DEP/DUA/1/22/09 (Normalised version)

Alexander Ogillvie

(1779-1780)

---

Alexander Ogillvie

Affected with several different symptoms some of which in all probability no connection with others.

Some parts of disease pectoral complaint [very] sufficiently [common] & with regard to which no [room] for doubt

Others however with regard to which have very great difficulty.

And that too principal & most important part of disease affection viz of foot & leg.

Here must acknowledge that equally at loss with regard both to proper name & nature of affection.

From general appearance would reasonably expect to find it either under head of tumores or of intumesentia

But by no means corresponds to definition of any genus referred to these heads by any nosologist¹ whose writing I have examined

Would not however from this circumstance represent it as an affection which have never before met with.

Have oftener than once seen similar instances where affection sometimes in one sometimes in both legs.

To these some Surgeons & these too of great eminence & most accurate observation give name of Elephantiasis.

This particular, denomination employed by a Gentleman of this place who some years ago delivered lectures on Surgery.

And would not deny that perhaps with greater propriety referred to that genus than to any other.

Yet [certainly] does not correspond to general definition of nosologists.

And elephantiasis in some of species affords example of very different affection.

Particularly that so prevalent in some parts of India.

And as that disease justly considered as elephantiasis [legittima], would seem improper to give same appellation to any other affection which in all probability nothing of same nature.

Of much less consequence however to determine name than nature.

And giving it merely general appellation of swelling of legs more useful inquiry here to determine nature.

For on knowledge of this cure, in as far as can be [conducted] on rational principles must proceed.

Here manifest enlargement which takes place can proceed only from one of two causes.

Either from morbid deposit of fluids or from preternatural increase of solids.

Of these two first by much most common

And may produce affection in many different ways.

Deposit may consist either of blood, water or other fluids of different kinds.

And these may either be contained in vessel or cavity natural to them, or preternatural.

From one or other of these causes great diversity of enlargement.

And as this cause most common gives some presumption that may operate in present case.

Farther probability from account given of origin of affection.

For according to representation did not commence in present form.

And at beginning progression of affection more rapid than should have expected of increase of solids.

Although however affection of solids more rare yet not to be represented as never occurring.

Has happened not only of softer solids particularly from [accretion] of cellular membrane but sometimes even of hardest.

Thus swelling of limb from preternatural enlargement of bone.

Circumstances then of less frequency, not even grounds of strong presumption.

Nor on other hand can we [rest] much on sudden increase at commencement.

For though then depends on fluid, may now have assumed solid state

Transition from one condition to other well known frequently to occur.

And indeed addition to all solids [brought] in fluid state.

Besides this from matters deposited in fluid form, watery part carried off [by] absorption.

And from long stagnation natural tendency in coagulated part of any fluid to assume solid state

From these circumstances then presumption that to some degree at least may have here occurred

And this corroborated by feel on pressure.

For does not yield to finger any more than solids may be supposed to do.

Has not like swelling from [most] fluids any change of shape on [change] of situation

If therefore entirely from fluid may conclude of very viscid nature.

Yet more probable that both in some degree conjoined.

And that with viscid fluid [mucus] combined also some enlargement from solids.

From this idea of nature precluded from entertaining expectation of speedy cure.

Here cannot as might be case with watery fluids hope for immediate removal by artificial outlet

Nor on other hand can we imagine that matter on which swelling depends ready subject of absorption.

In as far however as grounds for entertaining expectation is in this way alone that can expect will be affected.

And evidently appears from many [phenomena] that in cases even of hardest solids this not impossible.

In some instances whole earth of [bones] taken up.

This indeed the case only where morbid absorption occurs

But presumption that to certain extent takes place during health.

At least while growth of body continues.

For is only by supposing absorption from internal surface that can [account] from increase of [cavity].

When consider then extensive action of absorption gives some grounds for hope.

Or rather prevents us from pronouncing affection as altogether incurable.

And this perhaps utmost length that can with propriety go.

If cure affected can be expected only in very gradual manner.

And even more probable, after continuation which has already had that will [obstinately] resist any measures which can employ.

