DEP/DUA/1/37/27 (Normalised version)

Alexander McKay

1785

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Alexander McKay. March 10^th. 1785

Of disease of this patient very little needs to said.

For as never returned after first prescription can hardly be considered as having been subject of practice.

And in history of his affection nothing which could be considered as singular or peculiar.

His case exhibits the common appearances which take place in instances of chronic catarrh.

Could not be considered as any singularity that most [severe] in morning

This on contrary an almost constant appearance in the disease.

And indeed necessary consequence of accumulation of mucus & viscid [acquisition] from stagnation during night

Was perhaps somewhat more singular that aggravated after taking food.

But this also probably to be ascribed to a similar cause.

To distension of stomach viz preventing so free descent of diaphragm as might otherwise occur.

And thus mucus collected operates as greater cause both of cough & dyspnoea.

But in whatever way to be explained while little doubt concerning nature of disease opinion as to termination could be not be very favourable.

For while symptoms such, as to be very distressing to him, had already subsisted you will observe for space of five years.

Not indeed to be supposed that during the whole of that time, had remained with equal violence.

Is very common with this disease to have, if not complete remission, at least very considerable alleviation during summer.

And highly probable that this was case with our patient.

But whether this the case or not after so long continuation habit of augmenting secretion may be considered as it were fixed.

And well known that after such continuation very difficultly removed.

Nay frequently remarked that only wanting when patient in greater distress from other causes.

Although therefore patient had continued regular attendance am very doubtful whether should have been able to overcome affection.

Yet different measures might have been tried from which hopes of some alleviation of affection.

And by these conjoined with return of warm weather, may have had hopes of remaining free from it, till return of succeeding winter

Began practice you will observe by directing use of an Emetic, & the Squill pills.

By former hoped that the breast might be unloaded, & by determination given to surface.

By latter, an increase of urinary discharge, & more frequent attempts to exertion as soon as mucus deposited in vesicles.

But whether on these principles, or not, cannot be denied, that in such cases, both Emetic & Squills have good effects.

What however, were here affects, have not heard.

And desertion of patient, has [prevented] us from any farther practice in this [disease]