DEP/DUA/1/39/14 (Normalised version)

Jean McCall

1786

---

Jean McCall. February. 25. 1786

When this patient came first under care expressed suspicion that subjected to Phthisis Pulmonalis.

And from what saw of case during course of attendance here this suspicion not a little confirmed.

For not only subjected to cough, dyspnoea & pain of breast, but also to colliquative sweats & diarrhoea.

And with these such loss of strength as to give towards latter period of at least most alarming appearance.

And although with Phthisis symptoms others also as flatus, borborygmi globus hysteria etc here connected, yet these to be considered only as adding to distress of patient

And as thus forming complication even more unfavourable than Phthisis itself.

Am therefore I own inclined to apprehend that in no long time will have fatal termination

But of this at least doubtful whether shall be able to learn anything.

For patient finding little benefit from remedies prescribed became averse to continuation of them.

And at own desire dismissed from list

During course of attendance is but in very few instances, that can here do anything towards radical cure.

With present patient remedy chiefly directed to alleviation of symptoms.

With which view as have already observed had indeed but little influence.

Which indeed will more fully appear from short review of practice to which had recourse during attendance.

When came under care symptom more immediately distressing to her than even pectoral complaint was looseness.

And as most ready means of obviating this thought of employing opium.

But before use, imagined that might be of advantage to exhibit a gentle emetic.

By this hoped, not only to [clean] stomach, but also to unload lungs.

And indeed unless this previously done some reason to fear bad affect from an article tending to restore free expectoration.

Here however situation of patient such, that gentle emetic only could be [advised].

And as such directed grain XV of Ipecacuanha.

This as expected attended with affect of operating gently

And probably [had] some affect in aiding influence of thebaic pills on looseness.

At least as prevent matters from passing downwards by which might be increased & supported.

But whether this case or not under use of these looseness considerably mitigated.

While this symptom however alleviated others nothing relieved & some even augmented.

Thus cough & pain of breast as distressing as before.

Sweatings particularly in morning rather increased.

And thirst to which formerly subjected now so much aggravated as to be highly distressing to her.

These last symptoms while might be owing to progress of disease was inclined to suspect might in part at least be augmented by Opium.

For well known that while restrains almost every other discharge increases that by surface.

Probably from influence as diminishing resistance there.

And from cuticle discharge more than any other being influenced by general state of circulation.

But whether in this way or not general fact established by daily observations.

Hence then but natural to suspect that might here operate as cause increasing sweating.

While at same time no less ground to suspect that also augmented thirst.

For this also in whatever manner may be induced an affect also often arising from employment.

While however reason to think, that thus product of inconvenience not same urgent necessity for continual use.

Hence then directed employment to be omitted.

And in place of pills had here recourse to mixture of Cicuta with Peruvian Bark.

To this composition have often recourse with scrofula patients.

And to scrofula sores consider those ulcerations in lungs, which are effect of tubercles, most nearly to [app].

While in scrofula much mistaken if have not sometimes seen ulcer from use, obtain disposition to heal, am even inclined to think that in some instances of tuberculous Phthisis have seen benefit from it.

On this ground then, thought at least of giving it chance in present case.

But besides this, here also recourse to it, with view of obviating urgent symptoms.

These now most distressing to patient cough & sweating.

As allaying first expected some benefit from the Cicuta.

Which unquestionably one of narcotic vegetables possessing considerable sedative powers.

And which since introduction [against] Pertussis employed in alleviating many other coughs with considerable advantage.

But while hoped that Cicuta might be attended with this affect expected also that Peruvian Bark some influence as restoring colloquium sweats.

These, as already hinted in speaking of opium, probably often consequence of atonic state of extreme vessels.

And hence natural to conclude that a medicine increasing tone tendency to restore them.

But whether operates in this [manner] or not, that such an affect often derived from Peruvian Bark undeniable.

And expected that might be of some use in present instance.

These then reasons at least which led me to trial of this medicine.

But cannot say that intent answered.

At first indeed medicine seemed to sit easily on stomach.

And if not product was at least attended with good affect of appearance being [somewhat] mended.

But neither cough nor sweating alleviated.

While at same time subjected to frequent returns of looseness.

From these circumstances led to conjoin with this medicine the use of repeated Emetic.

From which hoped for some alleviation of cough as unloading breast & prevention of diarrhoea as unloading stomach.

In obvious operation of Emetic were not disappointed.

And at least not improbable that had some share, in producing alleviation both of cough & looseness which followed.

Emetic however remedy which could only be occasionally repeated.

And present situation of patient seemed to afford additional argument for persisting in use of Peruvian Bark [&] Cicuta.

Hence intermitted vomits directed this alone to be repeated.

Although however continued in some respects easier yet observed strength to be much diminished.

And now subjected to frequent spontaneous vomiting which disposed to attribute to powders.

Although imagined that in this mistaken yet an objection to persisting in use.

And from this led to alteration of formula.

In place of Peruvian Bark therefor substituted Pulveris Cretacea.

Which while served to give formula might also tend to restore both vomiting & looseness [and] [destroying] acid.

In this affect however were disappointed.

For at succeeding report though cough somewhat moderated looseness rather increased.

While at same time patient felt daily loss of strength an evident proof of progress of disease.

In this situation hardly perhaps surprising that became desired of [intermitting] use of medicine.

And as had I own, little expectation of being of any material benefit did not [more] continue.

And accordingly dismissed from list