DEP/DUA/1/23/15 (Normalised version)

Robert McDonald

(1780)

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Robert McDonald.

Though case inserted in register¹ yet has never attended us.

This want of attendance however less to be regretted as highly probable that would have been without effect.

Yet had he continued under care would at least have afforded opportunity for trial of some practices in a very threatening case of an obstinate & not uncommon disease

Had here I think a very distinctly marked instance of Tabes Mesenterica.

And that this disease born with patient may be inferred both from early period at which appeared & from symptoms of disease observed even upon birth.

Yet little doubt that affection aggravated by accidents to which afterwards subjected

Particularly by smallpox & measles to both of which lately subjected.

Here affection to which was subjected [marked] in first place by enlargement of abdomen.

While at same time as appeared from state of extremities & other parts general emaciation had taken place to very great degree.

This indeed taken alone by no means sufficiently characteristic.

For occurs even where no local affection, from distension by water, air etc.

Here however none of other symptoms either of dropsy or tympanites

No fluctuation of abdomen on percussion.

Nothing of that sound which occurs sometimes at least in tympanites

Nor any remarkable discharge either by eructation or flatus.

But had these symptoms even occurred is by no means uncommon to [have] such complications.

And may readily suppose that scirrhous of mesenteric glands may give rise to dropsy as well as any other similar [induration] in abdominal viscera

That the mesenteric glands here affected strong grounds for presuming from early appearance.

From [conclusion] with which swelling has [subsisted] during whole life of patient.

From tense & firm feel.

But above all from appearance of scrofula at other parts.

For that breakings out under chin were of this nature, at least highly probable.

Well known that scrofula in many instances a hereditary disease.

And when not hereditary yet often connate.

Thus appears even from earliest periods of life.

Where disposition to the disease [how] often [accelerated] by different causes.

Particularly by viruses of different kinds which when absorbed retained in glands.

Thus follows as immediate consequence of smallpox measles etc.

All these causes seem to have operated in present case.

And accordingly not surprising that with [patient] at early period should have made considerable progress.

From this view of present disease will observe that consider Tabes Mesenterica as being entirely a scrofula affection.

That Scrofula may attack any of lymph glands in body, universally admitted.

And while often observed in those about face so in many instances also those of lungs & mesenteric.

In every instance has progressed through different states.

Often for long time remains in condition of mere indurate tumour.

From this however in general passes to inflamed state

And from thence again to state of suppuration.

When proceeds to latter stage general affection of system in some degree necessary consequence.

Thus in any part of body in consequence of absorption of sanies producing wasting & hectic fever constitutes tabes scrofula.

In mesenteric glands gives rise to such a disease as occurs with present patient.

And to which, name in general given of Tabes mesenterica.

In glands of lungs produces same symptoms under still more threatening form

That viz of Tuberculous Phthisis.

Not unfrequently it happens that all these complications.

And not impossible in present instance.

At one time at least during progression according to history given, has affected glands of face.

And from pulmonary symptoms mentioned in case, have at least presumption of affection of lungs.

Still however from swelling of abdomen presumption that affection of mesenteric glands most considerable.

And high probability that degeneration of some of these into state of suppuration principal if not only source of hectic fever, which has here occurred.

With this view of disease expectation of recovery could not be very great.

Scrofula in every situation an obstructive affection.

But particularly dangerous when affects internal parts.

Of all situations indeed that most frequently fatal, is affection of glands of lungs.

But perhaps next to this in point of danger may mention, affection of mesenteric glands.

When recovery takes place is in general at more advanced period of life.

As then attempts to cure may be made both by regimen & medicine inadmissible at earlier periods.

But in present case almost everything against patient.

For besides tender years symptoms had already made very [alarming] progress.

And that too notwithstanding every remedy which could be tried.

Here then opinion from beginning was that case if had continued under our care, would have terminated fatally.

As far however as could learn, some measures, of which entertain favourable opinion [which] had not been tried.

This particularly the case with respect to Cicuta.

Was therefore with intention of trying what could be obtained from it that [selected] present case

From many instances in practice have seen good effects from Cicuta both where tumours in scirrhous & suppurated state.

If however had succeeded in present case would have added not a little to idea of efficacy.

Expectation however could only be entertained from long, & regular trial.

While at same time infirm state of patient required administration in very small doses.

Began use therefore by small proportion of extract diffused in water.

To this form of exhibition the rather induced as enables to give very exact division of small doses.

While at same time taken without much difficulty.

If had found it product of no inconvenience should have persisted in use increasing [quantity]

But what was effect even of first exhibition have never learned.

The less to be regretted as reason to [apprehend] would have had little influence.

And indeed not improbable that has already fallen victim to affection.

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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.