DEP/DUA/1/20/15 (Normalised version)

Duncan Ogilvy

(1779)

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Duncan Ogilvy.

With regard to disease of this patient am very much at a loss.

Consists of various & in some measure at least evidently unconnected symptoms.

Yet greater part & most distressing of these not obvious.

May arise from various causes.

And in circumstances of the case can discover nothing from which certain or even probable opinion as to nature of cause.

What is represented to us as principle & most distressing affection is pain of abdomen.

Of this has attacks continually with great severity for several days together without intermission.

After this interval of case for [illegible] equal length of time.

From such remission & exacerbation some presumption at least that no fixed cause.

And to this the rather led from pains somewhat of similar nature attacking other parts.

Has attacks also in back, sometimes low down, sometimes as high as Scalp

While these attacks occur as objection against local affection are at same time arguments also against supposition of worms.

A cause long & indeed naturally [suspected] as giving origin to pain of abdomen.

Now however besides circumstances mentioned several other objections to it.

Particularly length of time for which has continued without any worms having been ever observed to be discharged.

State of appetite during whole course which never [variation] but uniformly bad.

And absence of every other symptom of worms.

But here much more easy to say what is not cause of pain than to conject what really is.

Pains of such severity as those in present case are represented to be & shifting place in such manner after continuation of several days are perhaps more frequently of Rheumatic kind than of any other.

And among other suppositions that may here be entertained.

Did not proceed from exposure to cold or any other of causes by which Rheumatism in general [obviously] induced.

But to this also many objections occur

Age & constitution of patient by no means that with which Rheumatism a frequent disease

Has at no time been attended with that fever which known to be concomitant of Rheumatism.

And has never attacked those parts of body in which Rheumatism most frequently seated.

From all these particulars then this supposition also rendered improbable.

Yet would not say that certainly refuted.

And cannot offer any conjecture which seems to me to be more probable.

May observe that when first took this patient under care, was in hopes that some future occurrence might serve to explain nature of this [observable] affection.

No circumstance of this nature however has yet occurred.

And still at as great loss with regard to this part of affection as when first began

Hence, unless in as far as have attempted to counteract it by keeping belly gently open have as yet taken no measures with regard to it.

Same also may be observed with respect to affection of Eye.

Are informed that at times, particularly in morning, is affected with dimness of sight in right eye.

And this complaint seems to be accompanied with at least some degree of obvious morbid affection in that organ.

Pupil observed in more contracted state than that of other eye.

This may proceed from different nay very opposite causes.

Well known that is frequently the effect of morbid sensibility.

Or at least if preternatural contraction not often remarked from this cause very frequently see morbid dilation from want of sensibility

Equally manifest in cases of Cataract & of Amaurosis.

But if contraction sometimes from peculiar sensibility so in other cases often to morbid degree, from want of due [illegible] to motion.

That [illegible] & Iris may [possess] those motions which requisite to distinct vision a peculiar degree of mobility in muscular fibres is requisite.

And when this wanting, as is often consequence of inflammation particularly when extended to interior parts of Eye, not unfrequently in preternaturally contracted state

To this cause then, not to degree of sensibility would ascribe contraction of pupil in present instance as well as [indistinct] vision with which is attended.

This then may without hesitation view as being totally unconnected with other part of complaint.

And in as far as admits of cure requires very different treatment.

But besides these complaints patient subjected also to another still more obvious than last.

And if not equally distressing as first yet perhaps not less dangerous.

That is ulceration on left side of thorax.

This ulceration we are informed has now continued for more than space of year.

And although referred to an external injury yet from appearance as well as from long continuation great reason to suspect that is of scrofulous nature.

From this view then of different parts of affection prognosis in as far at least as can be given with any degree of confidence can be by no means favourable.

From great uncertainty respecting affection of abdomen are precluded from giving any judgement whatever of that part of disease

Yet although neither constant nor fixed to any particular place, long continuation as well as severity of this part of affection gives some grounds for alarm.

While at same time must be observed that since patient came under our care those attacks not so frequent. of shorter duration & less severe than before.

Hence although not without apprehension yet some hopes that even without artificial means may have favourable [conclusion].

And hardly to be expected that will remain for long time without changes in one way or another.

Same opinion can by no means be given with respect to disease of eye.

Hence while little doubt as to nature of affection must acknowledge that am acquainted with no probable measures for removal.

Without occurrence of fresh inflammation however do not think that any [reason] to dread its being suddenly aggravated.

And may continue in present situation even for whole remainder of life without giving great unease or being product of much inconvenience.

At present must own that am more apprehensive of danger from affection of side than from any other particular.

Whether sore scrofulous or not great reason I think to apprehend affection of bones of chest.

Cannot therefore expect expedient recovery.

And if shall make way internally into cavity of chest may soon prove fatal.

Nor is this the only footing on which patient may be cut off by it.

Still more probable that may terminate in death from supervening hectic fever.

And when consider exhausted appearance of patient, together with state of pulse which never below 130 in minute to this there already seems to be considerable advantage

Must however at same time be allowed that scrofula sores, even when bones below are affected often do heal contrary to all expectations.

Not therefore to be considered as very [illegible] if patient entirely recovered from this part of affection.

At same time cannot be expected while continues under our care.

And indeed had we the prospect of treating case for longer time at this place know no measures from which can hope to be of much benefit.

Do not see on what principle can [propose] rational plan of cure with any probability of success.

Since this patient came under our care only measures taken intended chiefly with view to affection of side

On supposition that this affection of scrofula nature, imagined that some benefits might be expected from Salt Polychrest

This need not observe is a saline matter nearly at least similar to what basis of some mineral waters most celebrated against scrofula.

And not very different from some of other [salts] as for example Salt Soda & like which have at different times had high reputation in this affection.

While Salt Polychrest also by some highly extolled imagined that in present case might be used with safety, if not with advantage.

Gave it preference in this case to Salt Soda, both as better acquainted with it, & as, at least as far as my observation with regard to [Soda] extends, has more effect in moving belly.

From this hoped that some alleviation might be obtained of pain in abdomen

Or at least wished to see whether would not be product of this affect.

Since began this medicine can at least say, that affection not increased.

Medicine used has had some, although not great effect in moving belly.

And although ulceration of thorax which considered as most dangerous part of disease & that against which affect chiefly intended much in same state as before, yet pains of abdomen have been less distressing.

[Probably] from more frequent motions of belly.

Can hardly however I think expect that from continuation of this course is to be removed.

And, as little prospect that shall obtain any farther light into nature of affection, see no purpose to be gained by longer continuation or by alteration of plan.

Unless therefore from some unexpected occurrence, is intention soon to dismiss this patient, recommending the use of Sea Bathing & drinking sea water.

From which some hopes at least of combating Scrofula.