DEP/DUA/1/15/16 (Transcript version)

Janet McKenlie

(1777-1778)

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On Saturdy last entered on consid of case of Janet McKenlie.

Observd that princip sympt with which this patient affected Cough, Dysp. pain of breast, &e, were such as might either arise from Phth or Catarrh.

And that in other respects pres affect at that state when these two disease very diff. disting from each other

Among other charact from which in such situat most certain judg. may be formd one is the ascert. matter [expect]

If merly mucus presumpt of disease being catarrhal.

But if cont. pus certainty [that] is Phthis.

After pointing out uncert. of various tests already prop. mentiond anoth which had at least appear. of being more cert than any of those.

That whatever had not then been able to put in pract. with matter [expec] by this patient.

[Toungue] indeed not unif clean a circum commonly occurring with purul. expect.

But was so at point.

And then usually first observd to occurr.

Patient compl. that matter expect has disagr taste

Circum from which some presumpt without seeing matter

Nor indeed had we ever seen it so as to be able to exam it in any way.

On saturd last however brought us some of what expect that morning.

And from every partic inclind to concl. that containd no inconsid prop. of pus.

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Colour & consist such as might [read] be [purul.]

With white & yellowish cast of pus, had at same time its usual consist in such condit.

And viscid not so great as that of mucus

At least not unif viscid.

While at same time greatest viscid in parts most transpar.

From circum of appear alone then pres.

But still more from smell.

Emitted even in recent state in which we receivd it an odour somewhat foetid.

And this [foetur] more consid on burning

Suppos of pus farther corrob. by specif gravity

When put into glass of common water sunk to bottom

And remaind there even when specif gravit of water encreased by addit of salt.

Thus then from common diagn. strong presumpt

And this presumpt conf. by tests which mentiond at last lect.

Put portions of it in separ glasses to one of which added Caust. Alk. Lix. to other vitriol acid.

In both cases by aid of agitat an ap. intim union soon took place

And in that with vitriol acid a change from white colour of pus, with [colouly] tranpar of acid, to blackish hue.

On addit of water in case of Caust alkali these soon took place evid precip to bottom.

Fluid above, which consid to be lixiv now diluted, still [susp.ing] part of expect matter which consisted of mucus, remaind transpar.

Addit of water to solut in vitriol acid led to same conclus.

Here also there took place an evid depos. to bottom of glass.

And had at least appear of pus in as far as respects colour & consist.

But besides this a more viscid & [tenac.] matter also separ.

This again [swimd] on surface of the glass.

And considered it to be part of mucus of the expector matter which the acid in diluted state no longer cap. of keep in solut.

This then would appear to be test by which pus & mucus as exist in expect matter may be separ from each other.

And as indicating in case now before us the pres. of both.

Must own therefore than from this second trial am still more convincd than before of certainty of test prop.

And from every circum may with confid conclude that mattr expect by [patient] does cont. pus.

From this expect. notwith doubt in other respects can have no hesit in pron case to be Phthisis Pulmon.

Here however next occurrs as quest whether this only disease with which our [patient] affected.

Or whether to consider her as subj to other diseases to which this has only superveend.

And here circum giving princip diff is want of menstrual disch.

This with female at period of life to which occurs has arrived will know to be chief constit of an affect disting in nosol. syst. by title of Ammen.

Want of menstrual disch. as taking place in Phthis may occurr in one of three ways.

Either may occurr as cause of Phths, as conseq. of it. Or as unconnected.

In first and last of these ways to be consid as proper idiopath disease

In the other would look upon it to be only sympt of phthis.

And indeed in this latter way does not take place till circulat in extreme vessels has every where also faild.

A circum partic manif by [appear] of eyes transpar viz of conjunct [from] total want of red vessels.

An occurr. which has not yet to remark degree taken place with our patient

From these circum alone then should conclude that want of menst disch. not here not here conseq. of Phthis.

But this still more confirmd by date of compl.

For of equal standing with other parts of her affection.

And indeed by her assignd as cause to which compl. to be attrib.

Must then here conclude amenorrh to be idiopath.

But does not from this follow that has had so great share in inducing affec as patient herself imag.

No doubt that irregul. in menst. disch cause of many disorders in female oecon.

And partic so when during flow causes operate giving sudden obst.

But if powerful cause of disease women not less apt to attrib much to it.

And sometimes blamed when in reality has no share.

This may even have been case with pres. patient.

For cause giving rise to obst. of menstruat such also as might be supposed to prod affect of breast.

Well know that Phthisis often orig from simple catarrh

And that this freq. effect of expos. to cold.

But especially of partial expos.

May therefore have here arisen from cause to which obst. of menses attrib

That this really affect of accid to which ascribd by patient can I appreh. be matter of little doubt.

Perhaps indeed few circum, on which can put less reliance on acct. given by patients than in what say respecting causes obstruct menses.

When actually arises from pregnancy with unmarried Wom often pretended that from other causes.

As thus hopes that by means used for restorat abort. may be procured.

From this then should perhaps be laid down as gener rule never to put [impli.] reliance on acct of unmarrid pat. respec this partic.

