DEP/DUA/1/19/19 (Normalised version)

Robert Davie

(1778-1779)

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Robert Davie

With respect to case of this patient must own have been by no means without difficulty.

And although since came under care greatest part of symptoms have disappeared yet still nearly as much at loss as ever with respect to affection

From Dyspnoea to which subjected conjoined with swelling of belly & legs some grounds for suspicion of Dropsy.

And even from latter of these symptoms alone could be no doubt that this affection had at least to certain degree occurred.

Yet when consider that swelling of belly without fluctuation, can be by no means certain that proceeded from water

While at same time Dyspnoea may be induced from any cause giving distension of abdomen & thus preventing free motion of Diaphragm.

But though want of fluctuation may [greatly] doubt as to existence of water yet do not consider this circumstance as by any means essential to existence of water.

For although water presently fluctuating may be prevented from different circumstances.

Particularly from dropsy being of [encysted] kind, from viscidity of watery fluid, or from great degree of tension of belly.

From any one of these circumstances then want of fluctuation here may be supposed to have proceeded.

Yet left at least greater room for suspicion that might have arisen from some other cause.

And to this suspicion the rather led from want of some other symptoms commonly occurring in dropsy.

Though patient complains of considerable thirst yet no affection of urine.

A circumstance which particularly after dropsy of any continuation is but very rarely wanting.

State of discharge by belly also by no means that which usually occurs in dropsy.

For in place of bound belly had here very considerable degree of looseness.

And that even to such extent as to constitute what might be considered as a separate disease

Especially when conjoined with other symptoms particularly severe headache to which patient subjected.

With diseases of alimentary canal this affection often combined.

And was here disposed to consider headache as being of this symptomatic kind.

Had even some suspicion that on diseased & debilitated state of intestines swelling might in great measure depend.

For well known that when intestines [much] debilitated very liable to distension from extrication of flatus which otherwise would have no such affect.

Yet at same time while had evidence of some dropsical affection in swelling of legs, could not help considering as having at least share in swelling of belly.

And upon whole was disposed to consider case as being of complicated nature.

As consisting viz of conjunction of Dropsical symptoms with affection of intestinal canal.

And these occurring rather as separate & distinct affections than as being dependent on each other.

In this state of uncertainty however was necessarily doubtful with regard to prognosis.

Yet no part of affection could be considered as of trifling nature.

And from length of time for which both [illegible] of symptoms had already continued could not reasonably expect very speedy recovery.

While at same time from difficulty with regard to affection, much at a loss to conject on what grounds would in end be most readily obtained.

Here began practice by directing for our patient the use of repeated Emetics.

And these I imagined might be attended with some benefits both as tending to removal of dropsical complaint & as counteracting affection of alimentary canal.

Well known that in both affections very frequently employed in practice.

In first acting as promoting absorption

In last as removing sordes from stomach & as giving determination to surface.

In neither way however did benefits resulting from repeated emetics seem to be either immediate or considerable in present case.

For although headache alleviated yet swelling of belly & looseness continued as before

In this situation wished at least to try how far a good effect would be derived from an astringent medicine employed with view of restraining looseness & of bracing intestinal canal.

Was with this intention that had [recourse] to simple infusion of the succus japonica.

And in order somewhat to aid it in expulsion of flatulence directed as a gentle Carminative addition of some proportion of simple Cinnamon Water

Under this medicine both looseness & [swelling] of belly diminished.

Remained still free from return of headache & was no longer subjected to Dyspnoea

After had persisted however in use for some time progress to recovery did not seem to be equally rapid.

And while some degree of looseness still continued a new affection [superseded].

Eruption viz of pustules terminating in suppuration on different parts of body.

This affection however am hopeful may be but of short continuation.

And am even disposed to think that will not require medical treatment.

But under this appearance had some doubts respecting propriety of continuing astringent.

For in consequence of promoting discharge by belly had reason to hope that would be diminished or at least prevented from arising to any great height

For these reasons to succus japonica have here substituted the Rhubarb.

From which expected good effects both as increasing tone, & likewise in some [degree] as evacuant.

The Rhubarb here both to give proper formula, & to promote tendency to looseness have combined with a small proportion of Magnesium.

And hope that under this medicine complaint may be soon so far alleviated that farther attendance will be unnecessary.