DEP/DUA/1/34/28 (Normalised version)

Duncan McKay

(1783-1784)

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Duncan McKay. April 3^d

When this patient came under care considered case as somewhat doubtful.

His most distressing symptoms were such as every day occur in cases of Catarrh.

For disease chiefly marked by severe fits of coughing with expectoration of yellowish matter.

And from this not improbable that all other symptoms mentioned in history of case may arise.

For none of them, even sickness at stomach & vomiting which do not frequently proceed from this cause.

While however this not an improbable supposition some circumstances giving suspicion of affection of much more dangerous tendency vizr Phthisis Pulmonalis.

This particularly the case with regard to night sweats & quickness of pulse

And was a circumstance no less suspicious than either that was at times affected with shivering fits.

To all these also to be added that Phthisis a very insidious disease.

And that often makes very considerable progress before distinctly marked.

In many instances even less grounds for suspicion than in present case.

And that too after has subsisted for some time.

Upon whole then could not help entertaining some apprehension in present instance.

But even from beginning was most disposed to adopt opinion of being merely catarrh.

And that opinion now rendered much more probable.

For since came under care symptoms most threatening Phthisis have disappeared

And is very little if in any degree affected either with shivering or sweating.

While at same time pulse in place of 120 now little above 90.

Hence then can with greater confidence conclude that merely Catarrh.

On this idea need hardly add that must be disposed to give favourable Prognosis

If conjecture right may hope that even soon, a speedy & favourable termination may take place.

And to this, even reason to presume, that considerable progress has already been made.

But notwithstanding apparent relief can by no means speak with absolute certainty against existence of Phthisis.

And if this the case notwithstanding present appearance & notwithstanding everything that can do for patient may soon fall victim to affection

In treatment of this case practice chiefly directed with view to Catarrh

At same time however not overlooking danger which there was of terminating in Phthisis.

Began with a remedy which often used at least with temporary advantage in both diseases viz Emetic.

Whatever nature of affection had here reason to hope, that from unloading breast might relieve both cough & dyspnoea.

Had at same time recourse to Cream of Tartar.

Which from extent to which here directed hoped might both operate as gentle diuretic & likewise as opening belly.

And from either operation no doubt that breast very much relieved.

With Cream of Tartar however here conjoined a proportion of Cicuta.

Principally with view to obtaining mitigation of cough from narcotic powers.

From these medicines seemed at first to obtain temporary relief.

But this probably more affect of free operation of Emetic than of Cream of Tartar with Cicuta.

And accordingly at succeeding report cough rather more severe.

By this led to application of a blister converted into an issue

And in place of Cicuta had [recourse] to a more powerful medicine for allaying inordinate action Opium under form of Pill Thebaic.

From use of these medicines symptoms have been very considerably mitigated

And reason to hope that by continuation of them, together with more favourable state of weather may soon be entirely removed.

If this however should not be the case, although still reason to consider disease as only catarrh may have recourse to repetition of Emetic, to Squills or to other expectorants & diuretics.

If on other hand either be already Phthisis or lands in that affection may try Cicuta or Gum Myrrh.

But in that case all endeavours will probably be but of little avail