DEP/DUA/1/43/55 (Normalised version)

Andrew Mein

(1787-1788)

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N^o29. Andrew Mein at 64.

Of disease to which this patient subjected have not I own been able to form any decided opinion.

And here particularly matter of doubt whether all symptoms from same origin or whether labours under complication of affections.

Can be no doubt that some of his symptoms of the catarrhal kind.

And probably may with justice attribute to cold to which was exposed, the cough & dyspnoea with which has been affected.

This also may be cause of pain of breast.

But that pain described as [somewhat] peculiar.

And from severity at cartilage ensiform as well as [affection] between shoulders suspect that partakes somewhat of Rheumatic nature.

This also rendered probable by severity on motion of parts.

But besides these symptoms another leading part of affection is headache.

This a common attendant of affections both of Rheumatic & Catarrhal kind.

But here also singularity giving difficulty with respect to nature.

For attacks him we are told as it were periodically, & continually for limited time

While also attended with remarkable affection of hearing.

In these particulars [somewhat] different both from headache depending on catarrh & from that which of Rheumatic kind.

Headache from catarrh chiefly the effect of severe coughing

And consequently occurs at no stated time.

Rheumatic headache indeed as well as rheumatic pains in other parts may be aggravated by heat in bed.

But in this case should not look for continuation during whole course of night.

And besides this Rheumatic headaches very rarely attended with affection of any of senses.

In deafness & tinnitus aurium have much more symptoms of that headache which is concomitant of fever.

And headache well known to be very frequent attendant of fever of intermittent kind.

This then perhaps grounds on which to account both for symptoms & likewise for regularity of recurrence.

At same time not impossible, that is mere consequence of recumbent posture.

[For] no doubt, that alteration in state of circulation in head very great influence.

And although at one time product of no effect at another will be means sometimes of inducing sometimes of removing headache.

Thus then appears that in several respects room for doubt with regard to this patients affection.

And before forming any decided opinion would wish to see somewhat more respecting it.

For not impossible that doubts now stated may a good deal depend on erroneous representations of patient.

In many instances where no intention to deceive, complaint in description given both aggravated & misrepresented.

And this particularly to be suspected where description such as present singular or uncommon combination.

In this state of uncertainty hardly to be expected, that can say anything of prognosis.

From anything indeed that we can discover neither to be considered as urgent nor dangerous.

But where appearance anomalous, hard to say what morbid affection may take place.

Although therefore disposed to look for favourable conclusion, & to consider disease as not even of obstinate nature, yet should not be surprised at contrary.

After uncertainty expressed hardly to be expected that can propose any rational plan of cure.

And till know more of nature chief objective to attend to progress & to mitigate urgent symptoms.

At same time using with these intentions what but little chance of aggravating affection.

Here only remedy to which have yet had recourse the [complex] powder of Guaiacum

Consists of equal parts of Cream of Tartar & Gum Guaiacum.

And have often I think directed it with advantage in affections of Rheumatic kind.

Its operation in general that of gently opening belly, & at same time producing slight discharge under form of diaphoretic

And on this principle imagined that might here be useful, both against catarrhal affection & likewise in counteracting pains if of Rheumatic kind.

But farther observations on practice [reserve] till have seen more of case & till again come to speak of it in order of list.