DEP/DUA/1/39/14 (Transcript version)

Jean McCall

1786

---

Jean McCall. Febr. 25. 1786

When this pat came first under care expressd susp. that subj to Phthis Pulmon.

And from what saw of case during course of attend here this susp. not a little conf.

For not only subj to cough, dysp. & pain of breast, but also to colliq. sweats & diarrhoea.

And with these such loss of strength as to give latterally towards latter period of at least most alarm app.

And although with Phthis symp others also as flatus, borborygm glob. hyster &e here connected, yet these to be consid only as adding to distress of patient

And as thus forming complic even more unfav. than Phthis itself.

Am therefore I own inclind to appreh. that in no long time will have fatal termin

But of this at least chance doubtful wheth shall be able to learn any thing.

For patient finding little benef. from remed pres. became averse to contin of them.

And at own desire dismissd from list

During course of attend is but in very few inst, that can here do any thing tow. radic cure.

With pres. pat. remed chiefly directed to allev of sympt.

With which view as have already obs. had indeed but little influ.

Which indeed will more fully app. from short review of pract. to which had recourse during attend.

When came under care sympt more immed distress to her than even pect compl. was looseness.

And as most ready means of obv. this thought of empl. opium.

But before use, imag. that might be of adv to exhib a gentle emet.

By this hoped, not only to unload [clean] stom, but also to unload lungs.

And indeed unless this prev. done some reason to fear bad affect from an artic tend to restr. free expect.

Here however situat of pat. such, that gentle emet only could be adv.

And as such directed grXV of Ipecac.

This as expected attended with affect of opr. gently

And probab. [had] some affect in aiding influ of theb pills on looseness.

At least as prev. matters from passing downwards by which might be encr. & supp.

But whether this case or not under use of these loosness consid mitig.

While this sympt however allev. others nothing relievd & some even augm.

Thus cough & pain of breast as distress as before.

Sweatings partic in morning rather encr.

And thirst to which formerly subj now so much aggrav as to be highly distress to her.

These last sympt while might be owing to prog. of disease was inclind to susp. might in part at least be augm by Opium.

For well known that while restr almost every other dich encr. that by surface.

Prob. from influ as dimin resist there.

And from cutic disch more than any other being influ by gener state of circul.

But whether in this way or not gener. fact estab. by daily obs.

Hence then but natur to susp. that might here oper. as cause encr. sweating.

While at same time no less ground to susp. that also augm thirst.

For this also in whatever mannr may be induced an affect also often arising from employm.

While however reason to think, that thus prod of inconv. not same urgent necess for cont. use.

Hence then directed empl to be om.

And in place of pills had here recourse to mixt. of Cicuta wih Peruv. Bark.

To this compos. have often recourse with scroph patients.

And to scroph sores consider those ulcerat in lungs, which are effect of tubercles, most nearly to app.

While in scroph. much mistaken if have not sometimes seen ulcer from use, obt dispos. to heal, am even inclind to think that in some inst of tuberc. Phthisis have seen benef from it.

On this ground then, thought at least of giving it chance in pres. case.

But besides this, here also recourse to it, with view of obv. urgent sympt.

These now most distress to patient cough & sweating.

As allaying first expected some benef from the Cicuta.

Which unquest. one of narcot vegetab possess consid sed. powers.

And which since introd [against] Pertussis empl. in allev. many other coughs with consid adv.

But while hoped that Cicuta might be attended with this affect expected also that Peruv. Bark some influ as restr. colliq sweats.

These, as already hinted in speak of opium, prob. often conseq of aton state of extreme vessels.

And hence natural to concl. that a med encr. tone tendency to restr. them.

But whether operates in this [manner] or not, that such an affect often deriv from Peruv Bark undeniable.

And expected that might be of some use in pres. inst.

These then reasons at least which led me to trial of this med.

But cannot say that intent answ.

At first indeed med seemd to sit easily on stom.

And if not prod was at least attend with good affect of app. being [somewh] mended.

But neither cough nor sweating allev.

While at same time subj to freq. returns of looseness.

From these circum led to conj with this med the use of repeatd Emet.

From which hoped for some allev. of cough as unload. breast & prevent of diarrhoea as unload stom.

In obv. operat of Emet were not disapp.

And at least not improb. that had some share, in prod allev both of cough & looseness which followed.

Emet however remed which could only be occas. repeated.

And pres. situat of pat. seemd to afford addit argum for persist in use of Peruv. Bark.[&] Cicut.

Hence interm vomits directed this alone to be repeated.

Although however cont in some respects easier yet obs. strength to be much dimin.

And now subj to freq. spont vomiting which disp to attrib to powders.

Although imag. that in this mist. yet an obj to persist in use.

And from this led to alterat of formul.

In place of Peruv. Bark therefor subst. Pulv. Cretac.

Which while served to give formula might also tend to restr. both vomit & looseness [and] destr. acid.

In this affect howevr were disap.

For at succeeding report though cough somewhat mod loosness rather encreased.

While at same time patient felt daily loss of strength an evid proof of progr of disease.

In this situat hardly perhaps surpr. that became desir of [interm] use of med.

And as had I own, little expect of being of any matter. benef. did not [more] contin.

And accord. dismissd from list