DEP/DUA/1/21/09 (Normalised version)

Thomas Mill

(1779-1780)

---

Thomas Mill.

Case of this patient after but short time under care had fatal termination.

And as had not opportunity of examining body after death cannot speak of disease with that certainty which might [otherwise]

With regard however to some parts of it no room for doubt.

From Oedema swellings of legs & thighs had unquestionable evidence of water in cellular membrane.

While swelling of abdomen with fluids could leave no room for doubt that water in cavity

Perhaps also may add presumption of existence in cavity of chest

For of this some evidence from cough & dyspnoea.

Not indeed it is true affected with all the symptoms considered as characterising Hydrothorax Pectoral.

And particularly no striking irregularity observed in pulse

Nor as far as could ever learn was he affected with sudden starting from sleep.

But though these commonly considered as characteristic symptoms of Hydrothorax yet by no means essential.

And have known many instances where considerable collection of water in chest on dissection without these.

But if thus presumption of water in breast must also be allowed that same symptoms without it.

And particularly in anasarca cases [where] affection general, & extends to lungs.

For cellular membrane of these also as well as other parts, not unfrequently filled with watery effusion.

But to whichever to be attributed no doubt that patient dropsical to very considerable extent

Still however a question whether morbid deposit of water to be reckoned even principle [disease].

For probable that still more [material] morbid state in cause from which this arose.

Here to be observed that although no evidence of any particular local disease yet commencement marked with very peculiar circumstance

Was attributed & probably with justice to a particular accident.

Or at least this accident followed by a very alarming consequence.

For immediately after profuse discharge of blood by anus.

That this haemorrhage of passive kind & effect of rupture, could admit of no doubt

And may presume that arose from rupture of some blood vessels of alimentary canal

But in what manner afterwards induced dropsy a more difficult probability.

This it is known sometimes a consequence of haemorrhage alone.

Here however was not to that extent which could lead us to suspect it from that source.

And that some local affection of intestinal canal induced at least probable from other symptoms.

Particularly from tenesmus, with which from commencement of affection, patient [uniformly] distressed.

But here there did not occur that bound state of belly giving evidence of stricture or scirrhous.

These indeed, particularly latter a circumstance which if induced might readily suspect to be cause of dropsy.

But could easily conceive haemorrhage & subsequent tenesmus from accident by no means fit to induce it

Among other causes of dropsy [pathologists] have enumerated a rupture of Lymph Vessels.

And may here at least be started as query whether a cause capable of rupturing blood vessel might not also have similar affect on these.

But to this, although a possible cause one circumstance occurring as an objection.

Would naturally have expected that should have produced only partial dropsy or at utmost either anasarca or ascites by itself

In present instance however this affect very general

And although rupture should have taken place, can hardly imagine that would have so far affected action of others, as to prevent effused water from being again taken up.

Upon whole then from general extent of affection inclined to think that diminishment of absorption concerned in [production].

But how this connected with accident, & subsequent haemorrhage, or whether in any degree connected with it a matter of doubt.

Yet still when consider violence of accident & obvious effects together with period at which dropsical affection commenced probability of connection.

And on this view was led from time that patient came under care to consider disease as more dangerous.

Was also an unfavourable circumstance, that before came under our care had been treated by other practitioners without affect.

Or at least although water for time removed yet soon again returned.

Well known that in dropsy much less difficulty in evacuation of water than prevention of return.

From all these circumstances then did not imagine that should have [illegible] of recovering present patient from complaint.

Yet hoped that might afford opportunity for trying effect of different remedies.

And was I own a good deal contrary to opinion I had formed that died so suddenly

By this means little or rather no opportunity afforded us for any trial.

Here however directed & even began a practice which have not employed in any former instance

In dropsical affections in general first objective must unquestionably be discharge of water already effused.

For on this all distressing symptoms immediately depend.

And till removal, measures directed with view to carrying off cause, cannot be supposed to have much effect

Whether discharge however affected by artificial or natural outlets is still an objective to increase vigour so as to prevent [tendency] fresh effusion.

This however so far from being consequence of greater part of measures [tending] to produce evacuation that have even opposite affect.

And long [desirable] to produce effective evacuation of water, by means which have least tendency to debility.

For this purpose emetics, purgatives, & diuretics have each been recommended.

But greater part of practitioners disposed to think that least debilitating influence from latter.

To these however uncertainty of operation & in most instances slowness of evacuation, occur as an objection.

And of late imagine that similar if not greater advantage to be derived from employment of sudorifics.

This in particular frequent practice in [hospital] by my worthy friend Dr Home & often with very singular success.

But with lower class of people, unless in an hospital from situation of lodging & beds no sufficient convenience for sweating.

Besides, with this patient, had before been tried without desired effect.

From this circumstance then naturally led to think of some other practice.

And imagine that might not be an improper instance for trial of a medicine of late much celebrated in France

This medicine particularly extolled as conjoins two purposes mentioned above.

For asserted that while evacuates water at same time augments strength of system.

Has Mr Bacher [invented] has given them name of Pill [Tonicae]

Active basis of this medicine an article much celebrated among more [art.] practitioners.

viz the Black Hellebore.

By them used in great variety of cases particularly in Mania affections

And with obvious effect of operating as very strong cathartic

But as well as many other drastic medicines was in great measure rejected from modern practice.

Or at least used only in small quantity and as acted upon by [spirit] [illegible]

And then not employed as purgative but chiefly as deobstruent in cases of Amenorrhea

This article however in form of Vinous extract is basis of Tonicae pills of Bacher.

And in order to form mass is combined with Myrrh & powder of Carduus Benedictus articles on which can suppose very little efficacy in this case at least to depend.

For particular account may refer you to observations in [Mil]. Hospital collected & published by Mr Ricard by order of French Government.

Will find also short analysis of this account in 2d Volume of Medical Commentaries.

Obvious operation that of inducing copious discharge both by stool & urine.

And for this purpose have been given to extent of thirty pills each of 2 grains for dose

These however not to be taken at once but to extent of 6. 8. or 10 at time & if no remarkable operation repeated at intervals of an hour.

In this manner said to produce cure even where symptoms portended greatest danger.

And in work mention besides testimony of Mr Bacher & Mr Ricard those also of several other practitioners mentioned.

Have indeed been informed that with some other of French practitioners use not attend with equal success.

And from use of other preparations of [illegible] which had myself tried on this authority had not been able to observe any remarkable effects

Yet wished to be able to form judgement of this remedy from experience & from trial of the pills as prepared by Mr Bacher himself.

Till of late however have not been able to procure them

And present first instance in which employed them

As case a very bad one was resolved to begin with great caution

And for this purpose began with directing only a single pill for dose

Even this according to account of patient some effect in producing looseness.

But without any considerable discharge of water either by stool or urine.

And that too although diluents liberally enjoined.

For to be observed as peculiarity with this medicine that patients directed to use [liquor] very copiously.

As single pill thus ineffective after some trial doubled dose.

And in this way patient continued to take them for some days but without more effect than before.

But in short time after, his coldness faintness & Dyspnoea increased disease had fatal termination.

Upon whole then consider this medicine in present instance as having had no effect either in aggravating or alleviating symptoms

And from this case can conclude nothing either for or against this medicine, judgement of which must be formed by future trials