DEP/DUA/1/42/43 (Transcript version)

Archibald McPhail

(1787-1788)

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Archd McPhail at 50

When spoke of case of this pat at time of admiss. expressd doubts with regard to it.

Obs. that diff supp. might be entert with regard to it.

But cheif diff was whether to view it as being merely a catarrh affect or an ex. of Hydroth.

Must indeed be admitted that had never all ordin charact of that disease.

But well known that Hydroth an affect often occurring where even less markd than in pres. inst.

Since came under our care no circum has taken place either to confirm or refute former conj.

Still therefore contin in same state uncert. as before.

But whatever affect may have been, now at least consid easier.

And this I think, have prob. ground to concl. has been affect of med empl.

On either suppos respect disease, thought some adv. might be obt from a gentle laxative & diur.

Was with this intent that at first directed Powder of Crem of Tart, in which well known that both these powers are comb.

This taken to extent a tea spoon twice a day.

To this quant had effect of gently moving belly.

And at same time some relief of Dysp.

Thus far then app. good effect.

But not obs. to have any influ in encr. quant of urine.

And with compl. so urgent wishd to try some more active med.

As such had here recourse to pills of Digital.

Digit Purpur. or Fox Glove long held to be active & even deliter. veg

Belongs to tribe of Solan. or Luridae. compreh. most of veget poisons.

And indeed cont. very few artic which are not of active nature.

This as well as many others long in some degree empl.

But although entered Pharm of diff colleges till of late but little in use.

And within these few years has been empl for purp. very diff. from those for which before used.

I mean for oper as diuret.

First remark case with which I am acq. a patient lab. under distinct markd Hydroth treated by Dr [Wilkin] of Birming & Dr Darwin of Derby.

And to latter former of these gentleman are partic indebted for know. we have acq. of its use.

Has pub. a treat profess. on subj cont. many import cases & many useful obs.

Since that use in Brit has been very common.

And while sometimes prod of aston good effects, in others accused of having done much mischief.

Must indeed be allowed that when overdosed very viol in operat.

Exciting not only sickness at stom but vomiting also very diff. allayd.

Must also be allowed that these effects sometimes occur unexpected.

Either from very slight encr of dose or even from contin of dose to which patient subj had before taken without any inconv.

Prob. depend on state of stom at time.

From this circum with some pract very strong prejud to use.

For my own part however, though have sometimes seen vomiting & sickness from use, yet have never met with any affect in this way in any degree alarm.

While at the same time have [often] seen it prove very useful & powerful diuret.

Am convinced that for obt effect in this way, not necess to push it to such extent, as to excite vomit or even sickness.

On contrary that by occur of [these] freq. disapp of succeeding diur.

Not even necess. to employ it in such manner as to have much affect on pulse.

For may obs. that in this way has remark influ as rend circulat slower.

And indeed know no med, belong to tribe of sedat. which has even equal effect in that way.

In so much that from 70 obs to fall to fifty & even under.

For avoid these conseq. partic sickness & vomit. is best exhib in small doses & in subst.

As thus acts more grad on stomach & better chance of being introd into syst.

On these acct in my own pract. pref much pills formd of dry powder to comm form of infus.

And under formul of pills seld exhib it to greater extent than single grain.

Must be allowed that uncert in oper. as well as other diuret.

And effect not always immed.

Yet from some contin of use more than by encr. dose end in view will often be obt.

This app. to have been much case in pres inst.

For during course of first week no obvious diures. app.

And as no obv influ either in prod sickness at stom or vomiting might have been thought that should have ventured on encr of dose.

But in affect of patient at this time nothing remark urgent.

For although still consid dyspn. & irregul [of] pulse yet less necess. to rise to erect post during night.

Imagind even that in this situat might omit powder of Crem of Tart.

To which some obj occurred both as carrying more quickly through intest canal. & might render it in some degree uncert if diur ensued whether entirely effect of digit.

Directed therefore contin of Digit alone & to extent only of gr as before.

In expected diuret effect were not disapp.

For at succeeding report found disch of urine very consid augm

And at same time affect of [breath] much relievd.

Now indeed compl of consid sickness at stomach.

But encour by relief obt. this did not prev me from persist in use of digit.

Nor did I even interm use, from being informed at succeeding report that during course of week had been repeatedly affected even with vom

Trusted that this merely accident & would soon abate.

And this confirmd by subseq report

For has since that gone on for sever weeks with same dose of digital, without any inconv. whatev

And while supports encr disch of urine sympt have now for a consid period contin unif [easier]

Unless therefore some change takes place, shall reckon farther contin unnecess.

Upon whole though cannot as have already said make any pos. assert respecting this case, yet at least some prob. that affords ex of Hydrothor. in which Digital empl with advant.

And have at least seen that from this artic diuret effect may be obt without any inconv. to patient.