DEP/DUA/1/18/12 (Normalised version)

Walter McFarlane

(1778-1779)

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Walter McFarlane.

Symptoms in case of this patient but few in Number.

Yet perhaps some room for doubt as to nature.

Am however disposed to consider it as affording example of an affection which has not frequently occurred to me.

Patient complained of some pain in throat

And on inspection of fauces slight marks of disease discovered.

But notwithstanding inflammation & pain can by no means hold it to be a case of Cynanche

Here nothing of febrile affection which attends that complaint.

Besides which long continuation & slow progress of complaint by no means corresponds with history of that affection.

To all this may be added that difficulty of deglutition much greater than can arise from any inflammation here taking place.

And indeed difficult deglutition may be considered as here constituting greatest part of [affection]

This symptom however in system of Mr Sauvages & others considered as great characteristic of a particular Genus of disease.

Distinguished by title of Dysphagia.

Defined as consisting of pain & difficulty attending & frequently [preventing] deglutition.

Distinguished from Angina by want of fever or affection of respiration.

To this genus then have little difficulty in referring present case.

And not only instance of this complaint which have had occasion to trial.

In volume of cases selected from records of Dispensary¹ will find sentiments delivered at considerable length on very remarkable instance of this affection.

To that publication then refer you for opinion as to disease of present patient.

May however observe that to genus of Dysphagia various species referred.

In system of Sauvages about 20 different [species]

To case mentioned above gave denomination of Dysphagia dolerifica .

And may I think bestow same name on present case.

Here also probable that affection depends rather on peculiar sensibility than on any local topical affection such as tumour or like.

But of latter supposition some probability from what happened to patient two years ago.

Then are told deglutition affected in similar manner from tumour on uvulae.

And that had favourably terminated in suppuration

At present know for certain that no tumour situated in that part.

May however be effect of tumour lower seated.

And in that case will belong to the Dyspnoea [Pharyngitis] of Mr Sauvages.

Here however must still observe that no evidence of tumour.

And upon whole rather disposed to former opinion.

On this ground inclined to give more favourable prognosis than if suspected tumour

And upon whole disposed to hope that shall be able to remove patients complaint & in no long time dismiss him free from affection.

This if conjecture right to be affected by restoring proper condition of sensibility to diseased parts.

If however depends on tumour by obtaining removal of it either by resolution or suppuration.

With hopes of answering any one of these intentions had here recourse to use of Electricity.

For mixture at first prescribed given principally with intention of not neglecting patient till machine in order

Electricity when duly employed hold to be one of most powerful agents in practice of medicine.

By this remedy obtained complete cure in case of Dysphagia already [attended] to

And am in hopes same may be [case] in present instance.

Of affects of electricity & modes of administering it much has been said.

Will find very distinct view in an inaugural dissertation by Dr Stevenson lately published at this place.

May not however be out of place briefly to deliver sentiments respecting it

Modes of exhibiting of great variety

Especially if attend to distinctions between positive & negative electricity.

But not at least ascertained by experience how far any real difference in effects between negative & positive.

And many circumstances in mode of exhibition which certainly produce no change in affection.

May I apprehend refer mode of employment to these heads.

From this account will readily understand foundation of expectation from it in present case.

And as consider affection to be local have chiefly directed it in way of spark

Am in hopes that whether depends merely on peculiar state of sensibility or even on tumour may have affect of curing complaint.

And indeed has already been product of very considerable benefits.

At present therefore no thoughts of any other measures but continuation of it.

May observe that few remedies in which more regular perseverance necessary.

Even therefore, if should not speedily yield, unless from circumstances, will not soon alter plan.

And if obliged to have recourse to other measures must be determined by circumstances in which shall then find patient.

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Explanatory notes:

1) Andrew Duncan, Medical cases, selected from the records of the Public Dispensary at Edinburgh : with remarks and observations : being the substance of case-lectures, delivered during the years 1776-7 (1778).