DEP/DUA/1/23/07 (Transcript version)

Margaret McDonald

(1780)

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Margt. McDonald.

Case of this patient consists of but few & these not uncomm. sympt

Yet not without diffic.

Affect may be said entirely to consist in cough & dyspnoea.

For all pains of breast to which is subj. may be consid only as necess & immd conseq. of concuss from cough.

Had sympt. here taking place been attended with copious or viscid expect. would have been little doubt.

Should then have had no hesitat in consid this mucus as cause both of cough & dysp.

And this suppos. partic favoured both by age of patient & by cause to which ascribes compl.

Must however be rememb. that cold the cause here susp to have operated, prod great diversity of compl.

And that with people past prime of life many other diseas. besides chron catarrh more common than at earlier per.

Must also observe that cough & dysp when without expector. the prod of great diver of causes.

And perhaps from none more freq. than action of lungs being impeded by water in chest.

Equally prod this effect, whether [effused] in cavity of chest constit Hydr or in cellul. memb. under form of Anas

Must then be allowed that dropsy of breast a cause suffic to prod sympt

Is also to be added that dropic affect very freq prod by cold.

And that more freq. at advan than at early period of life.

Would therefore occurr at least as possib suppos that may proceed from this cause.

But although possib - yet improb.

For here many of those sympt. which common attend drop of breast in any state are wanting.

In almost no inst does there occurr anasarc of lungs without anasarc. swell at other parts.

These not only its attend from commen. but in gener even precede

With this patient however has cont sever years without small. app of this kind.

A proof not only of that no anasarc of lungs, but evid also of absence of Hydr

For seldom of long contin without some oedem.

But besides this many other of most common diagnost. also wanting.

Has nothing of that sudden start from sleep, with partic palpit, which consid as pathogn of hydrothor.

Nor is even affected with dyspnoea on horiz. posture.

Appet. good, belly regul, circum uncom in any drop.

And what still more uncom no affect of urine.

Lastly may obser. that pulse of patient regul.

A circum which seldom if ever happ where such collect of water in breast, in any state, as to give diffic of breathing.

Upon whole then may concl. that here in reality no dropsy of breast.

And from circum already mentiond, although no evid expect. prob of catarr

With this idea of nature of affect. prognos. may be more fav than if entert diff opin.

True indeed that affect has already contin for consid length of time

And that too notwith use of most probab means of cure.

Cannot now therefore look for exped recov.

Must also be remarkd that is a disease which freq in end fatal.

But on other hand to be observd that this in gener. conseq only of very long contin. & of superv diseases

And that hitherto has induced no other affect.

Patient also not at that advan. period of life when affect most danger.

Besides season of year very much in favour.

For well known that such compl. often even spont. cease from occurr of warm weather.

Upon whole therefore hope that affect may soon at least be mitig.

And patient if not entirely recov yet still in situat to be dismissed.

Probab even that will contin free from affect till renewed by some accid cause.

Such for example as occurr of cold weath or accid expos when heated.

Of these partic however is not at pres our busin to speak.

But after what already said of name of disease & probab. event, come next to offer some observ on pract.

Here though disp to give disease, name of catarrh yet from sympt led to concl. that no great secret of mucus.

Otherwise during viol fits of coughing could not fail to be consid expect.

Hence then led to concl. that viol fits of coughing rather from nature than quant of muc to be expect

Prin object then to promote [excret].

And if this even affected by meas in some degr. encreas secret. yet still may be highly benef. to patien.

Is therefore from facilit excret. that here I think to look for greatest benef.

But besides this benef to be expected also from dimin determ to lungs.

For by this means that state of secret. by which diffic of excret is prod, may be prev.

And is thus I appreh. that warm weather gives relief while by cold affect is renewed.

On these diff princip many remed might be suggested from which in this inst might hope to derive benef.

And on these may explain [inten] in pract. to which have already had recourse.

Began pract. by directing applic of blister to breast.

From this hoped that should derive obtain some advant as giving determ to part to which applied.

And if notwith what have already observd disease should in any degree depend on collect of water, few meas more powerful either as prom absorpt, or as afford opport. for disch.

But besides blister had at the same time recourse to pil Scillit.

That active prop of squills, as affect. alim canal demonst. by immed effect.

But that besides this from [entering] circul system exerts influ on some secret. incontest proved from effect as diuret.

For my own part equally little doubt that exerts influ at secret [orgn] by lungs.

And that in conseq. of stim there has effect both in augm secret. & promot excret.

From prop contin then reason to hope that patien should derive more relief than perhaps from any other meas that could empl.

Began this med therfore with view of contin use for some length of time

And of grad encreas. dose as found that patient could bear it, without any consid affect of stomach

For here had in view to obt. effects of squills not as acting on alim canal but as entering syst.

And indep of action on lungs, if should encrease secret. of urine from this also expected benef

In obvious operat of blister were not disappointed.

And although but little influence on cough yet dysp. not augm rather dimin.

But if cough resisted blister seemd also to be as little affectd by Squills.

These however at first given only to small extent.

Quantit viz of five gr of Sq. Pill.

In this little more than gr ii of the squills cont.

Now therefore have directed for patient three times that quantity in day.

And if stom bears it without incon may yet still farther augm it.

But of this must judge from [effects]

And am hopeful that contin even to pres. quantit may be effect in remov of pat. compl.

But if this not the case while at same time is found to disagree with stomach must think of subs. other meas.

Or at least of conj. these with pres. used to less extent.

And here when consid state of Catarr benef. I think may be expected from action on lungs themselves.

For this purpose may have recour to steams of warm water, inspired by aid of machine lately invented by Mr Mudge.

Or may exhib these as deriv some degree of impregn. from Vitriol Aether

But am even inclind to think that such trials may not be necess.

If are necess & tried without effect can pretend to judge only of meas afterw to be employd by situat in which shall then find our patient.