But to judge also from other circum.

And partic to determine from pres or absence either of marks of pregn. or of other affect.

In inst. before us while no appear of latter pregn. have certain indicat of [diseased] state in other respects.

And cause to which obst. ascribed well known well known to be very powerf. means induc. it.

With many women a common pract const. to promote this disch. by [illegible] at every period.

And this may suppose operates only in conseq. of heat.

From fact alone then influ of [this] circ. here mentiond as affect menst disch put beyond doubt.

Nor is it diff. to conceive on what princip operat of cold as prod this affect to be acct. for.

This explan indeed must be in some meas. connected with cause on which suppose menst. to depend.

But on every theory admitted that disch. from vessels whose mouths either expand or whose sides rupt.

Hence may be checkd by construct indeed.

And this will be necess. conseq of cold in case of menst. evac as well as of other haemorrhages.

On suppos. that menst. from gener pleth, by this means blood which ought to be disch. retaind in circul. mass.

And on suppos. which have [elsewhere] endeav. to estab. nearly same thing will also occurr.

Cause of obst. here would operate merely as imped exit of blood by usual course.

But from action of uterus, blood accum in vessels not [findin] exit by natur. passage again forced into syst.

Thus then would operate as giving tendency to plethor state.

And thus imagine ammen. [concernd] in [induce] of Phthisis.

Have thus then deliv opin respect disease to which suppose this patient subj.

Consider most matter. part of compl. to be Phthis pulmon.

And this conj with Ammen not as sympt of Phthis but as idiopath [disease].

And indeed as having had some [share] in inducing Phthis.

Prog. from opin deliv respecting nat of this affect. must unquest be by no means fav.

Phthisis when distinct markd in general [reputed] an incurab. affect.

To this opin howevr although conv that is a most danger disease can by no means entirely agree.

And even where cannot be cured by art. will yet in some cases have natur. termin in recov.

Of inst having fatal conclus. most certain are perhaps to consid those origin from scroph.

And in such if expectorat of matter is rather bloody sanies than prop. pus.

And is cheifly to absorpt of such that are I appreh. to ascribe Hect. fever.

Where mild & bland pus formd no reason to dread any pecul. bad [affect] because from lungs more than other parts.

And where opport. for free disch ulcerat formd in lungs may no doubt heal as well as in other parts.

Must indeed be allowed that here some unfav. circum.

Such for ex. as const. expos. to air & const. motion

Yet at any rate better chance of recov where free disch than in contrary circum

And where mattr expect appar. mild pus than where bloody sanies.

From these circum then inclind to look upon case of pres patient as an inst of Phth. not altog. irrecov

But when go this length is utmost that dare venture to say.

For where circum even most fav. recov. but very rare.

Considering Ammen. here occurring as a distinct affect. do not think that circum such as to threaten great danger

Yet appreh. that very little prospect of return of disch. unless patient can recov vigour.

And if that shall be case may prob. as readily occurr from natural operat of syst. as from aid of med.

At same time if disch could be restored would at least go some length as encreasing patient chance of recov.

For this change in balance of circul. would at least go greater length than any artif alterat which are able to prod.

And to this opin not only led on prin but from facts also.

Have not indeed seen any influence where restorat of menses had any effect in curing ulcerat of lungs

But think the doctrine supported by case of suppur. mamma which occurred to me some years ago.

A lady after deliv affected with swelling & inflam of breast termin in suppurat.

While Suppurat which at first to great extent afterw cont. with great obstin.

And if for short time had appear of healing was again renewed in same manner as before.

Although in this situat did not nurse her child yet menses did not return in usual manner.

This I own was inclind to consid as affect resulting from suppurat of breast

But from what afterwards happened appeared that the reverse was rather case

For after suppurat had subsisted for many months menst disch. happ to be restored.

Almost immed conseq. of this [atten] for better in appear of [sanies]

And in no long time heald mildly.

From this then concl. that if menses restored chance of recov. encreased

Yet after all prospect of cure very faint

While however able to attend us or willing to take med may at least give her whatever chance are able

And if cannot do more may at least use some meas. with intent of allev

Shall now then expl. pract already employd & point out future intent.

In this affect consid us as having two distinct states to combate.

The ulcerat in lungs which suppose to be cause of Phthis sympt.

And the obstr. of menst. disch.

Cure of ulcerat in gener. to be From affected by process totally dep. on system itself.

And unless by removal of causes interrup it natur. process art can do but very little.

Seems to be effect of pecul inflam.

And to disting from others, greatest Phys. of our days Mr J. Hunter has given it title of adhes.

This inflammat depends on pecul state of action of vessels

And this again on sensib & tonic power which these vessels posses & on stim induc. to action.

Evid therefore that deviat in many respects will have affect of prev. [ready] healing.

And that this somtimes to be brough about by encreas. sometimes by dim. action

As however lungs so inacess. these ends less readily obt. than when ulcerat in other places.

And indeed what cheifly to be done is by regul. gener. state of circulat.

With this intent necess. to avoid all causes augm gener. impet.

But more especially to avoid circum determ to lungs.

