DEP/DUA/1/47/13 (Transcript version)

Robert Miln

(1789)

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N^o25. Robt Miln at 42.

Most alarm app in compl of this patient is bloody expect.

And can have no hesit in [confirm] it as a case of Haemoptys.

Here however room for some doubt as to relative connex which diff parts of compl. have with each other.

And partic whethr cough the cause of bloody expect. or bloody exp. the cause of cough.

For no doubt that may mutually prod each other.

At same time vessels of lungs in every respect in sound state, will bear very great concuss. without haem.

And when more effect of viol, is for most part rather from trachea than from lungs.

On other hand often very copious bloody disch with but very little cough.

And blood brought to mouth in great quant rather by tussic than tussis.

Blood [effused] in conseq of active haemorh.

And quant such as to give free & easy expect with but very little effort.

Case of pres pat therefore would seem to be diff from both

For here severe cough preceed bloody expect for some time.

And yet bloody expect when indeed took place to consid extent.

Would therefore inferr that while haemmor in some degree at least of passive kind, was yet conseq of a morb. condit of lungs.

And that thus concuss which otherwise no effect, had given rise, even to consid disch.

This case I hold to be by no means rare.

Perhaps even no less freq, than where haemorh entirely of active kind.

And may also add more danger.

For in haemoptys. can by no means estim danger from quant of disch.

Where merely prof active haemorh vessels of lungs heal as readily by first intent as those of nose.

And cases generally remarkd most fatal where [muc] tinge of blood with saliv Sputum

Probab. as then afforded from tubercle.

And perhaps in every inst danger to be estim only by diseased cond of lungs.

On this view of pres case then by no means the most fav.

And am inclind to think the probab. is that will at last termin in Phthis.

Of tend to this state already even some presumpt, from sweatings durin the night.

But at same time with pulse at 76 can consider him as having but little of hectic fever.

And at this not without hopes of recov.

With view to this have here had recourse to what will perhaps be disp to consid as a very inactiv med.

Mixt viz of G. Tragacanth & Starch with a prop of Sugar.

To this have had recourse on [adv] of an ingen friend Dr Odier of Geneva

And when again speak of case, shall state at more length inform which have receivd with resp. to it.