DEP/DUA/1/23/15 (Transcript version)

Robert McDonald

(1780)

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Robert McDonald.

Though case inserted in register yet has never attended us.

Hence little necess to be said.

While This want of attend however less to be regretd as highly probab. that would have been without effect.

Yet had he cont under care would at least have afforded opport for trial of some pract. in a very threat case of an obstin & not uncomm case disease

Had here I think a very distinct markd inst of Tabes Mesenter.

And that this disease born with patient may be inferrd both from early period at which app. & from sym of disease obs. even upon birth.

Yet little doubt that affect aggra by accid to which afterwards subj

Partic by small pox & meas. to both of which lately subj.

Here affect to which was subj [mark] in first place by enlargem of abdom.

While at same time as appeard from state of extrem & other parts gener emac had taken place to very great degree.

This indeed taken alone by no means suffic charact.

For occurs even where no local affect, from disten by water, air &e.

Here however none of other sympt either of dropsy or [tympan.]

No fluctuat of abdom on percuss.

Nothing of that sound which occur sometimes at least in [tympan.]

Nor any remarkab. disch either by fluct eruct or flatus.

But had these sympt even occur is by no means uncomm to [have] such complic.

And may readily suppose that schirros of mysent glands may give rise to dropsy as well as any other simil [indurat.] in abdom viscer

That the mysent. glands here affected strong ground for pres. from early appear.

From concl. with which swelling has [subsited] during whole life of pat.

From tense & firm feel.

But above all from appear of scroph at other parts.

For that breakings out under chin were of this nature, at least highly probab.

Well known that scroph in many inst a heredit disease.

And when not hered. yet often connate.

Thus appears even from earliest periods of life.

Where dispos to the disease [how] often [accel.] by diff causes.

Partic by virus of diff kinds which when absorbd retaind in glands.

Thus follows as immed conseq. of small pox measles &e.

All these causes seem to have operated in pres. case.

And accord not surpr. that with [pat] at early period should have made consid progr.

From this view of pres. disease will obs. that consid Tabes Mysen as being entirely a scroph affect.

That Scroph. may attack any of lymph glands in body, univ admitted.

And while often observ. in those about face so in many inst also those of lungs & mysent.

In every inst has progr through diff states.

Often for long time remains in condit of mere indur. tumour.

From this however in general passes to inflam state

And from thence again to state of suppurat.

When proceeds to latter stage gener affect of syst in some degree necess conseq.

Thus in any part of body in conseq of absorpt. of sanies prod wasting & hectic fever const. tabes scrophul.

In mysenter. glands gives rise to such a disease as occurs with pres. pat.

And to which, name in gener. given of Tabes mysent.

In glands of lungs prod same sympt under still more threat form

That viz of Tuberc. Phthis.

Not unfreq it happens that all these complic.

And not imposs. in pres. inst.

At one time at least during progr. accord to hist. given, has affected gland of face.

And from pulmon sympt ment in case, have at least presumpt of affect of lungs.

Still however from swelling of abdom presumpt that affect of mysent. glands most consid.

And high probab. that degen of some of these into state of supp princip if not only source of hectic fever, which has here occurrd.

With this view of disease expect of recov. could not be very great.

Scrophul. in every situat an obstr affect.

But partic danger. when affects intern parts.

Of all situat indeed that most freq. fatal, is affect of glands of lungs.

But perhaps next to this in point of danger may ment, affect of mysen glands.

When recov. takes place is in gen at more advan period of life.

As then attempts to cure may be made both by regim & med inadmiss at earlier periods.

But in pres. case almost every thing against patient.

For besides tender years sympt had already made very [alarm] progr.

And that too notwith every remedy which could be tried.

Here then opin from begining was that case if had cont. under our care, would have termin fatally.

As far however as could learn, some meas, of which entert fav opin [whch] had not been tried.

This partic the case with resp. to Cicuta.

Was therefore with intent of trying what could be obt. from it that [selec] pres. case

From many inst in pract. have seen good effects from Cicuta both where tumours in schirrous & supp. state.

If however had succeeded in pres case would have added not a little to idea of effic.

Expect. however could only be entert from long, & regul. trial.

While at same time inf. state of patient required admin in very small doses.

Began use therefore by small prop of extract diff in water.

To this form of exhib the rather induced as enab. to give very exact divis of small doses.

While at same time taken without much diffic.

If had found it prod of no inconv. should have persisted in use encr. [qua]

But what was effect even of first exhib have never learnd.

The less to be regreted as probab. reason to [appreh.] would have had little influ.

And indeed not improbab. that has already fallen victim to affect.