DEP/DUA/1/33/40 (Normalised version)

Robert Drysdale

(1783-1784)

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Robert Drysdale February 7^th

Principle part of disease of this patient, consists in obvious enlargement of abdomen.

That this in part at least arises from water effused into cavity, is evident from manifest fluctuation.

But several circumstances from which led to conclusion that not entirely from this cause.

Particularly tense feeling which has even at upper part of abdomen.

And still more frequently discharge of wind by both mouth & anus.

From this I own disposed to consider present affection as more of Tympanites than of Ascites kind.

But at same time no doubt that must be viewed as a complicated affection.

And with this idea opinion of termination cannot be very favourable.

For both diseases not only obstinate but also dangerous.

Must however be observed that several circumstances here much in favour of patient.

Disease comparatively speaking but of short continuation.

Even first symptoms not more than of two months standing.

And before that had always enjoyed good health.

No reason to suspect any fixed cause inducing either complaint.

And no distressing affection of any important function.

With patient at early period of life distension of abdomen from flatulence no rare occurrence.

And then for most part much less distressing than with adults.

With regard to dropsical symptoms also these at least limited

To exception in abdomen no symptoms of watery deposits elsewhere

And lastly to be observed that discharge continues freely

Urine at least little affected

And belly said to be rather loose

This indeed it must be allowed may have been effect of frequent cathartics

But at least showed that discharge thus increased without much difficulty.

Upon whole then grounds here for hoping for favourable termination.

At same time can hardly expect that will be very speedily accomplished.

For even allowing that dropsical symptoms soon entirely removed yet recovery of tone of intestines must be work of some time.

With a view however to removal of both different practices may be had recourse to

In dropsy though first objective the discharge of water already effused yet of no less consequence to prevent return.

And this chiefly to be done by increasing strength & tone of the system.

An end from accomplishment of which will also be best able to prevent distention from flatulence.

For this very generally consequence of want of due vigour in intestinal canal.

Hence then both diseases in some respects at least to be combated by same remedies.

And after remarks now offered objectives in view from particular practices to which recourse here had will be better understood.

Began practice by directing for this patient an electuary the basis of which was Cream of Tartar.

From this need hardly observe that had in view the obtaining an operation both as diuretic & cathartic

In both ways well known that influence very considerable.

In so much that now very few articles more frequently employed in hydropsical cases

And from influence in this way, expected removal of water contained in cavity of abdomen.

From Cream of Tartar alone however considerable quantity requisite for producing brisk catharsis

And for promoting absorption this at first at least seemed necessary

Hence added as adjuvant a small proportion of Jalap.

But if adjuvant here necessary state of bowels seemed no less to require a corrigent

And with view of preventing inconvenience from the refrigerant effect of the Cream of Tartar as well as to promote expulsion of wind had recourse to cortex Cassia one of most grateful of vegetable aromatics.

And although inferior in price yet very little if at all inferior in medical virtues to Cinnamon.

This electuary produced as was indeed expected frequent watery stools

And with this also some increase of discharge by urine.

With these [obvious] discharges patient appeared to his mother to be upon whole somewhat relieved.

Gave reason therefore to hope that by continuation cure might be obtained.

But at same time to be observed that had produced very little [diminishment] of [sweating]

This however was I own inclined to consider rather as effects of flatulence than of water.

While therefore directed the continuation of electuary had recourse also to another remedy with a view of obtaining effects of a carminative & tonic

As such here directed employment of mixture of Infusion Amarum with Tincture Aromatic.

The former basis of which one of [purest] vegetable bitters the Gentian is unquestionably very useful in strengthening alimentary canal

While latter contains Cinnamon, Cardamom, Angelica & other grateful vegetable aromatics has in most instances powerful effect as tending to immediate expulsion of wind.

By continuation of this course under proper administration am hopeful that both hydropsy & tympanites symptoms may be overcome.

If however in this disappointed have thoughts of next trying with this patient the use of Electricity.

With a view to Dropsy promises some advantage as being means of promoting absorption.

With view to Tympanites may expect benefit from influence as increasing nervous energy of intestinal canal.

And from use in Palsy, may conclude also that may be product of benefit in this disease.

Shall here therefore wish to give it fair trial under form of sparks drawn from surface of abdomen.

But if this also unsuccessful practices must afterwards be regulated by situation in which shall then find patient.