DEP/DUA/1/21/12 (Normalised version)

William Campbell

(1779-1780)

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William Campbell.

With regard to no part of disease of this patient much room for doubt.

Yet case by no means of simple nature

And not impossible even that greater complications than obvious.

Or at least that some parts of affection extend farther than should infer merely from appearance.

Most obvious and at present most distressing complaint is what arises from [water]

And this evidently [effused] in cellular membrane rather than in any particular cavity.

Can therefore have no doubt in bestowing upon it name of Anasarca.

Although to considerable extent yet of such standing only that may be considered in incipient state.

And notwithstanding great affection both of legs & scrotum yet when came under care had not extended very far in system.

Abdomen indeed manifestly swelled.

But not to such degree as to give any difficulty of breathing

And from freedom of respiration had reason to conclude that anasarca had not extended to lungs.

While at same time neither in appearance nor state of upper part of body any indication of it there.

Here also with respect to this part of complaint another circumstance in favour of patient.

Though more than ordinary degree of thirst yet urine continues free.

Thus not only less chance that swelling would increase but opportunity even for more safe & speedy removal.

If these however favourable circumstances with regard to this part of disease some others of contrary nature.

And particularly previous constitution of patient before commencement of any hydropsy symptoms.

Now appears manifestly affected with scrofula.

And this affection we are informed in history beginning at very early period of life has already continued for 10 years

Occurs therefore as question of some importance whether now to look upon dropsy as a consequence from that cause.

That from glandular swellings, dropsy in different forms does arise, cannot be matter of doubt.

And should as naturally suppose this effect of induration & tumour of Lymph glands as of any other.

For by this means progress of fluid through lymph vessels most effectively retarded & diminished.

Notwithstanding this however must be admitted that from Scrofula dropsy not frequent consequence.

And in present case no particular glandular swellings to which can attribute it

Besides this disease in most general form & as appears in legs collected from cellular membrane in every part of system.

But independent of glandular swellings scrofula may here be supposed to induce dropsy in another way.

Well known that dropsy in form of anasarca frequently consequence of obstruction or diminution of accustomed discharge.

And with present patient after being subjected to very considerable runnings for space of near 10 years discharge now almost stopped.

From this then not improbable that dropsy has arisen.

If however in any way connected with scrofula as cause, may conclude that shall find it obstinate.

And even on supposition that totally unconnected yet from occurring in such habits reason to apprehend that will be more obstinate than should otherwise suspect.

From these circumstances then cannot here look upon dropsical affection as of little importance or free from danger

And although successful in evacuating water yet not free from danger of return

Would hope however, that may be able if not radically to remove disease at least to keep it [moderate].

And if could employ any measure successfully combating Scrofula, might in the end be overcome

Of this however am afraid can have very little expectation, unless from operation of system itself.

By this means it is true, recovery as age advances not unfrequently brought about.

And may even be aided by some measures.

If therefore present case does not afford example of efficacy, may at least give opportunity of trial.

But in treatment first objective to be aimed at the evacuation of water.

This in such a case in particular should attempt to accomplish by those means which have least tendency to debility.

And such the less necessary as no dyspnoea or any other very urgent symptoms requiring immediate discharge.

From these circumstances then determined to use of Cream of Tartar & that too in but small doses.

Of late this substance very much used in dropsical complaints

When wish for brisk cathartics few answer the purpose better.

Especially if operation quickened by small addition of Jalap. [illegible] Gamboge or like

When thus exhibited not only operates without exciting thirst, but has tendency even to abate it.

And while produces discharge of [water] by intestinal canal has also powerful influence on producing same affect as augmenting urination

This consequence of copious diuresis often successfully obtained when given to inferior [quantity]

And was with this intention that employed in present case

As did not wish for anything farther than at utmost slight catharsis here added nothing to quicken operation.

Small addition of Cinnamon meant merely as corrigent that might sit more easily on stomach

And as acting on this viscera no [illegible] observed to result from it.

While at same time discharge by urine considerably augmented

Under this operation swellings already very much abated.

And am hopeful that no farther measures will be requisite for entire removal

If this effected, will be next objective as far at least as we can, to prevent [retention], & to remove Scrofula.

For this purpose have some thoughts of putting this patient as have suggested in last case on course of Emetics.

[Replayed] dose at interval of 8 or 10 days

These of late by some practitioners much extolled in Scrofula.

And from efficacy in other glandular tumours am inclined to think not without foundation.

Well known often successful in [removal] of swelled testicles.

Here the rather [induced] to use as while tends to combat scrofula may prevent return of dropsy.

For few means more powerful as increasing action of absorbency.

But while prosecute this course shall endeavour also to strengthen tone of system.

And for this purpose mean to employ Peruvian Bark.

If these measures unsuccessful what others will be adopted must be determined by state of complaint at the time.