DEP/DUA/1/14/09 (Normalised version)

John McLean

(1777)

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To affection of John Mclean patient next in order shall be at loss to affix any name

And perhaps true nature of disease not less obscure.

Yet apprehend that respecting origin of complaint can be no doubt.

And in no long time after came under our care disease brought to happy termination.

Perhaps may add in some measure by the means of cure employed.

At time when patient applied for assistance had a collection of symptoms not constituting any proper genus.

Had here indeed greatest part of the constitution of idiopathic fever.

Patient affected with [prostration] of sharp heat, thirst & quickness of pulse.

At same time distressed also with sickness at stomach destroying appetite.

In all these have symptoms of [illegible] fever.

But here these alone did not occur.

Were attended also with some other symptoms which although sometimes taking place seldom attendants of fever alone.

And that not properly to be reckoned fever might in some degree be inferred from continuation.

Of symptoms enumerated greatest part had subsisted for space of six weeks.

Which could hardly suppose to have happened in idiopathic fever without still more [serious] consequences than here occurred.

May then I think justly consider fever as symptom of some other affection.

And while patient might strictly be said to labour under febrile affection yet not to be looked for under genera of fever.

Must therefore look for some other circumstance from which febrile affection may here be supposed to derive origin.

Of symptoms here occurring not [common] in fever three might be pointed out on which some probability of its depending.

These are, pectoral complaint, pains in joints, & looseness.

When patient came under our care [indeed] was not affected with cough.

But had been subjected to this complaint even with considerable violence during greater part of affection.

Disease of six weeks standing & had only been free of this for fortnight.

But though cough gone, pain of breast still remained.

May therefore presume that affection producing cough not gone.

And that might be cause sufficient to support certain degree of fever.

But on other hand pain of breast may be supposed in some measure of same nature with that affecting joints.

And well known that fever often the attendant of Rheumatic affections.

In present case however hardly to such degree of violence that could be supposed to have induced the fever here existing.

Perhaps with more probability than [illegible] might here be referred to looseness.

Well known that from irritation of different kinds in alimentary canal whether depending on retention of faeces, or on acrid matter giving frequent discharge fever produced & supported.

And here frequency of discharge such as might give supposition of its originating from this source.

But to be observed also that even this affection not to any great degree.

And sole complaint depending on intestines consisted in frequency of discharge.

Was without gripes, tenesmus or any other painful or uneasy affection.

Upon whole therefore more probable that febrile affection here depended on [complex] [obscene] cause than that arose from any of obvious circumstances mentioned.

And must at any rate view case as consisting of symptoms having little evident connection with each other.

And which therefore not properly to be considered as constituting any particular genus.

Yet when consider origin of symptoms can hardly look upon them as unconnected.

Greater part of complaint indeed had now continued for space of six weeks.

But none of them of earlier date.

And previously to that period patient had uniformly enjoyed good health.

May conclude therefore that same particular cause then operated in giving at once rise to all affections.

And from perusal of history of case can be at no loss in fixing upon this cause

Are informed that at that period patient subjected to the measles.

An infection which few in this country at least escape in earlier periods of life.

Measles like greater part of febrile [infections] depending on specific contagion runs course in short time.

And have indeed as it were a natural termination

But although eruption and some other symptoms of the affection this short course, yet by no means rare to find complaints from measles running on to great length.

These in this country vulgarly known by title of dregs of measles.

And indeed rather to be considered as [sequential] than properly speaking disease itself.

That such the origin of affection of [pain] patient admits I think of very little doubt.

Such symptoms as here took place occurring to those affected with measles is subject of daily observations.

Sometimes indeed in one form, sometimes in another.

But not more frequently under any form than what proceeds from affection of lungs.

And indeed may be remarked that even from earliest stages of disease the mucus membrane particularly affected.

Is probably also from a circumstance somewhat analogous that are to account for increased discharge by intestinal canal.

And perhaps next to circumstance of cough looseness of colliquative kind most common sequelae of measles.

Both these either still existed or at least had been present in case of this patient.

Affection also occurring under form of pain in joints by no means uncommon.

And indeed almost constant consequence of even slightest exposure to cold with debilitated habit.

In every part then of this patients complaints had these occurrences which very frequently the sequelae of measles.

And could have no doubt in ascribing every part of present disease of patient to a morbid condition which measles had [induced]

On this supposition was I own not altogether without apprehension.

By no means infrequent to see fatal termination from this cause.

And this particularly the case with those at early period of life.

Especially happens also where [sequelae] under form of cough or of diarrhoea.

And these particularly to be dreaded where accompanied with much fever.

Must therefore own that did not here expect very speedy cure & was even in some doubt as to favourable one.

Event however has since shown that fears ill founded.

And that even without our being able to take much merit in treatment which here adopted.

In sequelae of any disease but particularly those from measles where many different appearances am of opinion that no general plan for radical cure can be laid down.

But that [measures] more particularly to be directed to symptoms.

Urgency of cough to be combated by diminishment of stimulus to action or of sensibility.

And on same general principle also are we to expect to counteract looseness.

But still more particularly by restraining deposit of fluid into alimentary canal.

Looseness here symptom which consider as chiefly demanding attention in case before us.

And was on general principles now mentioned that attempts made to restore it.

With this view directed present patient to use of Electuary Japonica dissolved or rather perhaps diffused in water.

This medicine of which have already oftener than once had occasion to speak perhaps not more useful in any affection than against diarrhoea.

In basis of this medicine Terra japonica as has been called which however an astringent vegetable extract have an article capable of producing constriction in alimentary canal.

Similar virtues also in Gum Kino [when] now enters composition.

And which a substance more soluble than the other

By cinnamon & nutmeg those warm aromatic vegetables is rendered grateful to stomach

While at same time in opium have a sedative for allaying inordinate action.

From these powers had I apprehend reason to hope for good affects from this medicine.

And in reality after patient began use of it looseness very soon ceased.

Reckon it not improbable that relief in some measure proceeded from this cause

Yet to this can hardly ascribe all changes for better which then took place

For at same time recovered appetite strength & spirits.

And although of [illegible] there still remained some slight degree of that in breast yet without cough.

May conclude therefore that besides benefits derived from medicine affection had in some measure naturally terminated in favourable manner.

And in this situation had no hesitation in dismissing patient as free from complaint.