DEP/DUA/1/12/15 (Transcript version)

Duncan McLean

(1776-1777)

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Duncan McLean.

A case which in no very long time term favour. in our hands.

Must however own that should not have been disp to give such opin. at time when patient came under care.

On consid case of this patient was disp. to look upon it as singul affect.

And acknowledge that so far mistook [nature] as to treat it at first in manner which would not have done if had prop. understood it.

In very accurate history of this patient compl. introd into regist. will find [collect] of sympt. somewhat anomal.

Cheif compl. however pains attended with swelling.

But both one & other in nature transit.

And begining at partic part of body propagated from thence in diff. directions.

Occas at same time, temporary affection of diff funct. partic respirat.

At same time many others unaffected.

Appetite unimpaird pulse natural.

These compl referrd by patient to a partic cause.

Influence viz. of fatigue from walking.

From this view of compl. cheifly dividd in opin whether to be consid as a Rheum or Nerv. affection.

In sympt now describd will not be [refused] that some resemb. to both.

Tempor swellings rather in fav of suppos of Rheumat.

Yet in attack & progrss of parox. had more resemb. to a Nerv. affect.

And this suppos. in some meas. [corrob] by affection of motion prod.

For during attacks at least after [pain] had made certain progr. unable to move chin head

On these suppos. treatment of case at first begun

Soon however reason to suspect that neither one nor other well founded.

And patients disease put on appearance which led to diff. suppos.

Attacked more regul. at determ hour.

And shivering at each attack [abund] even from commen. became more severe.

From this circum first led to [conjec] that might be an anomal. interm.

And this conject is since I appreh. in great meas verified by method of cure which proved successful

Perhaps few diseases with respect to appear subj. to greater varieties than interm. fevers.

Of this sufficient proof from consulting elab. work of Mr Sauv

Will there observe under how many diff forms all types of interm have been conceald

Such a suppos. farther corrob. by another circum in case.

For to be observd that here a probab [caus] that might have induced an interm.

Patient indeed himself ascribed disease to fatigue.

But to be observd that just before commen of disease had passed [harvest] in [Englan]

People in this country much in practice of hiring themselves for harvest work in Lincolnshire & other fenny [count.]

From whence often import interm.

And to these exposed not only both from marshy state of county & season of year.

Consid it therfore as probab. that diseas had origin there, as from fatigue in walking [home].

Perhaps may add still farther corrob by method of attack

Began with vomiting & purging

A circum by no means unfreq. at commen. of fevers of interm kind.

Must own however that even after adopt this opin should have been very doubtful as to prognosis.

And at no period of affection did I with any confid look for success.

Even on suppos of intermittent suspected that compl. would be tedious.

Imagind that this would be still more the case if a nervous affection.

And opin of its being a Rheum compl. of the three the least probab.

With respect to termin howevr was happily disapproved

For from practice adapted to intermittent patin soon recovered.

Must however observe that even yet no [absol.] security as to cure

For during spring season in partic interm apt to recurr.

But should patient again apply to us from suffer relapse will not alarm.

For aftr having yeilded so easily already may entertain hopes in future.

And at any rate spring interm if [sympt] moderate by no means danger affection.

And for most part even natural cure by progr of season.

Practice with this patient at diff times conducted on very diff. plans.

Which solely affect of uncertainty & must even acknowledge mistakes with regard to the disease.

On suppos of Rheum began patient with use of Tinct. Guaiac.

A remedy of which have already oftener than once has occas to speak.

And from which have I think in some instances of that affect. seen best conseq.

On compl. of pres. patient howevr had no affect.

At same time access. became more regul.

This lead me more to opin of affect being of Nerv. kind.

And imagining that pains might be affect of period spasm. had recourse to calx of Zinc.

And in order that might be more certain of action [premed] to use the employ of Emet.

Still howevr with out any bettr affect.

And at length irregul of fits cont. with encreasing shivering was led to opin of its being an anom intermittent.

On this suppos. resolvd on trial of common cure vizr Peruv. Bark.

Even suppos affect of Nerv. kind was of opin that would not be prod of bad affect.

And if intermittent had good ground to hope for cure.

Event as have already observd verif. conj.

And patient from use soon freed from all his sympt.

Did not howevr reckon it prud immed to intermit bark.

For by this means such fevers freq suffr relapse when would not otherwise be the case.

Cont. use therfore for space of [forthnig] aftr sympt. in great meas ended.

But giving only a dose morning & evening

During all this time no [report] even of relapse.

Reckond it therefore unnecess. that should cont. attend longer.

And as have not since heard of him presume that cont in health.