Dr [Pear]. as will obs. from treatise on Buxt waters.

But whether his observ. well founded or not cannot be doubted that pure atmosph. always adv to Phthis patient.

Hence our pres pat. [with] prop [pref.] it to any benef which could expect from contin attend here.

And especially as same course of med with equal adv contin in country.

Accord at [departure] adv. him to persist in it.

But have now heard nothing of him for some time.

And what event of case shall prob never be able to learn.