DEP/DUA/1/22/16 (Normalised version)

Betty McLean

(1779-1780)

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Betty McLean.

Subjected to several different symptoms which reason to presume little connected with each other

Principal complaint however of catarrhal kind.

And among symptoms not least distressing when came under care may mention cough & pain of breast.

With these in all probability another also connected still more considerable.

That is the hoarseness to which subjected.

Latter indeed though frequently occurring as symptom of catarrh & frequently from same cause yet in some measure to be considered as a different affection.

And accordingly in practical & nosological¹ systems has obtained different names as those of Aphonia, Paraphonia, Raucedo Raucitas etc

Here existed to such degree & had been of such continuation that thought of selecting it as subject of remarks & treatment

In majority of instances indeed turns out but a trifling affection.

And often even yields without any [unease].

But in other cases proves a most obstinate & distressing disease.

And in my own practice have met with more than one instance where every effort employed proved ineffective.

This however may now say has not been case with present patient.

For though cannot affirm that complaint entirely removed, has at least got rid of this part of affection.

And to this, treatment here employed has been chiefly directed.

Besides symptoms however already mentioned at time of admission, subjected also to some others.

And among these may mention as not least alarming, profuse sweats to which subjected.

Do not indeed mean that from sweating of itself, anything here to be apprehended.

But an evacuation, which when taking place to any great degree, always [indicates] want of health.

And often connected with states of system in which foundation laid for most dangerous affections.

Here however connected with no circumstance which could lead us, at time when case came under our care, to entertain any suspicion as to particular affection.

Resolved therefore to allow it, at least for some little time, to take course.

And by this means expected that should be able to judge how far might in reality deserve attention.

Now however appears, that measures with this view, were unsuccessful.

For as had commenced without any obvious cause, so in short time, spontaneously ceased.

A circumstance giving reason to presume that unconnected with other affection

If [paid] little attention to sweating, have considered it as equally unnecessary to pay regard to cutaneous eruption.

This although with [propriety] mentioned [another] morbid appearance yet never to any great degree.

Imagined that to all extent to which here did occur, might proceed if not from sweating itself, at least from same cause.

That this the case some reason to presume at least, from having now also ceased.

And whether conjecture well founded or not, yet viewed it as unconnected with Paraphonia which here principal object to treat.

In treatment of this affection measures must be in great measure accommodated to cause.

May arise from many different local affections, in organs [conceived] in formula of voice.

Such for example as ulceratur, [illegible ] scirrhous or like.

When however immediate effect of cold & connected with catarrh as in present instance, more frequently effect of change, in state of secretion, intended for lubricating larynx & trachea than of any other circumstance.

And when this the case even from demulcent lubricating fauces, often good effects.

Benefit in particular often derived from those of oleaginous nature

And was as such, that had here recourse to the common Mistura Oleosa in which oil diffused in water, by means of small proportion of Volatile alkali.

Here however taken for some time without any advantage

Or at least, although during use other symptoms against which could not suppose it to have any influence spontaneously ceased, yet hoarseness nothing diminished.

In this situation, as still accompanied with pain of breast, cough & other catarrhal symptoms, suspect that might be [illegible] [of] inflammation.

Was with view to counteracting this then, that had recourse to Blister.

And whether had effect of counteracting inflammation or not was at least followed by good consequences.

For while product of very considerable discharge hoarseness also very much diminished.

And since that from continuing on oily mixture alone now almost entirely gone.

And now also free from other symptoms to which subjected when came under our care as well as hoarseness.

While however has thus got rid of these affections, subjected to another from which at present at least considerable distress.

That is Ophthalmia.

This affection which yet of very recent date ascribes probably with [justice] to action of cold.

Does not appear with any such symptoms as to threaten much danger or even obstinacy.

Considering it, as in state of local [active] inflammation, have ordered topical bleeding, & repeated refrigerant cathartic.

To these hope will soon yield.

And that in short time may be able to dismiss patient free from all her complaints.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.