DEP/DUA/1/28/10 (Normalised version)

John Gardner

(1781-1782)

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John Gardner.

When this patient came under care subjected to several symptoms not a little distressing to him.

Of these one of most uneasy & most obvious swelling of belly.

This well known may arise from different causes.

And here must own at loss to think whether ought to consider it as depending on water or wind.

Had some evidence of former of these from constipation.

For although subjected to variation never entirely disappeared.

But still more in favour of supposition of water that some obvious fluctuation

This however in history of case marked to be but slight

Although therefore it depended on water yet principal swelling might [have] been from another cause.

And of this several circumstances giving presumption.

No appearance of dropsical symptoms in other parts, no swelling of legs, no affection of urine.

Seldom however that with ascites to any considerable degree these wanting.

But also circumstances still more irreconcilable to that affection in account given of swelling itself.

Although never entirely absent suffers very considerable changes.

And these too happen without any discharge which could be supposed to give diminishment of water.

But taking place suddenly & even [daily]

This then much more exactly corresponds to that abdominal swelling which is effect of wind in alimentary canal.

And was also in favour of this supposition that swelling attended with pain of belly.

A circumstance common with swelling from flatulence, & if ever yet at least but rarely attendant, of hydropic swellings

Upon whole then, although might in some degree proceed from water yet consider it as primarily from wind.

Although this however most obvious & most distressing part of affection yet another complaint no less alarming.

Looseness viz to which was subjected.

This we were told particularly severe in night

During that period seldom less than three or four loose stools.

No reason however to suspect that either originated from infection or capable of communicating infection to others.

And although great quickness of pulse, yet neither attended with febrile anxiety nor with bloody discharge.

Had no hesitation then in considering it as being merely diarrhoea.

To these affections to which now subjected are informed in history of case that one of different nature had preceded.

Had very short time before been patient in Royal Infirmary¹ for a fever.

And attributed all complaints to which was subjected when came under our care to cold to which exposed after dismissed from hospital.

From considering nature of these affections saw no reason to doubt truth of this conjecture.

Well known that cold a frequent cause both of diarrhoea & of dropsical affections even with strong habits.

But with our patient had every mark of exhausted & debilitated constitution.

Hence then may naturally be supposed that influence more considerable.

And to this state of habit together with supervening affection was disposed to refer, sickness, palpitation, & quickness of pulse which here took place.

Upon whole then looked upon all affections as depending more on previous state of habit than on any local cause

Hence then though symptoms such as are on some occasions of very alarming nature had here hopes of favourable termination.

And was inclined to think, that what principally requisite for removal of all symptoms was recovery of strength.

At same time however taking care to avoid all accidents by which affection [could] be aggravated.

And to employ such remedies as might obviate most urgent symptoms.

Was on these principles that had recourse to different practices here directed

With view of restoring vigour to system besides what may be done in way of [region] medicines also may be used.

But of all these as far as my experience goes, none of these in point of efficacy equal to Peruvian Bark

And particularly as employed in substance.

Upon supposition indeed that swelling entirely from water might be thought advisable that remedies first employed to evacuate.

But to those exhausted condition of patient a very strong [objection].

And besides this while no diminishment of discharge by urine, that by belly increased even to such degree as to [require] being obviated.

But still farther as have already observed was disposed to consider swelling as principally from wind.

Here therefore saw no circumstance which could be considered as objection to Bark

But besides this seemed also necessary to restrain looseness.

For unless such an effect obtained had reason to fear that would be again carried off without producing effects.

And farther to be observed that although in general binds belly, yet sometimes of itself exists looseness where did not previously exist

Still more has it tendency to aggravate it when has already taken place.

On these grounds then directed powder of bark under form of mixture with Infusion Japonica.

And with view to more ready [illegible] added to this a proportion of mucilage of Gum Arabic

This medicine taken at least without any inconvenience.

And after use pain & swelling of his belly somewhat diminished.

Still however looseness although not apparently aggravated by it continued as severe as formerly.

And other symptoms as palpitation, pain of breast & the like nothing relieved.

While pulse still at 120.

These latter however considered as consequences of looseness.

Hoped therefore that by mitigation of this might be countered.

Now [appears] however that for restraining looseness in present case Infusion Japonica was not of itself sufficient.

Hence then with former remedies directed addition of an opiate as [illegible] of allaying inordinate action in intestines

Liquid Laudanum added to former mixture in such proportions that would take from 20 to 25 [grains] in course of day.

Which with patient at 16^th year & unaccustomed to opium consider as full dose.

But still had no more affect on looseness than medicine in former state

And continued to be particularly distressed during night.

In this condition wished to employ some remedies for more especially countering it at that time.

On this account therefore wished to avoid use of Bark at bed time.

And at that time to employ opiate in full dose alone.

Ordered therefore that should be taken every night to extent [a] grain under form of pill at bed time.

Still however directed continuation of Bark conjoined with succus Japonica.

But now were ordered to be given in [substance].

Soon after these medicines directed however patient applied for admission into the Infirmary.

And had therefore no opportunity of knowing effects.

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.