DEP/DUA/1/37/19 (Transcript version)

James McGregor

1785

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James McGregor Febr 26. 85.

In case of this patient an examp. of an affect. of which cannot say that have before met with any inst.

At least by no means cert that this the case.

And when patient came under our care, sympt with which affected, by no means suff. certainty to charact. disease which here susp.

From exam case as introd into register may consider him as subj to three diff sets of sympt.

In cough, dyspn. & pain of breast as describd in register have pector sympt of consid severity.

And these indeed, partic the uneasiness from lying in bed in a horiz. posture, were most distress compl.

Next to these may point out as a morbid condit in general at least very little conn. with what here descr. the pecul. state of his surface.

Were informd that over his whole body had very lately acq. as it were new skin.

That cuticle in most parts of it had fallen off under form of furfurac. scales.

That in some parts had come off in very large portions.

And indeed when case taken was in such a state in palms of hands that had reason to believe, that in day or two would come off from each in one entire piece.

Where thorough desquam had occurred parts app. red & tender.

But in no other way in diseased state.

In this then had at least what might be consid as an uncomm occurr.

Espec. when occurring over whole body.

And may be consid as constit a very diff. affect. from pector compl. with which may safely venture to assert at least very rarely united.

But besides these, in pres. case still also anoth occurr & that too not a little alarm.

Swelling viz of abdom which here occurrd.

When patient indeed came first under our care was not very consid.

And chiefly obs. when lying in bed, prob. from press on abdom which thus took place.

But in progr of attend here becam soon more consid.

In so much that gave consid [tens] to cloathes formerly cont. him with ease.

And prob that from pushing the diaph. upwards had consid share in induc diffic of breathing.

At same time from pain in breast, felt on motion in horiz post. had reason to belive, that some other cause concern.

Upon whole however no doubt that in this case three diff. sets of sympt.

And these too often at least occurring unconn with each other.

Here therefore first quest is, whethr are to view them as having any mutual depend or not.

Whether any of them connected togth as cause & affect.

Or whether in any degree origin from one common cause.

Evid that on prop solut of these quest. just idea of nature of disease must depend & prop plan of cure must be founded.

For form conj on this subj howevr, must attend to origin of affect & preceding circum.

Are told in hist of case that all sympt. began nearly about same period.

That when came under our care had been of about four months weeks dur.

That all of them succeeded as conseq of febrile affect to which then subj.

And that this fever attended with general redness of whole surface.

Here then natural to consider whether this could be any disease of which pres. sympt. comm. sequel.

In the efflor. here described have at least what may be consid as descr. of the app, in scarlat.

No mention indeed of any sore throat a very common occur in that disease

But an occurr. by no means essent.

And indeed very gener. the least remarkd where efflor the greatest.

While again well known that in such cases of Scarlat, desquam of cuticle very comm. conseq.

Often furfur scales for long time disch. from whole surface.

Sometimes from hands in partic cuticle known to come off in one entire piece under form of glove.

But if presumpt that, desquam of cuticle, here conseq of Scarlat, may also susp. same, with regard to drop. symp.

For well known that dropsy one of most comm sequel of disease.

While often gives swelling of abdom, prod also watery effus into other cav.

And In partic often remarkd to induce hydrothor, or even hydrops pericard.

And in this manner sometimes even cause of sudden death.

Here then a natural suggest to consider, how far affect of breast here occurring are any indic of water in that cavity.

Or how far, this a cause from which these sympt may be expl.

With regard to diagnos of water in chest, is univ allowed to be very diffic.

Is thought to be partic charact. by fluctuat discov on percuss or shaking

By irregul. of pulse.

By inab. to sleep unless in an erect post, or when stooping forw.

And by sudden start from sleep, with sense of suffoc, palpit or tend to deliq. An.

But these, in gener. only sympt of advan stages, & of consid degree.

And certain that often takes place when none of these obs.

While equally certain, that often gives rise to such pect. sympt, as here occurr.

Cough an almost [invariable] attend of every inst of hydrothor.

Same may be obs. with respect to pain of breast.

At least though not always severe pain, yet seldom wanting under some one form or other.

In affect of breathing again have both most const. & most distress sym of the disease.

And partic in uneasiness in horiz posture.

Hence then, though cannot be said that in this case, had diagn of hydrothor, yet not improb. that exists.

And if be pres, may readily pres, that is cause of all pect. sympt. which here occurr.

If then had certainty of prev exist of Scarlat, might look upon all affect here occurring, as sequelae.

