DEP/DUA/1/14/09 (Transcript version)

John McLean

(1777)

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To affect of John Mclean patient next in order shall be at loss to affix any name

And perhaps true nature of affection disease not less obscure.

Yet appreh. that respecting origin of compl. can be no doubt.

And in no long time after came under our care disease brought to happy termin.

Perhaps may add in some measure by the means of cure employd.

At time when patient came under our care applied for assist. had a collect of sympt. not constit any proper genus.

Had here indeed greatest part of the constit of idiopath fever.

Patient affected with [prostrat] of sharp heat, thirst & quickness of pulse.

At same time distressed also with sickness at stomach destroying appetite.

In all these have sympt of [illegible] fever.

But here these alone did not occurr.

Were attended also with some other sympt which although sometimes taking place seldom attend of fever alone.

And that not properly to be reckoned fever might in some degree be inferrd from contin.

Of sympt. enumerated greatest part had subsisted for space of six weeks.

Which could hardly suppose to have happened in idiopath fever without still more [serious] conseq. than here occurrd.

May then I think justly consider fever as symptom of some other affect.

And while patient might justly strictly be said to labour under febrile affect yet not to be lookd for under gener. of fever.

Must therefore look for some other circ from which febrile affect. may here be supposed to derive origin.

Of sympt here occurring not [common] in fever three might be pointed out on which might be supposed to some probab of its depending depend.

These are, pectoral compl., pains in joints, & loosness.

When patient came under our care [indeed] was not affected with cough.

But had been subj. to this compl. even with consid viol during greater part of affection.

Disease of six weeks standing & had only been free of this for forthnight.

But though cough gone, pain of breast still remaind.

May therefore presume that affect prod cough not gone.

And that might be cause sufficient to support certain degree of fever.

But on other hand pain of breast may be supposed in some meas of same nature with that affecting joints.

And well known that fever often the attend of Rheum affections.

In pres. case howevr hardly to such degree of violence that could be suppose to have induced the fever here existing.

Perhaps with more probab. than [illegible] might here be referrd to looseness.

Well known that from irrit of diff kinds in alim canal whether depending on retent of feces, or on acrid matter giving freq. disch. fever prod & supported.

And here freq. of disch. such as might give suppos of its origin from this source.

But to be observd also that even this affect not to any great degree.

And sole compl. dep on intest. consisted in freq. of disch.

Was without gripes, tenesmus or any other painful or uneasy affect.

Upon whole therefore more probab. that febrile affect. here depended on [comp] [obscene] cause than that arose from any of obv. circum mentiond.

And must at any rate view case as consist. of sympt. having little evid connex. with each other.

And which therfore not properly to be consid as constit. any partic genus.

Yet when consider origin of sympt can hardly look upon them as unconnected.

Greater part of compl. indeed had now cont. for space of six weeks.

But none of them of earlier date.

And prev to that period patient had unif. enjoyd good health.

May conclude therefore that same partic cause then operated in giving at once rise to all affect.

And from perusal of history of case can be at no loss in fixing upon this cause

Are informed that at that period patient subjected to the measles.

An infect. which few in this country at least escape in earlier periods of life.

Measles like greater part of febrile [infec] depending on specif contag. run course in short time.

And have indeed as it were a natural terminat

But although erupt. and some other symp of the affect this short course, yet by no means rare to find compl. from measles running on to great length.

These in this country vulgarly known by title of dregs of measles.

And indeed rather to be consid as [seq] than properly speaking disease itself.

That such the origin of affection of [pain] patient admits I think of very little doubt.

Such sympt as here took place occurring to those affected with measles is subj of daily observat.

Sometimes indeed in one form, sometimes in another.

But not more freq. under any form than what proceeds from affect. of lungs.

And indeed may be remarked that even from earliest stages of disease the mucus membr. partic affected.

Is probab. also from a circum some what analog. that are to acct for encreasd disch. by alim intest canal.

And perhaps next to circum of cough loosness of colliq. kind most common sequel. of measles.

Both these eithr still existed or at least had been pres. in case of this patient.

Affect also occurring under form of pain in joints by no means uncommon.

And indeed almost const. conseq. of even slightest expos. to cold with debil. habit.

In every part then of this patient complaints had these occurr. which very freq. the sequel. of measles.

And could have no doubt in ascrib every part of pres. disease of patient to a morbid condit which measles had [induc]

On this suppos. was I own not altogether without appreh.

By no means unfreq. to see fatal termin from this cause.

And this partic the case with those at early period of life.

Especially happens also where [sequ] under form of cough or of diarrhoea.

And these partic to be dreaded where accompan. with much fever.

Must therfore own that did not here expect very speedy cure & was even in some doubt as to favour. one.

Event however has since shewn that fears ill founded.

And that even without our being able to take much merit in treatment which here adopted.

In sequelae of any disease but partic those from measles where many diff. appear. am of opinion that no general plan for radic cure can be laid down.

But that [measure] more partic to be directed to sympt.

Urgency of cough to be combated by dim of stimul to action or of sensib.

And on same general princip also are we to expect to counteract looseness.

But still more partic by restrain depos. of fluid into alim canal.

Looseness here sympt which consid as cheifly demanding attention in case before us.

And was on general princip now mentiond that attempts made to restore it.

With this view directed pres. patient to use of Elect Japon. dissolvd or rather perhaps diff. in water.

This med of which have already oftener than once had occas to speak perhaps not more useful in any affect than against diarrhoea.

In basis of this med. Terra japonicae as has been calld which howevr an astring veget extract have an artic capab of prod constrict in alim canal.

Simil virtues also in G. Kino [when] now enters composit.

And which a subst more soluble than the other

By cinnam & nutmeg those warm arom vegetab. is rendered grateful to stomach

While at same time in opium have a sedat. for allaying inordin. action.

From these powr had I appreh. reason to hope for good affect from this med.

And in reality after patient began use of it looseness very soon ceased.

Reckon it not improbab. that relief in some measure proceeded from this cause

Yet to this can hardly ascribe all change for better which then took place

For at same time recov. appetite strength & spirits.

And although of [illegible] there still remained some slight degr. of that in breast yet without cough.

May conclude therefore that besides benef. derivd from med. affect had in some measure natural termin in fav. manner.

And in this situat had no hesit in dismissing patient as free from compl.