DEP/DUA/1/42/09 (Normalised version)

Archibald McPhail

(1787-1788)

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N^o9 Archibald McPhail at 50.

Of disease of this patient, am not altogether without doubts

His symptoms merely those which frequently occur in catarrh.

And not improbable that this only disease to which is subjected.

To this supposition long continuation of affection may be considered as giving countenance.

Yet on other hand not attended with that degree of expectoration which common when Dyspnoea from catarrh.

And all symptoms such as often occur in Hydrothorax.

Particularly the case with constant dyspnoea & pain at sternum.

With his being able to sleep only on one side

And above all with being suddenly awaked from sleep by Dyspnoea during the night.

But while these present must be allowed that other marks of Hydrothorax absent.

Particularly no dropsical swellings elsewhere no scarcity of urine.

To this however to be answered that these by no means constant symptoms of Hydrothorax.

This is a disease very difficult to be discovered.

That often present when less grounds for suspecting it than on present occasion.

Hence though no certainty yet presumption of the disease.

Besides supposition mentioned indeed others & these of very different nature might be entertained.

Such for example as supposition of local affection of heart aneurysm or like

But without entering farther into that subject shall only observe that consider one or other of two suppositions already mentioned as most probable.

In this state uncertainty however must be doubtful as to Prognosis.

If really hydrothorax chance rather against patient.

If on contrary catarrh in his favour.

But on either supposition at this season of year speedy cure not to be expected.

On either however may I think look for some alleviation.

And at least somewhat fortunate that in both this alleviation may in some degree be looked for from same [remedy].

Particularly from increased discharge by urine.

For though this does not seem to have immediate tendency to cure catarrh yet in such cases often product of great advantage.

And indeed, know no remedy upon whole more beneficial in catarrh than diuresis.

But here treatment more particularly [directed] to supposition of Hydrothorax.

And is on supposition of this disease that while have employed composite powder of Cream Tartar to keep belly open have directed Pills with Digitalis.

Of these is intention to make trial with present patient.

And if not otherwise useful may at least see how far operate as diuretic.

In administration of these & in other practices to which may have recourse will be entirely regulated by occurrences & by situation in which shall find patient.