And indeed that whole arose from some one common cause, the rather prob. from all begining at same time.

There however to be remarked that somewhat against suppos of preced scarlat, that generally app. as an epidem disease.

And for my own part, have neither of late met with any inst of it in my own pract. nor heard of occur in that of others.

While at same time, have never on any formr occas, met with what could be calld sporad inst. of that disease.

From these circum then, must [acknw] that here ground for doubt.

At same time seems to me at least most prob. suppos. that here there occurd either scarlat, or some simil febrile affect, where analog efflores on surface, & analog condit of subcut vessels, as conseq.

That from this condit of surface & vessels there occurrd in first place that desquam of cuticle so remark in pres. case.

[That] from influ on state of disch there was prod the drop sympt.

And that while effus of water into cavity of abdom. gave obv. swelling there, that into cav. of chest, gave pain of breast, dysp. & cough.

While not improb. that headachs as well as occas haemmor. from nose were conseq. of interrupt circul.

Thus then, notwith very diff [sets] of sympt here occurring, seemd to me prob, that whole origin from one common cause.

And from view now given of the disease, may readily concl. that not a little doubtful respect prog.

From partic app on surface indeed had nothing to fear.

For no reason to doubt, that desquam which had already made very consid progr. would go regul. on, & would soon have fav. termin.

But much more ground for alarm with respect to drop sympt.

Dropsy from any cause & even when app. under slightest form. often prove both obs & danger. disease.

And few cases of it, where there [partic] more to be appreh, than where depos. in chest.

While also to be added that [hydro] as sequel of scarlat, has often proved suddenly fatal.

Here then such an event would not I own have surp. me.

At same time, had no less reason to expect a fav. conclus.

And after termin in recov. which has now in reality taken place, any farther observat on progn, may be consid as altog superseded.

How far this recov. the effect of med employd is I own with me matter of some doubt.

Highly probab., that some parts of disease, in which recov took place by what may be calld natur progr.

This partic the case with respec to desquam of cuticle, & recov of sound state to skin.

Hence, with view to this affect, no meas. whatever were taken.

Began pract you will obs. by direct applic of blister, to paind part of breast.

And by advis disch from thence to be supported by means of Episp. oint.

In this had in view, not only allev of pain of breast, but also of affect of breathing.

For susp. both, to depend on water.

And hence although consid blister as powerful outlet yet did not think that was alone to be trusted to.

Accord had also recourse to Cream of Tart but as gentle purgat & diur.

To this added as corrig with view of counteract uneas at stom. a small prop of powder of Cassiae.

And as adjuv partic with view to purgat operat. a prop of powd of Jalla.

In operat of blister were not disap.

But whether from want of prop appl. or from some other circum. running not afterwards supported.

While at same time, Cream of Tart, in quantit to which taken, no obv. operat, either in mov. belly, or prod diuresis.

Hence then could not be surp. that at succeed report, cough dysp. & pain of breast should cont as before.

[Desquam] of cuticle indeed as might have been expected had nat course.

But more urgent sympt cont. as before.

Did not however seem necess imm to repeat blister.

But with view to farther diuresis, directed use of Squill pills.

Effect however even of these not consid.

Had however, under use, very consid remiss, both of pain of breast & dysp.

While however from this inferrd dimin of water in cav. of chest, seemd to be greater, in abdom.

For swelling of belly encr.

From this therefore consid more powerful purgat as requis.

And in place of small prop of Jallap, before empl. now ordered what in our pharm stilld Comp powder

Consist of two parts of Cream of Tart to one of Jallap.

Here in prepar, will obs, artic directed to be pounded, not separ, but togeth.

And imagind that from this activ very much encr.

As far however, as my own exper. goes, have not been able to obs. this.

And accord ordered to extent of ℥i for dose, that is to quant of Ji of Jall.

And from this, not more affect, than could have wishd.

That attended with good affect, may inferr from swelling of belly, as well as all other sympt, being dimin.

While at same time desquam of cuticle seemd now to be compl.

And only inconven. from tender. of skin, partic in parts from which last thrown off the feet.

This so much case that even unable to walk.

Highly prob however, that [contrib] not a little to cure.

For dropsic sympt, succeeding scarlat, seem to be prin if not entirely affect, of obstr perspirat, arising from state of surface.

Accord when skin recov. natural condit, very gener. remarked to cease.

But whether from this, or from evac empl. was so well that farther attend or farther use of med seemd unness.

Patient therefore dismissd free from affect.