DEP/DUA/1/37/04 (Normalised version)

Rachael Drummond

(1785)

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Rachael Drummond

Disease to which this patient subjected when came under our care very distinctly marked.

Consisted of swelling affecting the inferior extremities & bearing impression of finger on pressure.

This swelling while gradually increasing through the day very much diminished from horizontal posture during night.

From these different particulars there could be no doubt in considering it as depending on water.

And as affording example of Anasarca.

And indeed besides these characteristic symptoms had here also other common attendant of the disease.

Respiration indeed we are told free

And must be allowed that in inveterate cases of Anasarca almost [always] in some degree affected.

But often in beginning of disease as with this patient entirely wanting.

And here had, which a much more common symptom of the disease, an affection of the excreta particularly of watery.

For while belly during course of the affection was bound, urine also scanty

Upon whole then no doubt respecting nature of affection.

And although patient herself not sensible of any particular cause to which could be attributed, yet probable that had proceeded from obstruction of perspiration, by cold or like.

For this often has affect where not [observed]. And rather to be suspected from [commencing] about [face]

And here no evidence of any fixed affection of any kind

From this conjecture as to cause as well as from being but of recent date, had reason to hope, that would not prove obstinate.

But must at same time acknowledge that when came under care did not expect so speedy favourable termination, as has taken place.

For in cases even appearing very slight sometimes difficulty, in removal of water.

Still more in prevention of return, after once removed.

Did not therefore expect, that in space of fortnight, would have been entirely free from affection.

This recovery however am by no means disposed entirely to ascribe to practices here employed.

For will observe that prior to application at the Dispensary, a spontaneous diarrhoea had occurred.

Had for space of some days to extent of six watery stools in 24 hours

Such a critical evacuation as it may be called cannot be represented as very rare in dropsy.

Sometimes even is means of recovery in most desperate cases.

And that too after artificial means of cure have been tried in vain.

Indeed perhaps few diseases, when by spontaneous evacuation, whether in way of catharsis or diuresis, more unexpected cures have taken place.

As occurring spontaneously remarked to have much more influence, than when articles induced.

Probably because in former case, discharge always affect of previous absorption whereas in latter, is affect of stimulating medicine taken, which may have influence whether stagnant [serum] absorbed or not.

Hence then understand why in one case, more certainly accompanied with removal of swelling than in other.

To looseness then here occurring can have no doubt in ascribing very considerable share in evacuation of water.

And this at least first step in combating affections of dropsical kind.

Considering diarrhoea as tendency to natural recovery could have no doubt that would have been very imprudent to check it.

Especially as had not taken place to extent in any degree alarming or even distressing.

Seemed therefore more proper to encourage & support it.

But here could not with propriety have employed those brisk cathartics to which recourse is often had in dropsical cases.

Where belly bound brisk stimulating cathartic Jalap & like, directed both as means of inducing discharge and increasing absorption

From these however, in circumstances of present patient some danger of hypercatharsis.

And [formerly] temporary great evacuation, chance even of checking after salutary discharge.

Hence then here objective, merely to promote catharsis, in slight manner.

But while aimed at increasing discharge in this manner, thought it might also be of service, to augment discharge of urine.

Had therefore recourse to a medicine, which has tendency to operate in both ways

The use viz of Cream of Tartar.

Even in most obstinate dropsical cases & where greatest evacuation required, this conjoined with stimulating cathartic, product of best affect.

And from addition of a proportion of Jalap, Gamboge, or like, can obtain from it, full affect even of most drastic cathartic.

Here any such addition unnecessary.

From considering influence however which has on stomach as a refrigerant, consider some corrigents as proper

And accordingly added to Cream of Tartar, a proportion of Cortex Cassia

Which from essential oil it contains hold to be one of most powerful, & grateful of aromatic cordials.

And indeed except in articles of price, nothing inferior to Cinnamon the bark of another species of same genus.

The one Laurus Cinnamon other Laurus Cassia.

From this formula then, expected sufficient effect in opening belly, & some influence also as diuretic.

But as still farther means of promoting that discharge directed also a small quantity of squills.

These employed under form of Pill Scillitica made with powder of dry root which hold to be most efficacious preparation both as diuretic & expectorant.

In operation of these medicines were not disappointed.

For though looseness not increased from Cream of Tartar, yet continued to extent of several stools in day.

And at same time urine very considerably augmented.

Under these discharges as might naturally have expected, from circumstances of patient swellings soon much diminished

In this situation, at second report though some swelling still remained, seemed advisable to have recourse to practice with view of preventing return.

By some indeed has been supposed that tonics not to be had recourse to till swellings completely gone.

For that by use previous to this, discharge apt to be checked, & thus removal of swelling retarded.

In my own practice however, have not seen any such affect.

And am convinced, that in many cases, evacuants & tonics may be united, not only without prejudice, but even with advantage.

In instance before us, as far as [practice] could be grounds for any conclusion, that observation confirmed.

For under use, remaining swelling soon disappeared.

And in very short time, dismissed free from all her symptoms.