And even, as far as able, to dimin impet. there by determ to other parts.

Is on these princip that are I appreh to expl. benef. from mild alim. partic diet of milk & veget

From warm climate, gentle exercise & emetics as determ to surface.

And from Blisters & issues as determ to partic parts in neighb.

Yet probab. that these last also operate from constit as it were nerv secret.

And that obviate hectic symptom from allowing as it were exit for part matter absorbed into blood.

On general principles mentiond then consider greatest part of treatm. of Phth to proceed.

And that cure in reality work of natur when does take place.

In greatest number of inst. nothing perhaps to be attempted with view of altering state of action of vessels

Yet can be no doubt that in other cases of ulcerat. this affected both by extern or topic applic & by remed taken intern.

For indeed Unless in way of [vass.] cannot be applied to ulcerat in lungs.

But latter many remedies such as Peruv. Bar mercur. mezer &e may undoubtdly affect act on lungs as well as other parts.

These not unfreq. employd even with very great advant. against other cases of obt. [ulcers]

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And cannot help thinking that some cases at least even of Phthisis in which not only admiss but even useful.

Am even disp. to think that beside these sever. other remed operat in same manner.

And among others may perhaps rank med on which have now put this patient viz the Gum Myrrh.

At same time as shall presently have occas to observe have not yet had suff. practice of this either to determ its affects or how prod these.

Besides med with views now mentiond many others also employd in Phthisis.

Princip however with intent of allev. partic urgent sympt which may occur

Such for ex. as remov. irrit. cough checking colliq. sweats, or diarh &e

And general prin already stated will at least expl. foundat of partic pract in this case.

Thus for respecting Phthis affect which consider as by much most [impor] part of compl.

Esteem it therfore less necess. to state to you gener. prin on which to comb could hope to remove other part of affect.

For in pres. situat of patient do not consider remov. of Ammen as a thing to be attempted.

May only in general way observe that from idea of cause of menst flux & of circum giving obst. consider it as in diff. cases to be affected on diff. princip.

Cheifly however on one of these following

1 By promoting accumul. of Blood in [illegible] vessels where this wanting.

2. By restoring due & regul. action where that defic.

3. By removal of causes obst or retarding passage of blood by uterus where such exist.

Is then on these princip. that imagine are to expect restor of menst disch. & to expl. action of diff emmen.

But how far in pres. case will think it advis to take any farther meas. with view to menses am I own very doubtful

But at same time should very high degree of debilit occurr [even] on most urg. state will be [inadmss]

And shall conclude observat on this case with few remarks on the partic remed which have already used.

Began treatmnt with an emetic with intent of unloading breast & determ to [illegible]

And were not disapp. either in obv. operat or in conseq. which might have been expectd from thence

With same intent therefore may have occas recourse to this pract. [especally] when dysp. urgent.

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Was as means of restoring menses that had here recourse to [madder] root.

Repres. by some as highly effic if not an infallib specif in [every] case of Ammen.

In my own pract have not freq. employd it

And in cases where used have not found it prod of affects alledged.

But from any trials have made dare not venture to pronounce it a remed of little effic.

And wish to form opin from result of full & candid exper.

Must own that some circum which incline me to consid it as of active [power]

That of highly penat. qualit through system appears from being capab of commun tinge even to hardest bones.

This circum alone I think affords full refut of opin of those who contend that can have no other affect but by action on stomach.

And there merly as gentle bitter & astring.

In pres. inst howevr had no opport of determ affect.

For by looseness which occurd, either from affect of med or some other accid cause [soon] obliged to omit it.

And to moder. this had recourse to infus. Japon. as an astring.

While employd with view of removing irritat at fauces. Mucil. mixt.

Sympt. being by these means somewhat mitig. have now put patien on anothr remed. med

And if find that able to bear it shall endeav to push it to some extent.

That med is the Gum Myrrh a bitter aromat. gummy resin.

Long esteemd to use language of mat. med writers both intern & externally for deobs corrob antisep & traumat [power]

Do not know however that has been much employd in such cases of Phthisis as that to which our patient subjected.

And for my own part have never employ it in any such case till within these few months.

Was first induced to try it on authority of that able teacher of med & great phil. Dr G. Fordyce of London.

Have been informd that in such cases is a remedy from which he thinks he has derivd best effects

And in one inst in which have used it where undoubted evid of very large intern suppurat., whether from the med or not patient recov. beyond all expect.

From this then among other [reason] wish to give it fair trial in pres. case.

If therefore no occur. prev. it shall be desirous of cont. this course without at same time exhib. other med.

And if patient recovers will I own be disp. to look upon it as strong proof of effic.

For as already observd look upon this case to be highly danger.

More than probab. howevr that from recur of looseness or such simil accid will not have opport of giving it fair trial.

And in that case shall hardly think it advis to attempt any thing farther with this patient than merely [pallit] plan.

That is by directing mild alim. & gentle meas. for determ either to [surf] or parts in neighb of breast.

And by endeav mitig such urgent sympt as may occurr.

If from these patient recov. cure must be ascribd to nature.

If ends fatally no more than I expect.