DEP/DUA/1/12/15 (Normalised version)

Duncan McLean

(1776-1777)

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Duncan McLean.

A case which in no very long time terminated favourably in our hands.

Must however own that should not have been disposed to give such opinion at time when patient came under care.

On considering case of this patient was disposed to look upon it as singular affection.

And acknowledge that so far mistook nature as to treat it at first in manner which would not have done if had properly understood it.

In very accurate history of this patient’s complaint introduced into register¹ will find collection of symptoms somewhat anomalous.

Chief complaint however pains attended with swelling.

But both one & other in nature transitory.

And beginning at particular part of body propagated from thence in different directions.

Occasioning at same time, temporary affection of different functions particularly respiration.

At same time many others unaffected.

Appetite unimpaired pulse natural.

These complaints referred by patient to a particular cause.

Influence viz of fatigue from walking.

From this view of complaint chiefly divided in opinion whether to be considered as a Rheumatism or Nervous affection.

In symptoms now described will not be refused that some resemblance to both.

Temporary swellings rather in favour of supposition of Rheumatism.

Yet in attack & progression of paroxysm had more resemblance to a Nervous affection.

And this supposition in some measure corroborated by affection of motion produced.

For during attacks at least after had made certain progress unable to move head

On these suppositions treatment of case at first begun

Soon however reason to suspect that neither one nor other well founded.

And patients disease put on appearance which led to different supposition.

Attacked more regularly at determined hour.

And shivering at each attack abundant even from commencement became more severe.

From this circumstance first led to conjecture that might be an anomalous intermittent.

And this conjecture is since I apprehend in great measure verified by method of cure which proved successful

Perhaps few diseases with respect to appearance subjected to greater varieties than intermittent fevers.

Of this sufficient proof from consulting elaborate work of Mr Sauvages

Will there observe under how many different forms all types of intermittent have been concealed

Such a supposition farther corroborated by another circumstance in case.

For to be observed that here a probable cause that might have induced an intermittent.

Patient indeed himself ascribed disease to fatigue.

But to be observed that just before commencement of disease had passed harvest in England

People in this country much in practice of hiring themselves for harvest work in Lincolnshire & other fenny counties

From whence often import intermittents.

And to these exposed both from marshy state of county & season of year.

Consider it therefore as probable that disease had origin there, as from fatigue in walking home.

Perhaps may add still farther corroborated by method of attack

Began with vomiting & purging

A circumstance by no means infrequent at commencement of fevers of intermittent kind.

Must own however that even after adopting this opinion should have been very doubtful as to prognosis.

And at no period of affection did I with any confidence look for success.

Even on supposition of intermittent suspected that complaint would be tedious.

Imagined that this would be still more the case if a nervous affection.

And opinion of its being a Rheumatic complaint of the three the least probable.

With respect to termination however was happily disproved

For from practice adapted to intermittent patient soon recovered.

Must however observe that even yet no absolute security as to cure

For during spring season in particular intermittents apt to recur.

But should patient again apply to us from suffering relapse will not alarm.

For after having yielded so easily already may entertain hopes in future.

And at any rate spring intermittent if symptoms moderate by no means dangerous affection.

And for most part even natural cure by progression of season.

Practice with this patient at different times conducted on very different plans.

Which solely affect of uncertainty & must even acknowledge mistakes with regard to the disease.

On supposition of Rheumatism began patient with use of Tincture Guaiacum.

A remedy of which have already oftener than once has occasion to speak.

And from which have I think in some instances of that affection seen best consequences.

On complaint of present patient however had no affect.

At same time accession became more regular.

This lead me more to opinion of affection being of Nervous kind.

And imagining that pains might be affect of periodic spasms had recourse to calx of Zinc.

And in order that might be more certain of action [premeditated] to use the employment of Emetics.

Still however without any better affects.

And at length regularity of fits continued with increasing shivering was led to opinion of its being an anomalous intermittent.

On this supposition resolved on trial of common cure viz Peruvian Bark.

Even supposing affection of Nervous kind was of opinion that would not be product of bad affects.

And if intermittent had good grounds to hope for cure.

Event as have already observed verified conjecture.

And patient from use soon freed from all his symptoms.

Did not however reckon it prudent immediately to intermit bark.

For by this means such fevers frequently suffer relapse when would not otherwise be the case.

Continued use therefore for space of fortnight after symptoms in great measure ended.

But giving only a dose morning & evening

During all this time no report even of relapse.

Reckoned it therefore unnecessary that should continue attendance longer.

And as have not since heard of him presume that continues in health.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.