DEP/DUA/1/13/06 (Normalised version)

William Rollo

(1777)

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William Rollo.

Respecting disease of this patient little room for entertaining much doubt.

Yet cannot assert that affection simple or uncomplicated.

And if were to judge solely from symptoms introduced into history given by patient at admission might even be some room for hesitation respecting some of principle affects.

This particularly the case respecting difficulty of breathing.

Which as the first mentioned so also most urgent symptom of patient at time of admission.

Well known that difficult respiration may proceed from various causes.

And must own that on first view of case before us was disposed to ascribe it to a different cause from what afterwards concluded to be natural one.

Supposed this symptom immediately connected with following one

Pain of bowels viz with which patient affected

As this neither constant nor fixed to any particular place had little hesitation in adopting supposition of patient that was affect of flatulence

And imagined even that by distension of stomach & other parts of alimentary canal free motion of lungs might be impeded.

To this supposition however occurred as objective that no evident distension of abdomen.

And although without this flatulence may occasion pain, yet will not produce difficulty of breathing

But still stronger objection [illegible] [illegible] of difficult respiration.

While at same time symptoms from flatulence an occurrence only at intervals.

From these particulars led even on first consideration of case to look for some other cause of affection of breathing.

And on attentive perusal of case was I own disposed rather to connect it with another circumstance

Difficulty vizr of passing urine, which an examination of patient appeared to be merely affect of scanty secretion.

Well known that from want of due secretion there occurs tendency to deposit of serous fluid in different parts of body.

But perhaps more frequently than any other part in cavity of cellular membrane

And often [afforded] in cellular membrane of lungs as well as other parts.

Such a deposit therefore was disposed to adopt as more probable cause of permanent difficult respiration than the ascribing it to flatulence.

And indeed supposition of watery effusion soon after put beyond all doubt by occurrence of swelling of legs.

This in point of extent not inconsiderable.

And in nature of that soft inelastic kind bearing impression of finger, & without inflammation which can suppose to be only the effect of water.

On this idea then of case before us had no doubt in considering greater part of complaint to be a dropsical affection of anasarcic kind.

Could not however consider this as only affection to which was subjected.

And as already observed had little doubt in considering pain of bowels to be affect of flatulence.

Of which indeed relief from discharge of wind incontestable evidence.

Flatulence in this case conjected to be affect of weakened tone of alimentary canal.

And indeed to this supposition impaired state of appetite gave countenance.

Concluded also that this state of alimentary canal might even go farther

And that might have some share not indeed as inducing but as aggravating dropsical symptoms

For well known that anasarca affects sometimes even symptom of diseased state of bowels.

Could not however consider this to be case at present.

For difficulty of breathing had preceded pain of bowels for long time.

Was then upon whole disposed to view affection as conjunction of diseases in some respects unconnected with each other

A complication viz of a dropsical affection with a diseased state of alimentary canal.

On this supposition grounded both opinion respecting prognosis & plan of cure.

And must here observe that do not entertain most favourable opinion as to termination

At same time may consider this patient as for present, at least in some measure dismissed

Have had occasion to see him on different occasions since last visit here.

And find that while swelling of legs diminished, from medicine employed breathing also considerably relieved.

Has neither however got quit of one nor other.

And should he even be more free from both than at present yet would by no means look upon it as radically cured.

For well known that few affections more apt to return than those of dropsical nature

And with a man advanced to age of 60 still greater reason to dread this than at earlier periods of life.

These then grounds of suspecting why patient although at present relieved may yet fall victim to affection.

Or at least have return of symptoms giving very considerable uneasiness.

Must however at same time observe that is from dropsical affection am here disposed to dread most.

Complaint of alimentary canal even to much greater height, not dangerous.

Particularly when as in case before us, consists if not entirely at least principally of flatulence.

And in this instance have neither been of long standing nor to great height.

Viewed these therefore as of much less consequence than the other.

And hence it is that in as far as had opportunity of prosecuting practice in this respect was directed solely to dropsical affection.

In this case then consider great objective to be the evacuating water from cavity in which contained.

And, after taken up from these, then discharge it from system.

By this hoped to obtain removal of all consequences resulting from effused water

Particularly of difficulty of breathing, swellings etc

After affecting this should next be objective to take such measures as would prevent return

And from these might at same time hope for removal of flatulence.

And consequently for prevention of frequent returns of pain of bowels.

This plan indeed have not had opportunity of following out in manner that could have wished.

As far however as remedy were here completed was on principles now mentioned that operation to be explained.

Began practice with this patient by ordering an emetic.

Than which perhaps few remedies more useful in dropsical affections.

Particularly in cases of anasarca which have not been of very long standing.

Properly speaking Emetics can hardly of themselves be reckoned evacuants of water.

Are however a powerful means of promoting absorption.

And from this circumstance give opportunity for discharge by various [illegible].

But have still farther affect of producing tendency to evacuate in different ways. Especially by surface

On these different grounds then appeared well adapted to present case.

Cannot however say that reaped much obvious benefit from use.

Probably in consequence of having operated but slightly

And this again proceeding from having been exhibited in rather too sparing a dose.

While disappointed in affects of emetic not more successful with another medicine, which at same time directed to be used after the Emetic

That was use of Squill pills.

Hoped that after absorption promoted by Emetic these might serve to discharge water by kidney.

And at same time that might obviate difficulty in passing urine.

For consider this to be merely the affect of scarcity

Was in no degree however attended with desired affects.

And symptom in place of being alleviated was very evidently augmented.

Still however hoped for relief from same remedy.

But as in former dose had no affect now ordered to be exhibited in double quantity that had done formerly.

And in place of emetic directed use of repeated purgative.

To this in some measure led from having been before disappointed in operation of Emetic.

But still more when consider uncertainty of diuretic as evacuant & evident increase of symptoms.

Wished therefore to employ a medicine in operation of which should not be disappointed.

And with this intention had recourse to the infusion Tamarind cum Senna.

A medicine which while more immediately operates by stool has also often very considerable affects as increasing quantity of urine.

Which indeed not surprising when consider proportion of Cream of Tartar which it contains.

In this affect however were disappointed.

And had not even so much influence in moving belly as could have wished.

Yet from this evident good consequences.

For swelling diminished, breathing relieved & cough mitigated.

Yet while urine still continues scanty, had little grounds to hope for permanent relief.

In this situation could not think of pushing evacuation to very great height, with a patient so far advanced in life.

At same time thought that still farther means to be used with view of promoting discharge of urine.

And was with this intention, that with continuation of squill pills directed use of Cream of Tartar conjoined to the Cinnamon as an aromatic

From time that this medicine ordered have not seen patient.

Learned however that has had more affect as increasing urine than any before employed.

And although has now given up use still continues tolerably easy.

While this the case shall probably see nothing farther of him here.

Hence reckon it unnecessary to say anything of future plans at present.

Although as already observed am far from considering him as radically cured.