Shall not even be surprised if in place of progress to recovery has degeneration into state more alarming than at present.

Yet against this supposition also [static] condition in which has remained for some length of time an objection.

But whatever may be future progress or termination, at least hope that may afford us opportunity for trial of different practices

And is with this view that have selected patient as subject of treatment.

If measures directed any obvious influence on swelling shall consider it as strong proof of efficacy.

And although fail may justly I think consider it as dependant on obstinacy of disease

From idea given of case will easily understand principles on which alone could hope for success.

Whatever cause of swelling imagined that possibility of removal by absorption.

Conclude therefore that great objective to be aimed at the promoting this.

Was with this intention that had recourse to Sal Ammoniac externally applied.

This hold to be an acrid & penetrating [saline] substance.

In certain states even exerts considerable degree of causticity

And hence even in watery solution employed as means of removing warts.

Cannot indeed be considered as powerful with this intention

Yet has unquestionably some effect as producing erosion

Influence in this manner not here requisite

Yet wished that should operate as powerful stimulant.

Was with view of obtaining these effects that here combined with axunge.

From this hoped that would obtain ready & long continued application

While at same time from unctuous matter, activity so involved that reason to hope would not be product of any inconvenience.

On these grounds then although had not high expectations from use yet considered it as meriting trial.

Even from beginning however had recourse also to another medicine.

Imagining that effect as promoting absorption might be aided by addition of a diuretic.

As thus matter absorbed would obtain more ready exit from system.

And demand even for action of absorption might be increased.

For this purpose had recourse to use of Nitre.

And to diminish influence on stomach as well as with view to demulcent effect combined it with Gum Arabic.

On this course patient continued for space of three weeks.

During that time Nitre no obvious influence as promoting urine.

Nor on other hand was either this or ointment with Sal Ammoniac product of any inconvenience.

Did not however appear to have had any effect as diminishing affection of leg.

Pain indeed somewhat relieved.

But whether this in any degree effect of medicine or not cannot venture to say.

Can hardly ascribe it to internal medicine.

And if effect of external application probably more from friction than from any [peculiar] virtue of ointment.

With this diminishment of pain however uneasy itchy sensation still remained.

And what more material no change of swelling.

From these circumstances then led to desert it as unequal to cure

Since that have had recourse to another practice from which do not know whether can entertain any higher expectation.

That is electricity.

Here employed on same principle as [formerly]

With view viz of operating as stimulant & [thus] increasing absorption.

Of various modes of applying electricity has been doubted of some whether stimulant or sedative effect.

With regard however to effect of electrical sparks drawn from part can be no dispute.

That operates as stimulant proved [from] inflamed & even vesication which excites.

But besides affect on skin am inclined to consider it as no less powerful than penetrating.

And hence hold it capable in many cases both of promoting absorption & of renewing circulation

In this way therefore have here directed use.

Has now continued use for space of two weeks

But cannot say that employment product of any obvious good effects

At same time however affection not increased.

Shall wish therefore still to persist in employment a little longer.

And to use it even with increased strength.

Particularly by giving pretty brisk shock passing through affected part.

Begun however to fear that will be equally ineffective as former [practices].

If this case have next thoughts of trial with Mercury.

And particularly as acting immediately on diseased parts.

For this purpose am inclined to hope more from stimulating than mild Mercury

And is intention to employ corrosive sublimate.

Rather however under form of ointment than of solution.

As by this means may I apprehend obtain longer continued & more active application

For this purpose due proportion just dissolved in Spirit of wine may be diffused through necessary quantity of axunge.

If from external application do not soon derive benefits shall wish to conjoin internal use

By this means may at least obtain full affect of it in as far as here able to bring about cure.

And if disappointment both from electricity & mercury hopes of recovery here still less than at present.

Still however other particulars which may be tried.

Particularly the use both internally & externally of different active vegetables lately introduced into medicine & recommended as so effective, in removal of scirrhous & other indolent tumours.

Such for example as Cicuta. Belladonna. Aromatic etc

And if any of them successful will give still [higher] opinion of power, than have hitherto entertained.

---

Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.