DEP/DUA/1/23/07 (Normalised version)

Margaret McDonald

(1780)

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Margaret McDonald.

Case of this patient consists of but few & these not uncommon symptoms

Yet not without difficulty.

Affection may be said entirely to consist in cough & dyspnoea.

For all pains of breast to which is subjected may be considered only as necessary & immediate consequence of concussion from cough.

Had symptoms here taking place been attended with copious or viscid expectoration would have been little doubt.

Should then have had no hesitation in considering this mucus as cause both of cough & dyspnoea.

And this supposition particularly favoured both by age of patient & by cause to which ascribes complaint.

Must however be remembered that cold the cause here suspected to have operated, produces great diversity of complaints.

And that with people past prime of life many other diseases besides chronic catarrh more common than at earlier period.

Must also observe that cough & dyspnoea when without expectoration the product of great diversity of causes.

And perhaps from none more frequent than action of lungs being impeded by water in chest.

Equally producing this effect, whether [effused] in cavity of chest constituting Hydrothorax or in cellular membrane under form of Anasarca

Must then be allowed that dropsy of breast a cause sufficient to produce symptoms

Is also to be added that dropsical affections very frequently produced by cold.

And that more frequent at advanced than at early period of life.

Would therefore occur at least as possible supposition that may proceed from this cause.

But although possible - yet improbable.

For here many of those symptoms which commonly attend dropsy of breast in any state are wanting.

In almost no instance does there occur anasarca of lungs without anasarca swelling at other parts.

These not only its attendants from commencement but in general even precede

With this patient however has continued several years without smallest appearance of this kind.

A proof not only that no anasarca of lungs, but evidence also of absence of Hydrothorax

For seldom of long continuation without some oedemata.

But besides this many other of most common diagnostics also wanting.

Has nothing of that sudden starting from sleep, with particular palpitation, which considered as pathognomonic of hydrothorax.

Nor is even affected with dyspnoea on horizontal posture.

Appetite good, belly regular, circumstances uncommon in any dropsy.

And what still more uncommon no affection of urine.

Lastly may observe that pulse of patient regular.

A circumstance which seldom if ever happens where such collection of water in breast, in any state, as to give difficulty of breathing.

Upon whole then may conclude that here in reality no dropsy of breast.

And from circumstances already mentioned, although no evident expectoration probability of catarrh

With this idea of nature of affection prognosis may be more favourable than if entertained different opinion.

True indeed that affection has already continued for considerable length of time

And that too notwithstanding use of most probable means of cure.

Cannot now therefore look for expedient recovery.

Must also be remarked that is a disease which frequently in end fatal.

But on other hand to be observed that this in general consequence only of very long continuation & of supervening diseases

And that hitherto has induced no other affection.

Patient also not at that advanced period of life when affection most dangerous.

Besides season of year very much in favour.

For well known that such complaints often even spontaneously cease from occurrence of warm weather.

Upon whole therefore hope that affection may soon at least be mitigated.

And patient if not entirely recovered yet still in situation to be dismissed.

Probable even that will continue free from affection till renewed by some accidental cause.

Such for example as occurrence of cold weather or accidental exposure when heated.

Of these particulars however is not at present our business to speak.

But after what already said of name of disease & probable event, come next to offer some observations on practice.

Here though disposed to give disease, name of catarrh yet from symptoms led to conclude that no great secretion of mucus.

Otherwise during violent fits of coughing could not fail to be considered expectoration.

Hence then led to conclude that violent fits of coughing rather from nature than quantity of mucus to be expectorated

Principle objective then to promote [excretion].

And if this even affected by measures in some degree increasing secretion yet still may be highly beneficial to patient.

Is therefore from facilitating excretion that here I think to look for greatest benefits.

But besides this benefits to be expected also from diminishing determination to lungs.

For by this means that state of secretion by which difficulty of excretion is produced, may be prevented.

And is thus I apprehend that warm weather gives relief while by cold affection is renewed.

On these different principles many remedies might be suggested from which in this instance might hope to derive benefit.

And on these may explain [intentions] in practice to which have already had recourse.

Began practice by directing application of blister

From this hoped that should obtain some advantage as giving determination to part to which applied.

And if notwithstanding what have already observed disease should in any degree depend on collection of water, few measures more powerful either as promoting absorption, or as affording opportunity for discharge.

But besides blister had at the same time recourse to pill Scillitica.

That active properties of squills, affect alimentary canal demonstrated by immediate effects.

But that besides this from [entering] circulatory system exerts influence on some secretions incontestably proved from effect as diuretic.

For my own part equally little doubt that exerts influence at secretory [organ] by lungs.

And that in consequence of stimulation there has effect both in augmenting secretion & promoting excretion.

From proper continuation then reason to hope that patient should derive more relief than perhaps from any other measure that could employ.

Began this medicine therefore with view of continuing use for some length of time

And of gradually increasing dose as found that patient could bear it, without any considerable affection of stomach

For here had in view to obtain effects of squills not as acting on alimentary canal but as entering system.

And independent of action on lungs, if should increase secretion of urine from this also expected benefits

In obvious operation of blister were not disappointed.

And although but little influence on cough yet dyspnoea rather diminished.

But if cough resisted blister seemed also to be as little affected by Squills.

These however at first given only to small extent.

Quantity viz of five grains of Squill Pill.

In this little more than grains ii of the squills contained.

Now therefore have directed for patient three times that quantity in day.

And if stomach bears it without inconvenience may yet still farther augment it.

But of this must judge from [effects]

And am hopeful that continuing even to present quantity may be effective in removal of patients complaint.

But if this not the case while at same time is found to disagree with stomach must think of substituting other measures.

Or at least of conjoining these with present used to less extent.

And here when consider state of Catarrh benefit I think may be expected from action on lungs themselves.

For this purpose may have recourse to steams of warm water, inspired by aid of machine lately invented by Mr Mudge.

Or may exhibit these as deriving some degree of impregnation from Vitriol Aether

But am even inclined to think that such trials may not be necessary.

If are necessary & tried without effect can pretend to judge only of measures afterwards to be employed by situation in which shall then find our patient.