DEP/DUA/1/17/16 (Normalised version)

George Allen

(1778)

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In former part of course have considered at some length most remarkable cases occurring at the Dispensary.

And which on account of importance or singularity had selected as subject of lectures [here]

Of these selected however as many yet remain to be considered as might be subject of several lectures.

Time however which had allotted for this summer course now draws toward conclusion.

Without therefore entering into those inquiries either respecting History. Theory or Practice which might naturally be suggested shall bestow present lecture in giving you in few words [my] sentiments & views of each.

In case of George Allen next patient in order have evident marks of Ascites.

This could not consider as demonstrated by swelling of belly alone.

But when that swelling with flatulence can be no doubt of dependency on water

Other symptoms occurring in case also particularly Cough & Dyspnoea almost constant attendants of that affection.

And probably both to be considered as consequence of distension of abdomen preventing free motion of diaphragm.

With these appearances however, some other particulars, [instances] at least in common to every ascites.

Urine we are told discharged in natural quantity.

And as far as can learn no morbid change in appearance.

Swelling of abdomen with peculiar local hardness & fixed pain.

From these two particulars taken together then may conclude that augmented effusion here not consequence of any morbid condition of secretion of urine but that proceeds from scirrhous giving obstruction.

And this scirrhous can have little doubt in considering to be consequence of intermittent.

A cause perhaps more frequently than any other giving rise to such affections of abdominal viscera but particularly of liver.

And in case before us from situation of tumour presumption that local affection is disease of liver.

This then then brief view of opinion respecting disease of present patient.

And from this view can by no means form a favourable prognosis.

Might indeed by discharge of water produce temporary removal of ascites.

And by this means afford no inconsiderable relief to patient.

Yet recovery at utmost but temporary.

And radical cure or even permanent relief to be expected only from removal of scirrhous.

This however an end which but very rarely obtained.

And in many cases nature probably [such] as to be totally unattainable.

With such idea of nature of complaint then could not expect much benefit from remedy commonly employed.

And was led to select this case [illegible] with view of trying practice which in this country at least not frequently in use.

Was intention to have pushed to some extent with this patient the employment of Tincture Melampodium & Electricity.

The black Hellebore or Melampodii much employed as purgative by most ancient practitioners.

Use with same intention lately [revived] in France by Mr Bacher

And is basis of what he calls his Pill Tonicae.

A remedy which while operates as powerful evacuant at same time said to have effect of bracing system.

And by these means said to be a most efficacious remedy in dropsical cases.

With this remedy here proposed to conjoin electricity.

As from some late facts great reason to conclude that is powerful means of removing scirrhous.

Probably from operating as penetrating stimulant

And thus having tendency to renew circulation.

But besides this am led also to consider it as means of promoting absorption.

Was in these grounds then that looked on medicine here directed as deserving trial.

[Could] only however expect advantage from trial for some length of time.

But from this entirely precluded in consequence of patient discontinuing attendance soon after he came under our care.