DEP/DUA/1/12/02 (Normalised version)

Robert Anderson

(1776-1777)

---

Another patient whom may consider as dismissed Robert Anderson.

At least have seen or heard nothing of him for some weeks past.

If however complaint removed cannot consider it as consequence of any treatment under our care

For by us very little done.

And I own from view of his case should not be inclined to consider it as trifling.

From account of his complaint indeed no evident marks of great severity.

Yet had much appearance of complete affection

Most urgent part, pains of shoulder & side

From situation presume that these of rheumatic kind.

Corroborated by being observed to be aggravated by heat of bed

And by cause from which probably induced viz sleeping in a cold damp room.

To this rheumatic affection are perhaps also to refer difficulty of breathing.

For by enlargement of chest parts here disease in some measure affected.

And this supposition as to cause rendered probable by difficulty of breathing being aggravated on motion.

And by occurring chiefly when patient lies on affected side

Contrary of which in general holds in Phthisis.

For there patient can breathe only when lies on side affected.

Must however observe that another circumstance to which probably likewise that present affection may be referred.

Patient for considerable time affected with swelling of leg towards evening.

But again disappears during night.

From this alone strong presumption that of anasarcic kind.

And although no other indication of hydrothorax gives reason at least to suspect some effusion of water in breast.

Whether however effused water any concern in difficulty of breathing or not, no question that as appearing under form of swelling in legs constitutes part of patients disease.

And when attend to other circumstances perhaps to be viewed as not least important part.

For although urine not scanty, yet such change of colour observed as indicates tendency to that state.

And conjoined with swelling of legs may be considered as giving evident marks of incipient Anasarca.

An affection probably originating from same cause as other.

But while unconnected with it requires very different treatment.

Thus far then have I apprehended evidence of different diseases

Must farther observe that consider it as not impossible might at same time be subjected to an affection more dangerous than either.

viz Phthisis pulmonalis.

Of incipient state of this cough, pain of side & difficulty of breathing are most common symptoms

And all there in instance before us.

Although therefore consider it as most probable that to be explained on principles mentioned.

Yet when consider lurking nature of this disease cannot be very positive.

From all circumstances taken together then should I own have been very doubtful respecting prognosis here.

Yet from patients so soon leaving us some reason to imagine that apprehension groundless

Particularly when attend to relief which expressed his having received from first prescription

In state of uncertainty regarding disease was at first contented with ordering application of blister to side.

This consider as in some measure adapted both for rheumatic affection & cough.

And on supposition that difficulty breathing affection of water might also be serviceable in alleviating it.

On whatever grounds operated would appear that in this expectation not disappointed.

For after free discharge these symptoms almost entirely removed.

Still however subjected to oedematous swellings of legs.

By this determined to keep blister open & to order an emetic.

What however affect of these measures or future state of patient have had no opportunity of learning.